Child Safety - Miller & Zois

Car Seat Safety

Kid in Car SeatConsidering that motor vehicle injuries are a leading cause of death for children in the United States, not enough parents are taking the necessary precautions to keep their children safe in the car. 35 percent of children under twelve who die in car crashes in 2015 are not buckled up. Car seats reduce the risk of death by 54 percent for toddlers and 71 percent for infants. But they work only if they are installed and fitted properly. Almost half of car seats are misused in potentially fatal ways, so brushing up on car seat safety tips could truly save a child's life.

Types of Car Seats

Car seats are designed to have three basic setups - rear-facing, forward-facing, and booster. There are a variety of multi-use or convertible seats out there, but it's important to know how each seat complies with one of these three categories because different seat designs are recommended for children of different ages. The following guidelines are based on average specifications for each kind of car seat, so parents are advised to read the manufacturer's instructions in addition to these generalizations. Every car seat is different, with different height and weight requirements.

Rear-facing seats are used for infants, usually until they reach 22 to 40 pounds. All babies should ride in rear-facing seats until they are at least two years of age, unless they exceed the maximum weight allowed by the car seat manufacturer. Most rear-facing seats have carrying handles and come with a base that can be left in the car. Despite their portability, infants and toddlers should not be kept in a rear-facing (or any type of) car seat for lengthy periods of time. Health risks, including difficulty breathing and the development of a flat spot on the back of a baby's head, can result from spending too much time in a car seat. It's safe, of course, to keep a babies in their car seats while they're in the car, but they shouldn't be kept in the car seat for too long after the ride is over.

After children outgrow their rear-facing seats, they should ride in forward-facing seats. Forward-facing car seats can accommodate children up to 40 or 80 pounds, depending on the model. They tend to position toddlers and preschool-aged kids in a more upright position. For children who are too young to use a booster seat but exceed the forward-facing car seat weight limits, combination seats or travel vests are two good alternatives. Combinations seats are designed just like other forward-facing seats, but can transition into an ultra-secure version of a booster seat when used with the regular seat belt rather than the built-in harness. Using the seat belt in combination with a forward-facing seat, if authorized in the manufacturer's instructions, can extend the seat's weight limit up to 120 pounds. Children between 20 and 168 pounds can wear travel vests, which may require the use of a top tether.

School-aged children under the age of eight should use either a high-back or a backless booster seat. Parents are advised to keep their children in booster seats up until they exceed the manufacturer's height and weight limits, even if they are over the age of eight. Most children aren't big enough to be kept safe without a booster until they are 10 or 11. Boosters use the vehicle's regular seat belts, but raise children high enough that the seat belt fits over the strongest parts of their bodies. High-back boosters are recommended for cars without headrests or with low seat backs.

Buying a Seat

When choosing a new car seat, it can be helpful to note its National Highway Traffic Safety Administration (NHTSA) Ease-of-Use Rating. On a scale of 1-5 stars, the NHTSA evaluates car seats based on the clarity of the instructions and labels, quality of the vehicle installation features, and child security. All NHTSA-rated car seats, at minimum, meet the federal safety and crash performance standards, and are therefore safe to use. The star rating system simply conveys how convenient a particular car seat is to install and operate.

The NHTSA ratings and seat finder are great tools that can help parents find the best seat for their child, but a large component of car seat safety has to do with how the seat fits in the car. Different cars have differently shaped back seats, so it is crucial to test a car seat before buying it. Don't trust a salesperson who says car seats are one-size-fits-all. Parents should try installing a variety of different seats in their car before settling on one. If the seat has room to wiggle more than one inch once properly tethered, if the straps on the seat don't align with anchors in the car, or if it just feels awkward to install, opt for a different model.

