Injury risks to children restrained in 2-point belts have been well described. “Seat belt syndrome,” associated with the use of 2-point belts, includes contusion of the abdominal wall, fracture of the lumbar spine, and intra-abdominal injury. Using crash reconstruction methodologies and prospectively collected clinical data, we compared injury patterns by restraint type among a sample of 98 belted children. There were no significant differences in injury severity or hospital charges by belt type. There was no difference in the risk of AIS ≥ 2 injury to the head, neck, chest, abdominal contents or extremities by belt type. Children restrained in 3-point belts exhibit a similar pattern of injury to those in 2-point belts, however 3-point belts appear to be protective for lumbar fracture.