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Sonja Brownlee, MD.
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Last Updated 3/2011

The information contained on this web site is not a substitute for direct examination and treatment by a physician. If any of this material is unclear or confusing, or if you have additional questions or concerns, please call the office at 778-6762. 

Disclaimer:Sonja Brownlee,M.D. cannot endorse all links presented on the website as they may link to unrelated third-party websites.

Car Safety

Riding in a motor vehicle is the most dangerous thing your child does, no matter what his or her age . Each year, more children between 1-19 years old are killed in car crashes than by any other cause. Many of these deaths could be prevented if the children were properly restrained. Contrary to what many people believe, a parent ’ s lap is actually the most dangerous place for a child to ride. In case of an accident, you would not be able to hold on to your child. And even if you could, your body would crush your baby as you were thrown against the dashboard and windshield. The single most important thing you can do to keep your child safe in the car is to buy, install, and use an approved car seat or booster seat.

All 50 states and the District of Columbia have child restraint laws requiring children to travel in approved child restraint devices. Unfortunately, recent studies show that many parents are not properly using them.

The most common mistakes are:

• placing rear-facing seats in front of an air bag
• facing car seats in the wrong direction
• failing to harness the child into the car seat
• not using the car seat on short trips.

Most fatal crashes occur within five miles of home and at speeds of less than 25 mph . It i s not enough to have a car seat; your child must use it correctly, every time s/he is a passenger in any car .

Make sure EVERYONE in the car is buckled up with a safety belt or appropriate child restraint.

• Unbuckled occupants (or those using a lap belt only) can be hurt or killed by an airbag.
• Always use your own seat belt. Your child is more likely to buckle up if you do. In addition to setting a good example, you wi ll reduce your own risk of injury or death in a crash by 60%.
• The back seat is the safest place for a child of any age to ride . Children younger than 12 years should not sit in the front seat. If you have more children than rear seats, the oldest child should ride in the front seat with the front airbag turned OFF. If you have a pick-up, be sure the air bag is turned OFF when your child is a passenger.
• Some newer cars are equipped with side airbags in the front or rear seats which can also be a danger, or fatal, to children or infants seated near them. Check with the dealer when you purchase a new car.
• Never let your child climb out of the car seat or undo his/her seat belt while the car is moving.
• Never allow children to share one seat belt .
• Keep all doors and windows locked while the car is in motion.
• Keep heavy objects (luggage, etc) in the trunk or roof rack (they become missiles in a crash).

Driver inattention is a major cause of fatal accidents .

• Never drive and use a cell phone. Don’t even think about text messaging while driving.
• Never drive and watch a video or computer screen.
• Always pull over if your child needs to be attended to – don’t try to keep driving while you turn around or lean back over to assist your child.

Children are very difficult to see when they are outside of the car.

• Always know exactly where your child baby/toddler/child is before backing up the car.
• Pick up and drop off children at the curb or driveway. Do not drive off until you see them safely away from your car and other traffic.

Used Car Seats may not provide maximum safety.

If a child safety seat has been subjected to a crash of any severity, it must be thrown away; even if you think it “ looks OK.” The crash has stressed the seat, and it may not protect your child optimally in the next crash.

Car seats sometimes get recalled, and unless you have registered the seat, you will not be notified. When you purchase a car seat, be sure to register it.

Avoid burns in hot weather, by draping a towel over the car seat when you leave . Before putting your child in the seat, touch the vinyl and the metal buckle with your hand to be sure they are not hot.

No matter how short your errand is, never leave an infant or child alone in a car:

• S/he might get too cold or too overheated and die.
• S/he might become frightened and panicky when s/he realizes s/he’s alone.
• Any child alone in a car is a target for abduction.
• An older child may be tempted to play with things such as a cigarette lighter or the gear shift, which could cause him/her serious injury.

 Seating Children Safely

Both age and weight requirements should be met before you advance your child to the next type of restraint; however,

Some of the ages and weights overlap because children vary in height and leg length.
Consult the paragraphs below for guidelines on the proper fit of the car or booster seat to your child’s body.

*Correct adult seat belt fit is not achieved until a child is at least 4' 9" tall and 80 pounds (around age 9).