It is crucial to know a car seat's history, so buying used is not advisable. If it's necessary to buy a used car seat, or reuse a hand-me-down seat for a younger sibling in the same family, make sure it meets the following specifications:

  • Labeled with the manufacture date and model number
  • Comes with instructions
  • Hasn't been recalled
  • Is no more than six years old and hasn't expired
  • No visible damage (such as cracks or chips), no missing parts
  • Has never been in a moderate or severe crash. A minor crash, defined by the NHTSA, must meet five criteria
  • When in doubt, don't reuse it. It is unsafe to use a car seat without knowing its complete history

After buying a car seat, register the seat with the manufacturer online or by mail using the registration card that comes with every seat. The card should list the seat's model number, serial number, and date of manufacture, but this information can also be found on a label attached to the car seat. Registration is the fastest and most foolproof way to be notified if the car seat is recalled. Those who register their car seat in advance will automatically receive repairs from the manufacturer. The NHTSA website also keeps a list of all car seat recalls since 2007.

Installation Tips

The first step is finding the right place to install the car seat. Rear-facing seats should never be placed in the front seat of a vehicle with an active passenger airbag. If an airbag inflates on a rear-facing car seat, even in a relatively low-speed crash, a great amount of direct force will hit the baby's head. Airbags can be a danger to any child, but they are particularly lethal for babies in rear-facing seats. Children in forward-facing seats can ride in the front, but this option should only be exercised as a last resort. If it is absolutely necessary for a child to ride in the front seat, make sure the passenger side airbag is deactivated and the vehicle seat is pulled as far away from the dashboard as possible. If a car seat can fit there snugly, the middle of the back seat is the safest place for a child to ride. Unfortunately this option isn't always practical, since the middle seat is often narrow or uneven, and some cars don't have lower anchors for the middle position.

Most cars have two car seat installation options. The LATCH system, standing for "lower anchors and tethers for children," is included in passenger vehicles made after 2002. All car seats have attachments that are compatible with these anchors, located where the seat cushions meet in the back seat. Lower anchors are only rated up to a total of 65 pounds, including the weight of the car seat and the child. Always check the car seat manufacturer's instructions to make sure a child falls under the maximum weight to use lower anchors. The car's seat belt can also be used to secure a child's car seat. Parents, particularly those using convertible or 3-in-1 seats, should follow the instructions to make sure the seat belt is routed through the correct path. The LATCH system and seat belts are equally safe, but particular car seats may be better suited for one or the other. Regardless of the system parents choose, the most important thing is to get a tight fit. The seat belts in newer cars will lock into place after they are pulled all the way out and allowed to retract. Information about seat belt locking can be found in the vehicle's owner's manual. If the car seat can move more than one inch side-to-side or back-to-front, the seat belt or LATCH system isn't tight enough.

In addition to the LATCH system or a seat belt, forward-facing car seats should also be secured with a top tether. These tether anchors are located on a panel behind the seat in most sedans, or at the back of the seat, ceiling, or floor in most other vehicles. The top tether is crucial for forward-facing seats, but should not be used with rear-facing seats. Some full-backed booster seats may offer a top-tether option, so make sure to check the manufacturer's instructions for confirmation.

Since the purpose of a booster seat is simply to give children the extra height they need to use a standard seat belt safely, boosters typically don't use any kind of attachment system. It is still important to make sure the booster can sit on the back seat firmly without wobbling, and consult the manufacturer's instructions. Rear- and forward-facing seats include their own internal strapping system so it is safe to fasten them using only a lap (or two-point) belt. Boosters, however, are used in combination with the car's seat belt, and as such they should only be used with a three-point belt, or a seat belt with a chest strap. Children in booster seats can suffer greater injuries during a crash if they are using only a two-point belt. Without the chest strap, their torsos will jackknife forward and the lap belt will cause more damage to their pelvis and abdomen.

Finding the Right Fit

Most seats are rated for infants starting at four pounds, but make sure to check the manufacturer's instructions. Premature babies have to be tested in the hospital to make sure it's safe for them to sit in a semi-reclined position. Some babies may need to lie flat during travel, in which case parents should find a car bed that meets the Federal Motor Vehicle Safety Standards. All rear-facing seats include angle adjusters, and should be moved to a position where the baby's head doesn't flop forward and his or her airway is kept open. Continue to adjust the angle as the child grows.

