The need for stronger child restraint laws To the Editor: Children are vulnerable road users in South Africa (SA), with road traffic crashes being the second leading cause of death for children aged 5-14 years. [1] Two road-user groups, child pedestrians and child passengers, are particularly vulnerable, constituting 62% and 36% of child road fatalities, respectively. [2] Several interventions have been proposed to reduce this preventable burden, including the appropriate use of child restraints. Evidence shows that, when installed correctly, child restraints can reduce the likelihood of a road traffic fatality by between 54% and 80%, depending on the child's age. [3] Two observational studies conducted at Red Cross War Memorial Children's Hospital, Cape Town, in 2008 and 2019 found that a concerning number of children arriving at the hospital by car were not restrained-in an age-appropriate child restraint system or by a seatbelt. [4,5] While the findings in 2008 were expected because SA had no child restraint law at that time, the 2019 results are disappointing because of the 2014 amendment to the road safety law, which requires the use of a child restraint. The amendment to regulation 213, section 6A of National Road Traffic Act No. 93 of 1996 [6] mandates the use of a South African Bureau of Standards-approved child restraint for all child passengers under the age of 3 years and also requires children aged 3 years and older to sit in the rear and use a seatbelt. Child restraint use can be increased significantly by applying a systems approach that includes adequate enforcement of the law. [5] We decided to review the SA Road Traffic Act and associated regulations, to determine whether the existing legislation and associated penalties are comprehensive without any ambiguity or loopholes that might enable road users to escape the consequences of breaking the law. Our review identified three main issues. Firstly, the law remains ambiguous on the type of restraint that should be used for children older than 3 years, and does not comply with international best practice as defined by the United Nations Economic Commission for Europe regulation 44 or the latest version, regulation 129. [7] Furthermore, the SA law in its current state gives no indication as to the best position for a child under the age of 3 to sit in a car with his/her child restraint, i.e. the back seat or the front seat. The bestpractice law categorises restraints suitable for a child up to the age of 12 years based on three factors: age, height and weight. Furthermore, older children who are above the height and weight specification must wear a seatbelt. International law further states that a child must be restrained in the back seat [7] in order to minimise injury during a road crash. Our second finding was that the age specification in the SA law imposes the challenging task of age estimation on law enforcement officials, which results in low restraint use. A study in 2002 found that 87% of observers were able to estimate the age of a child co...

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