Car Safety For Kids   

Paula Zollner, MD
2010

     Motor Vehicle crashes continue to be a leading cause of death and disability in children.  Children who ride unrestrained, improperly restrained, or too close to the instrument panel are at particular risk.  Read on to review the facts about motor vehicle accidents and the particulars on the use of child restraint systems to keep your child as safe as possible.
We know that the use of child restraint systems reduces fatal injury in infants by 70% and by 50% in children in the one to four year age group.  All 50 states have some form of child restraint laws.  Thirty-eight states currently have booster seat laws.
The various forms of car seats and boosters have been manufactured to accommodate a child’s growing and developing body.  An understanding of the differences will allow you as parent, caretaker and responsible driver to select the most appropriate system to protect the child or children under your care. 

     Infant–Only car seats should always be positioned rear facing.  They are most safe in the back seat, never in the front passenger seat if there is an active air bag.  These seats accommodate infants 4 to 5 lbs to 22 to 30 lbs whose maximum height is 28 to 30 inches.  The retainer clip should be placed midline at the level of the underarms, not the belly or neck. 
A Convertible car seat can be used initially rear facing for an infant and then eventually forward facing (at 2 years old) for a child up to 40 to 65 lbs.  A convertible car seat can be a money saver in the long run.  It however can not be easily carried in and out of the vehicle to be used as an infant carrier.  Combination seats accommodate children weighing between 20 and 100 lbs.  They must always be used in a forward facing position.  The advantage is that they can be changed from a five-point harness system to a belt positioning booster seat. The purpose of a Booster seat is to raise the child up in the seat to provide appropriate positioning of the seat belt.  Children who have outgrown their convertible seat should be in a booster until they are 4 ft 9 in tall, generally between 8 to 12 years of age.  The shoulder belt needs to lie across the chest without touching the face or neck.  The lap belt should be positioned over the upper thighs, not across the abdomen.  High back type booster seats in contrast to those without demonstrate a 70% reduction in injury from lateral collisions and so are preferred. Seat belts can be used alone when they fit appropriately as noted above, when a child is 80 lbs or more or is at least 4 ft 9 in tall.

     Children are five times safer when their car seat is in the rear facing position.  Therefore let your child outgrow the car seat manufacturer’s maximum limits before turning a convertible seat or buying a new forward facing seat. 
For children younger than 16, years evidence shows that there is 40% decreased risk for serious injury when sitting in the rear seat versus in the front passenger seat.  Young people whose height is less than that of an adult are more susceptible to cervical spine and head injury when air bags rapidly inflate. 

     A few notes about car seat installation:

       is available in car seats and vehicles made from September 2002.           
This system simplifies securing car seats without the use of seat belts. 

     Some of the factors that lead to incorrect car seat use include child acceptance, peer pressure from older riders, cost, parenting style, unexpected social and transportation issues and parental misinformation. Please be aware that most collisions occur close to home on local roads and in areas of low speed limits.  Avoid being tempted to relax your regular car safety rules on short trips, or for local driving.  If a motor vehicle accident has occurred the child restraint system used should be replaced. 

      Some kids have special needs regarding an appropriate child restraint system.   Prematurely born infants and those with respiratory issues for example, should have a “car seat test” that monitors for any problematic changes in breathing and heart rate before hospital discharge.  If an infant “fails” the car seat test he or she may temporarily need a car bed and or to be prescribed stimulant medication.  Another example of a special needs child is one who has a condition associated with low tone.  He or she may need to have the car seat reclined backwards to prevent the neck from hyper flexing and blocking the airway.  Extra tethers and lap belts and a” positioning vest” may be necessary for such a child.   

     What about children traveling in school buses?  Restraint systems or lack there of vary greatly across the country.  There are laws for buses weighing over 10,000 lbs to have lap belts.  Buses less than 10,000 lbs are only required to have compartmentalization (closely spaced seats with high padded seat backs).  The American Academy of Pediatrics supports the use of lap and shoulder belts for children traveling in school buses.
Seat belt use is recommended for children and adults traveling in taxi cabs.  No one should ride in the cargo area of a pick up truck where the risk for injury is significantly higher.

     Surprisingly, there are no restraint laws for children younger than 2 years traveling by air.  Preventable injuries and deaths have occurred in unrestrained children under conditions of turbulence and survivable crashes.  The American Academy of Pediatrics does recommend a mandatory federal requirement for restraint use for children on aircraft.   

     Adolescents are at particular risk for injury while on the road.  Their general lack of driving experience along with easy distractions (cell phones, DVD players, ipod, peers as passengers) and experimentation with illicit substances can be deadly.  Graduated licensing systems, restrictions on passengers and for nighttime driving, and driver’s ed programs have been helpful to reduce risk.    

     Of the fatal motor vehicle collisions in children, one quarter are related to drunken driving situations.  It’s surprising to realize that in most such cases the child was being driven by the intoxicated motorist. 

Some Online Resources;

Car Safety Seats and Transportation Safety
www.aap.org/healthtopics/carseatsafety.cfm

Seatcheck website
www.seatcheck.org

Child Restraint Laws
www.iihs.org/laws/ChildRestraint.aspx