Improper use of car safety seats poses a significant risk to the lives of young children. The leading cause of death for children from ages 1 to 10 is motor vehicle crashes. In 2005, 1,335 children ages 14 and younger were killed in car crashes in the United States.1 While approximately 80 percent of Marylanders use car safety seats, it is estimated that 90 percent of those safety seats are used incorrectly and may not protect the child in a crash.2
When used correctly, safety seats can reduce injury by 71 percent for infants and 54 percent for toddlers.2 Health care providers can educate families on appropriate car seat use that provides the maximum protection as children grow. The following tips can help providers and parents use their car seats correctly:
General Guidelines
- The vehicle manual has information on proper seat installation. Safety seats should be secured tightly to the vehicle with a seat belt or LATCH attachments.3
- Test the tightness of the car seat by tugging the area where the belt goes through the car seat. The seat should not be able to move more than an inch in any direction when pulled at the seatbelt path.
- Harness straps should fit snugly and be inserted through the proper harness slot (for rear facing: at or below the shoulders; for forward-facing: at or above the shoulders). The chest clip should be located at the level of the armpit.
- Never place safety seats in the front seat. Airbags can injure infants and children. If there is no rear seat (e.g. trucks) the airbag must be turned off.
- Never leave a child in a locked and closed car while running an errand.
Safety Outside the Vehicle4
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- Never leave a child in a car safety seat unattended, including when it is being used outside the vehicle.
Never leave the harness partially fastened. A child could fall out of the seat, tip the seat over or be strangled by the safety harness.
- When outside the vehicle, the best place for an infant to sleep is on his or her back in a crib.
Infants
Small infants have soft backbones that can be damaged in a crash. Studies have shown a high rate of serious or fatal spinal cord injuries in infants who sit in safety seats facing the front of a vehicle. The American Academy of Pediatrics recommends:
- Keeping infants in a rear-facing safety seat as long as possible until they are 30-35 pounds and 18-24 months.
- The seat should recline at about a 45-degree angle.
- If a car seat is made so children can be rear facing longer, for best protection, the child should stay rear facing until reaching the maximum weight for the car safety seat.5
- A convertible safety seat can face the rear and then be turned around to face forward when the child reaches the seat’s rear-facing weight limit. Follow the instructions of the car seat manufacturer.
Toddlers
Toddlers have different safety needs than infants. To provide the most protection:
- Use a forward-facing safety seat or want to turn the convertible seat around when the child has reached the seat’s maximum rear facing weight.
- Use a forward-facing seat until the child is too heavy for the seat (usually 40 lbs.) or has grown too tall for the seat (ears are above the back of the car seat or shoulders above the highest strap slot). Then it is time for the booster seat.
School Age Children
The booster seat is the last step before using a regular safety belt. A common mistake is to skip this phase, but booster seats are important because safety belts do not fit children properly until about 8 years old. Lap belts often cross the child’s belly and can damage internal organs in a crash. The booster seat allows the lap-shoulder belt to fit properly.
- Booster seats should be used with a combination lap-shoulder belt. If a vehicle lacks a lap-shoulder belt, parents can buy a shield booster or vest, which can be used in vehicle seats with lap belts only.
- Children should use the booster seat until they are approximately 4 ½ feet tall and 80 lbs.
- After the booster seat, it is time to use the safety belt. The safety belt should fit snugly over the upper thighs, not on the belly.
- Children should always sit in the back seat, and use a lap-shoulder belt whenever possible.
- Safety belt use should be a life long habit that parents teach their children.
Health care providers can make sure parents are aware of the Maryland Child Passenger Safety Law. The law states:
A person transporting a child under the age of 8 years in a motor vehicle shall secure the child in a federally-approved child safety seat in accordance with the child safety seat and vehicle manufacturers’ instructions unless the child: is 4 feet, 9 inches tall or taller; or weighs more than 65 pounds.
A person may not transport a child under the age of 16 years unless the child is secured in: a child safety seat or a seat belt in all seating positions in all vehicles.
It is the driver’s responsibility for making sure all children are correctly buckled up.
It should be noted that the law only requires a minimum standard. Following the above guidance can increase your child’s chance of surviving in a crash.
Health care providers can also direct parents to the following links for more information:
Anne Arundel County Department of Health:
https://www.aahealth.org/child-passenger-safety-car-safety-seats/
Maryland Kids in Safety Seats
Maryland Department of Health
https://phpa.health.maryland.gov/oehfp/kiss/Pages/Home.aspx
1-800-370-7328
National Highway Traffic Safety Administration (NHTSA)
https://www.nhtsa.gov/
1-888-DASH-2-Dot (1-888-327-4236)
American Academy of Pediatrics
https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx
For Health care Providers: Maryland Institute for Emergency Medical Services Systems, Child Passenger Safety
http://www.miemss.org/home/emsc/cps
1WISQARS Leading Cause of Death Reports:https://www.cdc.gov/ncipc/wisqars/
2https://health.maryland.gov/phpa/Pages/home.aspx
3Lower Anchors and Tethers for Children come with all new vehicles since September 2002.
4 AAP Policy State–Selecting the Most Appropriate Car Safety Seats for Growing Children: Guidelines for Counseling Parents
5 Ibid.