Using car safety seats correctly is the best way to prevent injuries from happening to our children. The best seat for our child is the one with the best fit, is properly installed—following the car manufacturer’s instructions and used correctly.
When shopping for a good seat, make sure that it will fit your car, keeping in mind that it may not be the same as the ones on display. The seat should be taken out of the box in order to check whether your child would fit snugly in it, with all harnesses and buckles properly adjusted. Always follow the manufacturer’s instructions.
Rear-facing safety seats must be used with all children younger than one year of age, no matter what their weight. Some safety seats should be used only until the child reaches a weight of around twenty pounds; some can be used only with infants, having different harnesses. Larger safety seats could be used forward-facing with older children, always in the back seat, away from airbags.
Different safety seats may come with three- to five-point adjustable harnesses and straps (for shoulders, hips, and crotch), padded, T-shaped, etc. Multiple harness slots allow for the seat to be used as the child grows. Overhead shields and head supports are also important.
Some late model cars and vans have built-in safety seats; be sure to follow the manufacturer’s instructions closely when considering using them. Booster seats should be used when our child weighs over twenty pounds: they are actually designed for the use of the car’s safety belts. As the child grows, the car’s belts would fit better while using the booster seats. Later on, and depending on height and weight, the car’s lap and shoulder belts will provide a reasonable amount of safety, provided the child rides on the back seat ... always away from the passenger’s air bag. Seat belts must be used correctly, snug across the shoulder, chest, and thighs; if this is not possible, then a booster seat must be used.
Children must be always buckled snugly into the safety seat and the seat tightly secured to the car’s back seat. Late model cars come with extra attachments, such as tethers, that prevent the safety seat from moving around. Beware of devices that do not come with the original safety seat, because they may actually interfere with its proper function. If in doubt, contact the local police department; many of them offer instruction classes for parents on how to install and use safety seat.
Some safety seats designed for infants can be secured to shopping carts; many stores offer now shopping carts with built-in safety seats. Beware of them, because they may tip over, hurting your child; strollers and front- or backpacks offer much better protection.
Small infants can use safety seats, provided a blanket is used to make them fit snugly into them. Remember that an adult should always ride in the back seat to watch the baby. Because of health problems, some children may need extra protection and special restraint systems while riding in a car; always talk to their pediatrician before considering purchasing and installing a safety seat.
Air bags are dangerous to any child because of the speed and force they deploy during accidents. This includes “curtain” or side air bags. Be sure to follow the car manufacturer’s safety recommendations before using a safety seat you have purchased or the ones that are already installed in the vehicle.
Regarding seat belts, they can be used safely to restraint older children only if they are the shoulder-lap combination; if the children still weigh around twenty pounds, a safety seat must be used. Older children may ride on the front passenger seat only if the safety belt (shoulder/lap) fits snugly and the seat is pushed back as much as possible, in order to avoid injuries from air bags.
Safety seats must be used for air travel; federal guidelines recommend them for children up to age four. Many child safety seats are certified for air travel—just be sure to check before purchasing them. Also, it is a good idea to call the airline before a trip in order to be sure the safety seat is approved.
Installed safety seats must be replaced with new ones when the vehicle they were in was involved in a moderate to severe accident, having sustained serious damage, particularly to doors, air bags deployed, etc. Damage to a safety seat may not be obvious, however, because of the accident, buckles or clips may be broken or the seat could be misaligned, preventing the harnesses to work properly. This also applies to used car safety seats simply because we would not know if they were damaged in an accident, they have missing parts, etc.
We should remember that children must never be left unattended in a vehicle, whether they are in a safety seat or not, for many reasons: significant increase or decrease in the temperature, injuries caused by either starting the vehicle or putting it into gear, or by accessories such as cigarette lighters, power windows, or sunroofs, etc. Animals should not be left with children in a vehicle without adult supervision. We also have to consider that the vehicle could be stolen, etc.
Safety seats are designed to be properly used inside vehicles; they should not be used away from them, even when “the baby is asleep.” Safety seats may tip over with limited movements from the child, falling from chairs or other furniture, causing serious injuries.
By Alice M. Crawford, MD, PhD