While spinal injury in child occupants is relatively rare, the significance of these injuries is high. For children too big for booster seats the best available protection is adult belts in the rear seat. This paper presents a case series of 27 rear seated restrained child occupants aged between 8 and 16 years diagnosed with a injury to the spinal region, and discusses the current lack of regulatory or consumer assessment of injury risk to child occupants too big for booster seats.

Data was collected from retrospective medical record review of all children treated at two major children’s hospitals over a five year period. Cases were collected using spinal trauma related ICD 10 codes and all restrained child occupants between the ages of 8 and 16 years (inclusive) were extracted. All types and severities of spinal injuries were included. Restraint, seating position and crash details were taken from ambulance reports.

Most children sustained minor injuries (56%), however 13 of the 27 sustained moderate to severe spinal injuries. These include spinal cord injuries, vertebral fractures and dislocations and major ligamentous damage. Most minor injury occurred in the cervical region, and most serious injury occurred in the lumbar region. Almost all children were using the available lap sash seat belt (23/27).

There was more serious spinal injury among those children aged 8 – 12 (9/18) than there was among the older children aged 13-16 (3/9), and more than half of those younger children with serious injury (5 of 9) had associated abdominal injuries, while associated abdominal injury was not a feature among the older children.

International booster seat use legislation, the lack of regulatory and consumer assessment of injury potential to older rear seated children and the need for more widespread evaluation of rear safety for older child occupants is discussed.