Parents of newborns knowledge of child safety seat in Sichuan Province, China: A mixed method study

• CSS ownership among Sichuan newborns’ families is 40.5 %, income is key predictor. • 49.3 % parents mistakenly believe adult seatbelts protect newborns in crashes. • 72.2 % non-owners intend future CSS purchase, valuing quality & certification. • New parents recognize CSS importance but lack specific usage/selection knowledge. • Antenatal/postnatal healthcare channels identified as vital for CSS education. Traffic injuries in children pose significant global public health risks. Despite the proven efficacy of Child Safety Seats (CSS) in reducing infant injury and mortality rates, the national usage in China remains below 20 %. This mixed-methods study examined barriers to CSS adoption among parents of newborns in Sichuan Province. Quantitative surveys (May-August 2024) assessed the CSS knowledge, attitudes, and behaviors of 684 parents. Qualitative interviews (July-December 2022) were conducted with 20 parents to explore the decision-making drivers. We found that only 40.5 % of families had CSS, which was significantly predicted by household income (high-income OR = 7.54, 95 %CI:3.63–15.63). Critical knowledge gaps existed: 49.3 % mistakenly believed that adult seatbelts protected infants. Among non-owners, 72.2 % intended future purchases, prioritizing product certification (58 %) and quality (98.5 %). Qualitative analysis revealed awareness of CSS importance but confusion regarding usage standards, cost, convenience, and policy mandates as primary adoption barriers, and reliance on variable online information versus trusted healthcare guidance. Affordability and knowledge gaps constrain infant passenger safety. Policy priorities include integrating CSS education into antenatal/postnatal healthcare systems, implementing economic support (subsidies/rental programs), and strengthening the enforcement of China’s 2021 CSS legislation. These interdisciplinary measures include bridge transportation safety, public health, and policy implementation.