A child killed or injured in a car accident is a tragedy still all too common on New Zealand roads - but the anguish suffered by parents whose child has been injured because they were belted in wrongly can be even worse.
So says Dr Mike Shepherd, Starship Hospital's director of child health (medical and community) whose colleagues see the grievous head and abdominal injuries suffered by children either not belted in or, even more tragically, belted in by caring parents who strapped them in wrongly.
"We see two main sets of injuries," says Shepherd, "severe head injuries and abdominal injuries - usually from seat belts that do not fit properly.'
Latest figures of children killed or injured because of inadequate restraints are hard to nail down - not all reporting from crashes goes into that kind of detail.
However, last year it was reported that 18 children aged 14 and under die each year in crashes and about 26 are hospitalised every month in New Zealand. Official figures say child car seats, when correctly installed and used, can reduce the risk of death by 70 per cent for infants and up to 54 per cent for toddlers.
The latest Police, Plunket and Auckland Transport checkpoints for child restraints in Auckland also demonstrate that incorrect restraint of children is still a problem.
The checkpoints are not designed to punish but to educate parents by pointing out the errors in installation or use. Last year, after checking nearly 1800 cars across Auckland, 62 per cent had restraint faults.
North Shore and South Auckland showed slight drops from the last survey while central Auckland had only a small sample base. The worst area was west Auckland which had 77 per cent of cars with restraint faults of some description that could result in an injured child in a crash.
Another common mistake is to put a seat belt on a slightly older child but, unless they are over 148cm tall, they often slide out of the belt on impact or suffer serious abdominal injuries from the belt. That's where booster seats come in.
Shepherd is at a loss to understand parents who do not restrain their kids in safe harnesses at all: "We still hear things like, 'We were only going a short distance down the road'."
Another disturbing trend, he says, is for parents to buckle infants into the front passenger seat of cars when child restraints are designed for the back. Being in the front also puts the child at risk of damage by airbag if there is a crash.
"There is an increasing trend overseas towards more injuries and fatalities from the impact of airbags when a child is in the front seat - and I have no reason to think New Zealand is immune from that pattern."
He can only guess at the motivation for parents who belt their child into the front seat: "I can only think it is because they want their child to see them, or because they are within easy reach - and there may even be a bit of the child wanting to be a grown-up.
"But it just goes to show that we have to keep up the strong messaging regarding child restraints. It has been very effective - I can't stress enough that, overall, the trend is down as regards death and injuries but that is no consolation to the parents who have a child lost or hurt in an accident because they were incorrectly restrained.