Car-Seat Safety - A Parent's Life - Harvard Commentaries

It's always a good time to remind parents and caregivers that all children should be placed in properly fitting child safety seats, booster seats or seat belts, every time they ride in a car or truck.

The message is getting out, and many people are listening. According to the National Highway Traffic Safety Administration (NHTSA), fewer children aged 15 and younger were killed in motor vehicle crashes in 2008 than during any year since 1975, when record keeping started. Injuries also have continued to decrease.

In large part, this is due to increases in the numbers of children who are restrained by being buckled up properly while riding in a car. Today, 99 percent of infants (under age 1) and 90 percent of toddlers (aged 1 to 4) are riding in car seats. Although car seats and seat belts cannot prevent all injuries or deaths, research has shown that the use of child safety seats in passenger cars significantly reduces the number of deaths (by 71 percent for infants and 54 percent for toddlers) and injuries. Unrestrained children are three times more likely to be injured in a crash than those who are restrained.

Even though more infants and toddlers are restrained while riding in cars, and despite strong evidence that car seats and seat belts save lives, millions of children still ride completely unrestrained. In 2005, 1,451 children age 14 and younger were killed while riding in a car or truck; tragically, more than half of these children were completely unrestrained.

Of particular concern, too many children who should be restrained in booster seats do not ride in one. The NHTSA recommends that children who have outgrown child safety seats (usually after reaching age 4 and 40 pounds of weight) be properly restrained in booster seats until they are at least 8 years old or are taller than 4-feet, 9-inches. seats until they are at least 8 years old or are taller than 4-feet, 9-inches.

Many teens also are not wearing seat belts, yet 16- to 19-years olds are more likely to be involved in a motor vehicle crash than any other age group. Approximately one out of every three teens (aged 16 to 20) never wears a seat belt or wears it only occasionally. Almost two-thirds of teens killed in motor vehicle crashes were not wearing seat belts.

Choose a car seat based on your child’s age and weight, and carefully follow the instructions for proper installation and use. Some studies show that 80 percent of child safety seats are used the wrong way.

The back seat is the safest place for all children, because it is the seat farthest away in a front-end collision, the most common type of accident.

Infants should be placed in rear-facing seats, in the back seat, until they weigh at least 20 pounds and are at least 1 year of age. NEVER put a child in a rear-facing car seat in the front seat if there is a passenger-side air bag. Serious injury or death can occur from the impact of the air bag against the back of the car seat.

Children older than 1 year who weigh between 20 and 40 pounds can ride in a forward-facing safety seat. It is still best, however, to have them ride rear-facing in the back seat when possible.

Children who weigh more than 40 pounds should use a booster seat until they are at least 8 years old or over 4-feet, 9-inches tall.

Car seats can become worn, broken, and quickly outgrown. Check your child's car seat regularly to make sure it still fits and that all buckles are working properly. Keep the car seat clean. Dirt collecting in recessed buckles (built into the seat, between a child's legs) can cause them to malfunction. Never use a car seat that has been in a crash.

Remember, children and teens will imitate what they see around them. In one survey, half of the young drivers (aged 16 to 20) said that when they wear a seat belt, they do so because others want them to wear it and because the people they're with are wearing them. Make sure to buckle yourself and your child up for EVERY ride, no matter how short; your lives depend on it!

Henry H. Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.