Is your car seat installed and fastened properly?

Car seats are proved to reduce injuries and deaths in children but are effective only if they are installed and used properly. A correctly used child seat can reduce the risk of death by up to 71 percent and risk for serious injury by up to 45 percent for children ages 4-8.
Photography: Steve WoodEvery three hours in the United States, a child loses their life due to injuries sustained in car crashes, often a result of a car seat not properly installed or used. In studies conducted over the past 10 years in the United States, Canada, France and Australia, up to 70 percent of car seats were installed incorrectly, with infant seats often being the most challenging.

Car seats are proved to reduce injuries and deaths in children but are effective only if they are installed and used properly. A correctly used child seat can reduce the risk of death by up to 71 percent and risk for serious injury by up to 45 percent for children ages 4-8.

“Knowing how to properly restrain a child in the car can mean the difference between a minor bump and a major injury,” said Candice Dye, M.D., associate professor of pediatrics in the University of Alabama at Birmingham Marnix E. Heersink School of Medicine and Children’s of Alabama. “It’s critical that parents and caregivers understand the importance of correct car seat usage, including how to install the seat and then how to secure the child properly in the seat.”

Types of car seats

There are four main types of car seats depending upon children’s ages and uses. Understanding what type of car seat a child needs and when to transition to the next safest option is key:

• Rear-facing-only and rear-facing-convertible seats with five-point harnesses are for infants and toddlers. All infants and toddlers should ride in a rear-facing seat until they reach the highest weight and height allowed by their car safety seat manufacturer. The child should remain rear-facing until at least 2 years of age but ideally as long as the seat allows, which should be even closer to 4 years of age. A convertible seat is one that will rear-face up to a certain height and weight maximum and then can be transitioned to a forward-facing seat per the seat manufacturer instructions.
• Forward-facing convertible and forward-facing seats with five-point harnesses are generally for older preschoolers. Children who have outgrown the rear-facing seat weight and height limits should use a forward-facing seat with a harness for as long as possible, up to the highest weight and height allowed by their car safety seat manufacturer.
• Booster seats are generally for elementary school-age children. All children whose weight and height exceeds the forward-facing five-point harness car seat limits should use a belt-positioning booster seat. Some forward-facing car seats can convert into a booster seat where the five-point harness is properly removed and the vehicle’s seat belt is used correctly with the booster. There are booster seats with and without a back based on what your child needs per their height. A child should continue to use a booster seat with the vehicle’s seat belt until the seat belt fits properly without use of a booster, which is typically when they have reached 4 feet, 9 inches in height.
• Seat belts for older children, adolescents and adults should fit properly when the shoulder belt is across the center of the chest and shoulder, not the neck or face, and the lap belt is across the upper thighs, not the stomach. For a seat belt to properly fit, a child is usually at least 4 feet, 9 inches tall and between the ages of 9 and 12.
• All children younger than 13 years old should ride in the back seat, properly restrained.

Buying decisions

With so many car seat model options to choose from at a variety of price points, it can be easy to be swayed by seats with different bells and whistles. Dye reminds parents that there are safe car seats at all price points, but the three most important factors in selecting a car seat are the child’s age, weight and height.

It is important to note that age does not decide when the child is ready to face forward. When making this decision, weight is often the limiting factor to keep in mind over a child’s age.

“Weight and height are more important as compared to these age limits because each child grows differently,” Dye said. “Infants can endure severe injuries and damage because of less head control developmentally, so you do not want to move up a car seat size prematurely. Always check the car seat labels and manual for the size limits, and always discuss with your pediatrician at your child’s routine health visits.”

“Car seats save lives,” said David Schwebel, Ph.D., professor in the College of Arts and Sciences’ Department of Psychology and director of the UAB Youth Safety Lab. “Remember that you need to adjust the seat often as your child grows. Infants and toddlers grow quickly, which means you need to evaluate the installation and safety of your car seat frequently, adjusting it as your child grows.”

A last point that parents need to remember when purchasing a car seat is when it will expire. As car seats are an investment, parents often want to reuse for younger siblings or keep the child in that seat as long as they fit properly, but car seats expire six years from the date of manufacture. A sticker is located on all car seats that provides the serial number and includes either a manufacture date or expiration date. Also, if a car seat has been in a motor vehicle accident, it is no longer certified for use.

