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October 13, 2025

Interactive Virtual Presence to Remotely Assist Parents With Car Seat Installation

Key Points

The study found that the accuracy of car seat installation with remote assistance was comparable to on-site help.
Participants in the on-site group achieved a mean accuracy of 97.7%, while the remote group had 95.6%.
This randomized controlled trial assessed installation accuracy in 1509 participants at seven US locations over three years.
Results suggest that remote assistance could enhance pediatric public health outcomes, especially in underserved communities.

Abstract

OBJECTIVES Motor vehicle crashes are a leading cause of preventable pediatric death. Child restraints (car seats) reduce risk, but ∼80% are installed and/or used incorrectly. Individualized appointments with certified child passenger safety technicians improve installation and usage, but access is inadequate. METHODS A phase III randomized noninferiority clinical trial was conducted from 2020 to 2023 at 7 US locations with 1509 individuals who regularly drove vehicles with child restraints installed (booster seats excluded). Participants were randomly assigned to install a child restraint with assistance from a certified technician either live and on-site or remotely via interactive virtual presence, a smartphone app offering simultaneous verbal and visual communication plus the ability to interact virtually, telestrate, and freeze screens. The accuracy of restraint installation/usage was scored objectively. RESULTS Mixed model analyses were conducted with technicians nested in the research site as a random effect, and with technician, site, and child restraint installation type as covariates. The on-site group had an unadjusted mean of 97.7% (SD = 3.5) of installation/usage facets correct following the intervention, and the remote group had an unadjusted mean of 95.6% (SD = 5.8). The adjusted difference of 1.80 fell within the a priori noninferiority margin of 2.5% (upper bound = 2.34; P = .006). Sensitivity analyses controlling for demographics, how the restraint was previously installed, and installation type yielded comparable findings. CONCLUSIONS The accuracy of restraint installation and usage following education with a remotely located technician via interactive virtual presence was not inferior to accuracy with an on-site technician. Uptake by industry, nonprofit, or government agencies could dramatically improve pediatric public health, especially among underserved populations.

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