Car Seat Safety Checks

• Transitioning children to the next car seat stage too quickly: from a rear-facing seat to forward facing; from a 5-point harness to a booster; or, from a booster to a standard seat belt. In the past decade, the weight limits for all stages of car seats have increased as manufacturers start to design child restraints for larger children.
  
  
• Having the harness too loose. If the harness isn’t positioned through the correct slots in the car seat, you won’t have a good, snug fit. Parents should use the slots just below a baby's shoulders while they are riding in a rear-facing position, and the slot at or just above the child's shoulders once they transition to a forward-facing seat.

A NHTSA study revealed the following:

In rear-facing infant and convertible seats, the most common misuses (excluding those specific to the installation method) include:

• Child is less than 1 year old and the angle of the seat is less than or equal to 30 degrees (42% of misuse cases).
• Loose installation, where the car seat could be moved more than 2 inches laterally (29% of misuse cases).
• Harness slack over 2 inches (15% of misuse cases).

In forward-facing car seats, the most common misuses include:

• Loose installation, where the car seat could be moved more than 2 inches laterally (47% of misuse cases).
• Harness slack over 2 inches (28% of misuse cases).
• One or more harness straps behind the child’s arm, back, or leg (15% of misuse cases)
• Children are often turned forward facing too soon (keep children rear-facing as long as possible, until they have outgrown their rear-facing seat by weight or height. The American Academy of Pediatrics’ policy requires children to remain rear-facing until a MINIMUM of two years in age and 30 lbs., and some state laws including CT, NJ, NY & RI reflect this.

In highback and backless booster seats, the most common misuses include:

• Lap belt across child’s abdomen and/or ribcage (59% of misuse cases).
• Shoulder belt behind the child’s arm or back (24% of misuse cases)

• When used properly, child safety seats are designed to "ride down" the forces of a crash on a child's fragile body.  A child's developing body is not the same as a small adult's. For example, the same crash forces that might cause an adult to experience what we know as "whiplash" could cause a young child to have an "internal decapitation," a colloquial term for an injury known to surgeons as occipital-cervical dislocation. It potentially fatal injury occurs when the ligaments, muscles, and joints that connect the base of the skull to the top of the spine are damaged. This is why the American Academy of Pediatrics (AAP) and the National Highway Transportation Safety Association (NHTSA) policies are to keep children riding rear-facing until a minimum of age two.

• You should not be able to pinch any slack in a harness. Note that clothing, such as puffy winter coats, can get in the way of a tight harness fit.  During cold weather, try to dress children in warm but thin layers and then use a blanket or poncho over the harness in the car seat.

• Height and weight – not age – determine when a child outgrows an infant seat. It is easy to tell if a child has outgrown their seat by their height – the top of their head should be at least one inch below the top of the seat’s hard plastic shell.
  
  
• Every seat sold in the US is required to have a weight limit label – usually a large sticker – on the seat.  Manufacturers have varied limits, so always check the sticker!  Some infant seats have a limit of 35lbs, others max out at about 21 lbs.; most convertibles max out at 65lbs, but some have a 40 lb. limit.  Combination seats have harnesses with even higher weight limits.  Above all else remember that a harness will protect a child better than a vehicle seat belt which is designed for adults.

• According to Dr. Marilyn Bull, the pediatrician who represents AAP on the National Child Passenger Safety Board, children are flexible and able to comfortably cross their legs.  There is no data to support evidence of leg injuries in a crash, but there is a great deal of evidence that keeping them rear-facing reduced brain and spinal cord injuries, both of which are serious and often fatal. It is much, much safer to keep them rear-facing as long as you can.

• Connecticut, New Jersey, New York, and Rhode Island laws state that a child can be forward facing in a car once they reach two years of age or 30 pounds.  The American Academy of Pediatrics uses age two as a minimum; it's safest to keep children rear-facing until they reach the maximum weight of their rear-facing (convertible) car seat.

• A forward-facing car seat has a 5-point harness system that restrains the child at the strongest parts of their body. This distributes crash forces over a larger area to prevent injury.  The chest clip should be positioned at armpit level, and not down near the child's stomach.  A booster seat requires the use of a seat belt, which meets the body at only three points (two hips and one shoulder).  Additionally, seat belts on young children often ride up near their neck, a vulnerable area that should not be met with force). Most modern booster seats come with a belt guide to prevent the seat belt from coming near the neck.  

• Both the child’s size and behavior should be considered.  Can the child sit for a car ride without wiggling out of the seatbelt, or pulling it behind their back? If they can’t, keep them in a forward-facing seat.  Some smaller children may need more head support than a booster seat offers. And children who nap in a car are more comfortable in a seat with back and head restraints. A forward-facing seat is always safer. Once the child outgrows their forward-facing car seat by height and weight (this is very important because the internal harnesses in forward-facing car seats often have weight limits of 65lbs). Children should use the seat belt and a belt-positioning booster seat until they are both tall and mature enough to sit safely in a vehicle seat belt. Many state laws require booster seats until a minimum of age 8, however, it is important that the seat belt fits at the child’s shoulder and does not ride up near their neck, they can bend their knees comfortably over the seat without slouching.  Achieving this proper seat belt fit and the maturity to remain safely belted varies with age.

• The National Highway Transportation Safety Association (NHTSA) has a great "Ease of Use" Chart, which has a five-star rating system for hundreds of car seats in the market. The website also offers guidance on installing car seats, harnessing children, reading and interpreting labels, and weight guidelines.

• Parents can use this link to find a technician in their area: https://www.nhtsa.gov/equipment/car-seats-and-booster-seats#install-inspection.  Many police and fire stations have a technician who can assist; just call in advance.  Additionally, Safe Kids Coalitions are a great resource for information on seat checks!