ObjectivesThis study investigated the frequency of child restraint system (CRS) use in cars and assessed parental knowledge and attitudes toward such restraint systems in western China.Study DesignCross‐sectional survey.MethodsThis cross‐sectional survey was conducted between December 2021 and January 2022. Hospitals and kindergartens were convenience sampling selected, and parents with cars were asked whether they owned and used CRS. Parents’ knowledge and attitudes toward such systems were also determined. Factors associated with CRS were explored using binary logistic regression.ResultsA total of 4764 questionnaires were distributed to parents with children 0–6 years old. Among the 4455 responses received, 50.8% of the respondents owned CRS, and most of which were front‐facing child seats (42.0%). Less than half (44.4%) reported using a CRS sometimes, but only 19.6% used it all the time. The possession and use of a CRS varied significantly with the parental education level, age of the child, place of residence, number of children, family income, travel frequency, and travel distance. Logistic regression analysis showed that the frequency of car travel with a child and monthly family income significantly affected CRS use. Most parents (85.2%) perceived that adult seat belt in cars are effective at protecting their children in the event of a crash. The most frequent reason for not using a CRS was the tendency for children to travel in the car less often.ConclusionsAlthough approximately half of the respondents owned a CRS, most of them used it rarely, if at all. Educating parents about safe ways for children to ride in a car and use of safety belts may promote CRS use.