Objective  To explore child safety seat use and its associates among 0 – 3 year old children in Shanghai city for providing references to the promotion of child safety seat use in the children.

  Methods  Using stratified multistage sampling, we recruited 1 303 parents of children aged 0 – 3 years in 20 urban communities of Shanghai city and conducted a face-to-face questionnaire survey on demographics, commuting behaviors, child safety seat use, and awareness on relevant traffic regulations. Multi-level model was used to analyze factors affecting the preparing and using of child safety seat in the parents.

  Results  Of all the respondents, 81.58% (95% confidence interval 95% CI: 79.37 – 83.65) and 42.90% (95% CI: 40.19 − 45.64) reported the preparing and using of child safety seat. The respondents with higher education (undergraduate vs. junior high school and below: odds ratio OR = 3.32, t = 3.388; P = 0.001), being aware of traffic regulations relevant to child safety seat use (yes vs. no: OR = 2.26, t = 3.546; P = 0.001), living in communities with higher preparing rate of child safety seat in the residents (high vs. low: OR = 1.04, t = 6.335; P < 0.001) were more likely to prepare child safety seat; while, the respondents going out less frequently (once a month or less vs. almost every day: OR = 0.36, t = – 3.002; P = 0.003) and not wearing seatbelt during driving (seldom vs. always: OR = 0.30, t = – 2.221; P = 0.026) were less likely to prepare child safety seat. The respondents with children at older age (3 years vs. less than one year: OR = 2.75, t = 2.967; P = 0.004), being aware of traffic regulations relevant to child safety seat use (yes vs. no: OR = 1.66, t = 3.245; P = 0.002), living in communities with higher preparing rate of child safety seat in the residents (high vs. low: OR = 1.04, t = 8.227; P < 0.001) were more likely to use child safety seat; whereas, the respondents of girls (versus those of boys: OR = 0.69, t = – 2.828; P = 0.005), going out less frequently (once a month or less vs. almost every day: OR = 0.24, t = – 4.619; P < 0.001) and not wearing seatbelt during driving (seldom vs. always: OR = 0.10, t = – 2.172; P = 0.003) were less likely to use child safety seat.

  Conclusion  Improving parental awareness on traffic safety and promoting parents′ good traffic behaviors and creating supportive community environment are important measures for increasing parental use of child safety seat.