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Car Safety

Submitted by Elizabeth Lindsey, R.P.T. and mother of three (c) 2001

Automobile accidents are the number one killer of young children. Experts estimate that 80-90% of all child safety seats are installed incorrectly, if used at all. Below is a list of things you may or may not know about protecting our children for a ride in the car. It is time we as parents take responsibility for this important issue, both with our own children and with others!

I have become a self appointed "Safety Deputy!" I peek into other people's car windows in parking lots and look to see how their child safety seats are installed. Many a parent has returned to the car to find the seat reinstalled--sometimes in a different location or maybe with a brand new locking clip if they needed one. (My husband says I'm going to be arrested for attempted Grand Theft Auto!) Now, I'm not suggesting that you actually break into other people's cars like I openly admit to doing, but keep your eyes open. Leave the person a friendly note on the windshield. Tell them the seat is not installed properly and they may want to contact the local fire station or the car dealer for assistance. Certainly offer your assistance to friends and family who may need help in this area. If you reach out in this way, you run the risk of offending a parent. You may also save a child's life.

TIP #1: Read your carseat manual cover to cover and your car manual (seatbelt and child restraint sections). Study this material. Know it. If you don’t understand something, contact the appropriate source for an answer. The reason you must be familiar with your specific manuals is that there are many different types of seatbelt systems and many different types of child restraint systems. Not all seatbelts will work with all child restraints. Some seatbelts require a locking clip. (Ever heard of one of those?) Some seatbelts cannot be corrected even with a locking clip. Occasionally it is even necessary for the seatbelt system to be replaced by the dealer to work properly with a child carseat. Though this may seem drastic, it is a small price to pay for the life of your child!

There is no shortcut! The forces in even a minor car accident are so great, your child will be severely injured or killed if not properly restrained!

If you have a hard time understanding the manuals or are still unsure if the seat is properly installed, call your local fire station or car dealer. Take the car and the carseat to the fire station or car dealer and ask them to install it for you. Learn from them. Ask questions. Do not feel self conscious about asking for help. If 90% of carseats are not installed correctly, it must be a pretty complicated task, right?

The one thing I will tell you is that the child's safety seat must be held TIGHTLY by the seatbelt. If it moves easily or the belt loosens when you pull on the seat, it is NOT installed correctly. In order to get a tight fit, try kneeling your weight onto the safety seat to push it down and then buckle it. While a carseat can be correctly installed by one person, it is easier and more effective if two people team up.

TIP #2: Never place a child under the age of 12 in a seat with an airbag! The airbag will deploy in even a minor accident and kill or severely injure your child. It is possible to have a switch placed on your airbag so you can turn it off and on. You need permission from the government to get a switch and they will give you permission if you need to transport children under 12 in that seat. You must contact the National Highway Traffic Safety Administration: http://www.nhtsa.gov/

TIP #3: Check regularly to see if your child’s carseat has been recalled. A surprising number of carseats do get recalled for various reasons. (My own daughter’s carseat was recalled recently because the harness had been shown to unlatch in a crash!) The NHTSA has a special section specifically for this purpose: http://www.nhtsa.gov/people/injury/childps

TIP #4: Make sure you “install” the child correctly into the seat! This is just as important as installing the seat correctly into the car. You will find this information in the carseat manual, but I will just touch on some of the common errors.

  • The harness must be snug on the child. Carseat manufacturers usually recommend no more slack than just enough to slide two fingers between the child and the harness. That's pretty snug!

  • Make sure there are no twists in the harness. In an accident those twists could actually cut into the child.

  • The harness tie must securely contain both belts of the harness and be positioned over the child's chest. It is very common to see one of the belts hanging out of the harness tie or the harness tie positioned too low, over the child's belly. In an accident the forces must be absorbed through the bony chest, not the soft belly. The harness tie should not be positioned too high, either. This is not as common of a mistake, but occasionally older children will actually pull the harness tie up all the way, by the neck. This should be discouraged and the harness tie moved back down into the correct position over the chest.

  • Make sure the straps are at the right height for your child. This information is in the carseat manual. Strap height will have to be adjusted periodically as the child grows.

