St. David's HealthCare - September 16, 2016
by Kristen Hullum, MSN RN PCCN

Motor vehicle accidents are the leading cause of death for children ages 1 through 12, according to the National Highway Traffic Safety Administration. Even though many parents believe they have done the right thing by placing their children in car seats, three out of four kids are placed in a car seat improperly.

What can parents and caregivers do to best protect their children in the car?

Familiarize yourself with the difference between what is legal and what is the best practice—the two can be very different.

  • Texas law states that a child must be in a car seat if they are under age 8 or until they are 4’9” tall.
  • The best practice for restraining children is to keep them in each phase of restraint (rear facing, front facing with a five-point harness, or booster) for as long as possible, which means until they reach the maximum height or weight requirements as stated by the car seat manufacturer.

When your child reaches a height of 4’9” tall (which may be at an age over the legal requirement of 8), he or she can be safely moved to a regular vehicle seat. 4’9” is the height at which a child’s legs can typically bend appropriately at the seat’s edge, his or her feet can touch the floor, and the seat belt appropriately crosses their shoulder and chest.

Children should remain in the back seat until age 13, when they are typically big enough to sit in the front passenger seat. Although a frontal air bag is designed to save lives, it deploys at great force and can cause severe injury or even death when a small child (especially if still in a rear-facing car seat) is placed in the front seat of the vehicle.

What is the right direction for my child to face?

Remember, your child should stay in each phase of car seat placement for as long as possible.

  • Children should be in a rear-facing position until a minimum of 2 years old, but preferably longer. They should stay rear-facing until they max out the rear-facing weight limit of the car seat (refer to car seat manufacturer’s instructions). Rear-facing is the safest possible direction in order to minimize crash forces that cause head, neck and spine injuries. When placing your child in a 5-point harness, the harness straps must be at or below shoulder level for the rear-facing position.
  • When the child maxes out of the rear-facing position, you may turn them to forward-facing with a five-point harness. The harness straps must be at or above shoulder level for the forward-facing position. Children should also stay in this position until they max out the weight limit of their seat.
  • Once they reach that top weight limit, they are ready for a transition to a booster seat. Children need to stay in a booster seat until they reach 4’9” tall, which can sometimes be age 10 or older.

Final tips on securing your child…

  • The straps must be tight enough so that no extra belt or webbing can be pinched over the shoulders. A loose belt will allow a child to move greatly or possibly even be ejected during a collision.
  • The chest clip must be raised to arm pit level. A chest clip that is too high could cause damage to the throat (airway) in a collision, and a chest clip that is too low over the stomach could cause severe abdominal injuries in a collision.
  • The seat installation must be fairly tight, with less than one inch of movement left to right when testing movement at the belt path.

Securing your child in a car seat can feel overwhelming and complicated, but could be critical in protecting your child from injury or death in the event of a crash. Read through vehicle and car seat manuals carefully, and consult official resources online (several listed below). Finally, it is always wise to have a Certified Child Passenger Safety Technician evaluate your car seat installation. Car seat check events occur throughout communities by hospitals, EMS, and private organizations.

The best way to keep your child safe in a car is to put them in the right seat, in the right place in the vehicle, facing the right directionEVERY SINGLE TIME.

Kristen Hullum, RN, MSN
Trauma Injury Prevention Coordinator
St. David’s Round Rock Medical Center

*St. David’s Round Rock Medical Center, in partnership with Baby Earth and Williamson County EMS, will host a car seat safety event on Saturday, Sept. 24 from 9 a.m. to noon. Call Baby Earth at 512-600-7050 to make an appointment. Inspection events are also held at Baby Earth on the second Thursday of each month from 9 a.m. to 12 p.m.

tags: car seat