Installation

Schwebel notes that a huge number of car seats traveling on American roadways today are installed incorrectly. He advises parents to take the time to learn if their car seat is properly installed and adjust if there are errors.

“Installing a car seat can be complicated at first. It even can be frustrating sometimes,” he said. “But parents should work hard to get the seats installed correctly, and to place their children properly into the seats, because mistakes can lead to serious injuries or even death.”

Depending on the type of car a person has and/or the type of car seat purchased, installation can look different.

“It is vital for parents to find out how to install their car seat into their vehicle,” Schwebel said. “Every car seat is a little different, and every vehicle is a little different. Take the time to learn how to get yours installed correctly to keep your child as safe as possible.” 

There are two ways car safety seats may be installed: with the vehicle’s seat belt or with its latch system. The top tether, third point of anchor attached to the seat, should always be used with a forward-facing seat, whether you use the seat belt or lower anchors to secure it.

Latch systems and seat belts can be equally safe, assuming the seat is installed properly. However, never install a car seat using seat belt and lower anchors together unless permitted by the manufacturer.

To check that the car seat is installed properly, use the non-dominant hand and try to move the seat. If it moves more than an inch, it needs to be tightened to be properly secured to the car seat. If a car safety seat is installed by using the vehicle’s seat belt, make sure the seat belt locks to hold the seat tightly. 

Manuals also illustrate exactly how to remove a car seat, if needed, and how to clean and care for the car seat, as well as how to harness the child in properly.

There are many ways to get free advice on installation such as careful reading and following an instruction manual and utilizing certified car seat technicians available at Children’s of Alabama and across the country, according to Schwebel.

Harnessing

Harnessing children into a car seat may seem straightforward; but if the child is not strapped in securely including the chest clip in proper location, the child may be more susceptible to serious injury or even death.

In a rear- or forward-facing car seat, buckle the five-point harness and place the chest clip at the center of the chest, even with your child’s armpits. Adjust by tightening the straps to where the slack of the strap cannot be pinched between one’s fingers at the level of the child’s collar bone or shoulder area.

In booster seats, the lap belt should lie low and snug across a child’s upper thighs and the shoulder belt should cross the center of the child’s chest and shoulder.

To keep children warm, parents may be tempted to put in blankets or keep children in coats before harnessing them. This practice causes the straps to not fit properly, thus putting children at risk. Only the items that came with the seat are safety tested for that seat. Any additional items, such as an extra cloth layer or play toy, may be dangerous and can cause suffocation or injury.

“Many parents take time to safeguard their home to prevent child injury; they might install outlet covers, cabinet locks or stair gates,” Schwebel said. “Do the same thing in your car — learn how to strap your child into it safely and adjust the seat as your child grows.”

Other key reminders

According to the American Automobile Association, loose toys can become significantly dangerous during a crash and can potentially also interfere with how a car seat is designed to perform in an accident. Acceleration during a crash makes flying objects much heavier upon impact than they are at rest. Therefore, soft toys are the best option while traveling in a car if the child is over a year of age and not otherwise at risk of suffocation.

Before driving, here is a short checklist to follow:

• Is the car seat installed and secured correctly? If yes, proceed with traveling.
• Once the child is buckled in their five-point harness, is there any excess strap? If yes, readjust.
• Is the chest clip positioned at the child’s chest armpit level? If yes, ready for travel.
• Is the position of their head right? In rear-facing seats, there should be at least an inch from the top of the car seat to the top of a child’s head. In a forward-facing seat, the tops of the ears should not be above the top of the car seat shell or head restraint.
• If appropriate size to use a seat belt, is the lap belt across their upper thighs and the seat belt across their chest and shoulder? If yes, proceed with travel.
• Are those less than 13 years of age properly restrained always in the back seat? If yes, ready for travel.

Car seat installation can be tricky, but there are free resources that parents can utilize. To talk with a passenger safety technician at the Children’s of Alabama, please call 1-800-504-9768. To learn more about car seat safety, watch the seminar “The Importance of Car Seat and Booster Seat Safety” held by School of Public Health.