Seat Restraints: Keep Children Safe in the Car

Written by Carnie Lazarre, M.D./M.P.H. candidate
with Julie Belkowitz, M.D., M.P.H., Lyse Deus, and Oneith Cadiz, M.D.

Motor vehicle crashes are a leading cause of death among children. Using car seats and seatbelts appropriately for their specific age groups can be a lifesaver. These restraint systems reduce the risk of a child getting ejected out of a car, can decrease injuries to the brain, neck, and abdomen, and save everyone’s lives.

Look at the label on your child’s car seat to check the weight and length limits. Depending on your child’s weight and height, different car seats will be more appropriate. Car seats and booster seats should always be in the back seat of the car.

Here is how to choose the right car seat for your baby or child, according to the American Academy of Pediatrics and the National Highway Transportation and Safety Authority.

Infant/toddler (Birth – 3 years)

Recommendation: Rear Facing Seat

Infants and toddlers should be placed in a rear-facing car seat until they reach the highest weight or length allowed by their car seat manufacturer. The car seat should be placed in the middle back seat and should be strapped down according to the instruction.

Importance
Infants and toddlers’ heads are the heaviest part of their bodies. They also have a very fragile neck, and spinal cord as their bones have not been fully formed. A rear-facing car seat will support your child’s head, neck, and spine during a collision reducing injury to those fragile areas.

General tips to avoid common mistakes

• Always put your infant in the rear-facing car seat in the back of the car
• Shoulder straps should be adjusted to be at or below the baby’s shoulders
• Make sure the car seat is secured tightly in place- if it moves more than 1 inch in any direction, tighten it down some more
• Top of the chest clip should be at armpit level
• Do not put a blanket or any other item behind, underneath, or between the child and the harness
• Remove bulky clothing before placing your child in the car seat because it can interfere with how tight the harness can be
• Most babies will outgrow the infant carrier type of seat after a few months and will need a new convertible or another type of rear-facing seat.

Preschoolers (2 – 5 years)

Recommendation: Forward Facing Car Seats

After children have outgrown the rear-facing weight or height limit, they should use forward-facing car seats until the highest weight or height is allowed by their car safety seat manufacturer.

Importance
As the child grows, they can be forward-facing. These car seats have a harness that limits the child’s forward movement during a crash and protects them from injuries.

General tips to avoid common mistakes

• Thread the shoulder straps at or just above the child’s shoulder
• Straps should lie flat without twisting
• Top chest clip should be at armpit level
• Once the top of your child’s ear reaches the top of the seat, they can be switched to a booster seat

School-age children (age 5 – 12 years)

Recommendation: Booster seats

All children who have outgrown their forward-facing car seats’ height or weight limit should use a booster seat in the back seat until the vehicle seat belt fits properly. This is usually when the child is at least 4 feet 9 inches tall.

Importance
Research shows that using belt position booster seats lowers the risk of injury to children compared to using seat belts alone. As the child outgrows the forward-facing car seat, it is essential to use a booster seat.

General tips to avoid common mistakes

• Make sure the lap belt lies low across the child upper thigh below the hip bone
• Shoulder belt should always cross the chest, resting snuggly on the shoulder
• Remember the rhyme “Under the arm, seatbelt causes harm. Behind the back, safety will lack.”

Older children

Recommendation: Seat belts

All children who can fit the vehicle seat belt properly and are below 13 years of age should be seated in the back seat area wearing a seat belt.

Importance
Children under 13 should sit in the back seat because airbags are designed to protect people the size of teenagers and adults, and they can cause face and brain injury to younger children.

General tips to avoid common mistakes

• Shoulder belt should lie across the child’s chest and shoulder
• Lap belt should be across the thigh below the hip bone
• Never allow children to share seatbelts
• Lead by example. All adults should wear seatbelts at all times when riding in the car.

These recommendations are based on well-vetted studies that show a decrease in fatality risk when car seats are used appropriately.

Practicing these recommendations is the best approach to protect your child during a car crash. For more information about passenger safety for children, visit www.healthychildren.org. You can also contact the Injury Free Coalition for Kids, a program of the Children’s Trust, at 305-243-9080 or online at www.injuryfree.org to make an appointment with a Certified Child Passenger Safety Technician to learn more about how to keep your child safe in the car.

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Tags: age-appropriate safety restraints, car seats, child safety, lap belt, seat belts