TIP #5: Face your child the right way!
  • Infants under one year and under 20 pounds must face backwards!

  • If your child weighs 20 pounds, but is under one year old, he must still face the rear of the car! The rule is one year old and 20 pounds. There is a very good reason for this. Before one year old, the child’s neck ligaments and spinal joints are not that strong and will allow a lot of stretching in a whiplash type situation. The problem is, the spinal cord does not stretch that much and will actually tear. Until children are at least one year old, they must face backwards so that the forces of the accident are distributed the whole length of their bodies into the back of the seat.

  • If your child is one year old, but weighs less than 20 pounds, she must still face the rear of the car! Remember, one year old and 20 pounds. (My youngest daughter is tiny and had to ride facing backwards until she was 17 months old!) The forces of an accident on a baby lighter than 20 pounds would be catastrophic in the forward facing position. The rear facing seat helps absorb all those forces over the whole length of the child's back so he is less likely to sustain injury. In some European countries such as Sweden, children ride facing backwards until 3 or 4 years old! It is safer.

  • Make sure the carseat you are using is made to face the way you need it to face for the age and weight of your child. Some carseats are made for infants only up to 20 pounds and will only work facing the rear of the vehicle. So, if your child reaches 20 pounds before the age of one year you must switch to a carseat that is made to face the rear and will hold children over 20 pounds in the rear-facing position. Wow! We could spend a fortune on carseats before this is through! Or…Plan ahead and start out with a convertible carseat that will work rear-facing up to 30 or 40 pounds and then work forward facing. There are even one or two carseats out there that will do all that, and then convert into a child’s booster seat until 60 pounds! One seat from birth until about 6 years old. Now that’s thinking ahead!

  • The "tilt" of a rear-facing carseat is critically important! The angle at which the child is sitting can make the difference between life and death in an accident. Wow! This is detailed stuff! If a rear facing carseat is lying down too flat, there will be great whiplash type forces to the neck and head. If a rear-facing carseat is positioned too upright, it is more likely to flip forward (toward the rear of the vehicle) in an accident. Also a younger baby may experience trouble breathing if the carseat is too upright because their head may roll forward. With limited head control, a younger baby may not be able to raise his head to allow clear breathing.

  • The good news about "tilt" is that there are rear-facing carseats available with tilt indicators. When the seat is positioned at the correct tilt, the little ball in the indicator is in the green area. While I don't recommend choosing a carseat based solely on whether or not it has a tilt indicator, parents should at least get familiar with the approximate correct tilt by looking at model carseats in the store.

TIP #6: Do not purchase your child’s carseat second hand or accept someone else’s used seat. Now, I am all about sharing clothes and toys and finding deals at the consignment stores, but…You never want to re-use a seat that has been in an accident. If you purchase it second hand you won’t know the seat’s history. Also, newer seats are constantly being improved with new safety features and conforming to updated safety standards. Again, this is not the place to cut corners if you can help it!

TIP #7: If someone else is going to be taking your child in their car, install the seat into their car yourself and teach them the proper way to do it! Do not assume that Auntie or Grandma will be able to properly use the carseat without instruction and practice. It always amazes me when I see people hand the kid and the carseat off to auntie or grandma and assume that that person will be able to properly use the carseat. Do not worry about offending anyone. Your child’s safety is too important!

TIP #8: Keep your child in an appropriate carseat/booster seat until at least 6 years old or about 60 pounds. Regular seatbelts generally do not fit children until at least this age. You know your child is ready for a regular seatbelt when the seatbelt crosses comfortably over the shoulder, NOT the neck. Also, NEVER allow a child to put the shoulder belt behind them or use a "lap belt only" type seatbelt. They would be seriously injured in a crash. If a child is tempted to put the shoulder strap behind them, the seatbelt probably doesn’t fit well and they should be put back into a booster.

TIP #9: In order for a carseat to protect your child in an accident, it must be secured to the car by a seatbelt and your child must be secured to the carseat by the restraining harness. (Here’s where we’re hitting on the common sense issues.) The carseat will not protect your child if it is just sitting on the seat unsecured. A carseat with no restraining harness isn’t much good, either. I include this point because I’ve seen it so many times!