When adjusting the harness on a rear- or forward-facing seat, make sure it's snug. Parents should not be able to pinch any slack between their fingers, and the harness chest clip should be placed at the center of the child's chest. Bulky clothing, such as winter coats, snowsuits, or blankets, could compromise the effectiveness of the harness. Shoulder straps may appear snug over a thick jacket, but clothing can compress in a crash, leaving the straps too loose to properly restrain a child. A safer option is to dress children in thinner layers and wrap a coat or blanket around them, over their buckled harness straps, once they are already secured in their car seats. Extra products, like car seat sleeping bags, can have the same compressing effect as a bulky jacket. It is dangerous to use any products that do not come with the car seat because they haven't been crash-tested. An exception can be made for infants who slump in their seats because they are too small for their harnesses. With a doctor's approval, parents can place a tightly rolled blanket on either side of their infant or a tightly rolled diaper or cloth through the crotch strap, preventing the baby from leaning or slumping in the car seat. This form of padding is safe because it does not interfere with the fit of the harness over the baby's chest and shoulders. No additional padding should ever be placed under or behind an infant.

In a rear-facing seat, the shoulder harnesses should be positioned in slots that are at or below the baby's shoulders. Some parents move their child to a forward-facing seat too early, concerned that the child's legs are touching the back seat. It is comfortable and safe, however, for children to bend their legs, and leg injuries are actually more common for kids in forward-facing seats. Parents should keep their children in a rear-facing seat as long as possible because it's the safest option. It is only necessary to move to a forward-facing seat if a child reaches the weight or height limit specified by the manufacturer, her shoulders have reached the top harness slots, or the tops of her ears are above the top of the seat.

The shoulder straps on forward-facing seats should sit at or above a child's shoulders. For convertible seats, the reclining angle will have to be adjusted to sit more upright when it transitions from a rear- to a forward-facing seat. It's common for children to request a booster seat, or no car seat, prematurely. And parents, tired of lugging heavy and unwieldy car seats around, often cave in, inadvertently putting their children at risk. Kids between the ages of four and eight are more likely to be injured in a car crash than younger children, perhaps because parents tend to relax the rules about car seat safety as their children get older. In spite of their pleading, kids should be kept in a forward-facing car seat until they exceed the manufacturer's height or weight limit.

Seat belts should fit the same way for children in boosters and adults alike. The lap belt must lie low and snug across the upper thighs. If a child slumps down or is too small for their booster seat his lap belt could ride up, risking injury to a variety of organs in his abdominal cavity. Some boosters include a plastic clip to help guide the lap belt into a proper position. The shoulder strap should run across the center of the chest, resting on the shoulder and away from the neck and face. The seat belts in most cars can be adjusted up and down at the point where the shoulder strap is attached to the cabin. Make sure a child does not tuck the shoulder belt behind his back or under his arm, because this could cause more severe chest and head injuries in the event of a crash. Kids are big enough to ride without a booster seat when they exceed the manufacturer's maximum height or weight, or when they're tall enough to sit with their backs flat against the back of the seat and their knees bent comfortably over the edge.

Additional Information and Resources

Most accidents involving kids occur near home, on local or residential roads during an everyday trip to school or the grocery store. It doesn't matter how short the car ride or how familiar the route, it is critical to buckle up in an appropriate car seat before every drive. This goes for parents too, because children are always mimicking adult behavior. Nearly 40 percent of kids who ride with unbuckled drivers are unrestrained themselves, so it is important to set a good example.

If parents need additional help installing a car seat, Certified Passenger Safety Technicians (CPST) are available to help. CPSTs offer one-on-one car seat counseling or coordinate seat installing events. To find a CPST or event near you, visit the National Child Passenger Safety Certification or the NHTSA websites.