TIP #10: Every time you put your child in the carseat, check to make sure it is still buckled securely to the car. It is not uncommon for other passengers or even an older child to accidentally unbuckle the seatbelt. You also want to make sure the seatbelt is not gradually loosening over time. If you do notice the seatbelt loosening, it probably was not installed correctly in the first place. Seek help from the experts if necessary. Installing a carseat correctly is not a “do it once and forget it” type thing.

TIP #11: Did you know your child's carseat could kill you? Any large object including an unrestrained carseat (meaning one that is not seatbelted to the car) could go flying and injure or kill passengers riding in the car. (People usually don't think to make sure the carseat is belted in if the child is not in it.) Many rear-facing carseats require belting and unbelting with each use. This is also the case with booster seats for older children. Loose objects should be placed either in the trunk or on the floor of the car, never on the seat. Child restraints should be belted to the car whether or not they are occupied to protect the passengers.

TIP #12: All harness styles are not created equally. While the protection any one carseat offers is dependent on many factors besides harness style, experts generally agree that the 5 point restraint system is safer than the 3 point. The five point is basically a 3 point with extra straps that encircle the legs at the hips. This means that in an accident, the forces would be distributed through the pelvis and the chest (a much better situation than having all the forces absorbed at one point through the chest.)

TIP #13: Do not allow eating in a moving car. In a sudden stop or accident, there would be an increased risk of choking. Also, do not allow drinking through a straw in a moving vehicle. The straw could actually puncture the soft palate in the back of the mouth in a sudden stop or accident.

TIP #14: What about when the worst actually happens and you become involved in a serious car accident? You need to be prepared for the possibility that you may be unable to speak for your child because you yourself may be seriously injured! There have certainly been cases where the only survivor in a motor vehicle accident was the baby, safely strapped into his carseat. I recommend putting a few big bright stickers on the child's carseat with the following information:
  • Child's full name (and nickname if this applies)
  • Birth date
  • Parents'/guardians' names
  • Address and telephone # for all involved parents/guardians
  • 2 or 3 names and phone numbers of local relatives or friends in case neither parent is able to care for the child
  • Name and phone number of child's pediatrician
  • Any medical conditions the child may have or have had in the past (such as diabetes, asthma etc.)
  • Any allergies the child may have, especially to medication
  • For a young baby, type of formula (if formula fed)
  • Insurance information if applicable
  • Anything else you would like medical personnel to know about your child (fears she may have, favorite song that may help calm her, anything you can think of that would be helpful)

TIP #15: Emergency Medical Personnel should be the ones to remove a child from the carseat after an accident even if the child does not appear to be hurt. There could be internal injuries or spinal injuries that could be worsened by being moved by non-trained individuals. As is advised with any accident, victims should not be moved. A car accident is a stressful situation and children most definitely will be upset too. Do not be tempted to remove the child from the safety seat because he is crying. Comfort him with words and songs and gentle touch. Keep in mind his crying could be because of pain in which case you definitely don't want to move him!

If the car must be evacuated because of fire, it is recommended that the entire carseat be removed with the child still in it if this is possible.

Do not give a child food or drink after an accident! It may seem like a good idea to comfort a baby with a bottle or snack, but this could be very dangerous.

TIP #16: The most important thing you can do to protect your child in the car is to take responsibility and learn all you can! Never cut corners and never assume it won’t happen to you! In my 7 years as a physical therapist (including pediatrics) I have seen countless lives shattered. It is beyond heartbreaking to see a child that will never walk or talk or lead a normal life and to know the injury was probably PREVENTABLE! The regret and guilt that parents feel when they know they didn’t do all they could have done to prevent their child’s injury (or death) is something I hope you will never feel!

Invest your time and energy to make your child as safe as possible in the car and share your knowledge with others!

"Safety Girl" Speaks!"
Child Safety Information Every Parent Must Know!

Submitted by Elizabeth Lindsey, R.P.T. and mother of three
"I'm a stay at home mom because I'm a work at home mom! Ask me how!"

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