Installing a car seat properly can be difficult. You can get help from www.DMV.org and search for “child safety seats.” Also try www.seatcheck.org or call 866-SEATCHECK (866-732-8243) or 888-327-4236

• Your baby should ride in a rear-facing infant or convertible safety seat until s/he is both 20 pounds AND 1 year of age . Just because your baby can sit up and support his/her own head, does not mean s/he can sit in a forward-facing car seat. Your baby’s head is very large relative to his/her body and his/her neck bones and ligaments are weak and unable to withstand the extreme forces of a car crash - even at speeds less than 25 mph.
• The infant safety seat should be tilted at an angle of about 45 degrees
• The seat belt must be locked into position around the seat -- because seat belts have “ give” to allow normal motion and only lock up in the event of a crash, the belt holding the safety seat must be locked into position. If installed correctly, the safety seat should not wiggle more than one inch in any direction.
• Be sure the harness straps are snug against your child ’ s body, and are flat, not twisted. You should not be able to get more than one finger between the straps and your baby ’ s body.
• The shoulder straps of a car seat should come through slots level with or just below your child ’ s shoulders. The chest protector should be at about the level of the baby ’ s armpits to prevent the shoulder straps from sliding off.
• The crotch strap should be kept short.
• Change from an infant seat to a convertible car seat when the maximum height (when the infant’s head is within 1 inch of the top of the seat) and weight (usually 22 – 32 pounds) have been reached for that infant seat as suggested by the car seat manufacturer.

Keep your toddler in a rear-facing car seat until age 2 (not 1) – New research indicates that toddlers are more than 5 times safer riding rear-facing in a car safety seat up to their second birthday.

• If an infant car seat is used, the infant should be switched to a rear-facing convertible car seat when the maximum height (when the infant’s head is within 1 inch of the top of the seat) and weight (usually 22 – 32 pounds) have been reached for that infant seat as suggested by the car seat manufacturer.
• Toddlers should remain rear-facing in a convertible car seat until they have reached the maximum height and weight recommended for the model, or at least the age of 2.

2 to 4 Years of Age and 20-40 lbs: Forward-Facing Child Safety Seat in the back seat

• Children older than 1 year and who weigh at least 20 lbs. can ride facing forward but should stay in the back seat.
• Because each seat is tested for certain weight limits, it is important to check the manufacturer ’ s information booklet to ensure that your toddler and the seat are a match.
• The seat should be upright and the harness straps should go through the upper slots (over the top of the shoulders) and snug (no more than 2 adult fingers between the straps and child). The seat should fit securely (no more than one inch of play in any direction).
• Newer cars will allow you to use tether systems that are much easier to install.
• The integral (built-in) car seats in some vehicles are usually safe for toddlers (check the owner ’ s manual).
• Children should remain in a safety seat until they reach at least 40 pounds. However, they can stay in this type of seat as long as it fits well:
• the top of the child ’ s ears should be below the top of the back of the safety seat
• child’s shoulders should be below the uppermost strap slots
• child’s weight should be below the maximum manufacturer’s recommendation.

5 to 8 Years of Age and 40-80 lbs and under 4 feet 9 inches: Booster Seats in the back seat

• Without a booster seat, adult seat belts are dangerous because:
• the lap belt slips up to ride across the stomach, instead of staying low against the pelvic bones, and can cause severe abdominal injuries in a crash.
• your child can “submarine” (slide out of the lap belt) during a crash
• because of the improper fit, the shoulder belt can cause neck injuries, or your child may just put it under his/her arm or behind his/her back, which will increase the risk of injury in a crash.
• Do not use any of the devices marketed to improve the fit of the adult-sized seat belt for children . They pull down the shoulder strap while pulling up the lap belt over the abdomen. And they have not been crash tested.
• Booster seats simply raise your child a few inches to improve the fit and comfort of the adult seat belt. They lower the risk of serious injury by 50%, compared with using an adult seat belt alone.
• Booster seats do not have to be secured directly to the vehicle, so they are easy to use.
• A high-back booster seat is best because it provides head support.
• Booster seats should always be used with a lap and shoulder belt, rather than just the lap belt alone.

 9 to 12 Years of Age and over 80 lbs and over 4 feet 9 inches: Back Seats and Adult Seat Belts:

• Be sure the adult seat belt fits correctly . The shoulder belt should fit across the chest and midway between the shoulder and neck, and the lap belt should lie low and flat across the hips. Your child ’ s bottom must rest against the seat back, and his/her knees must be comfortably bent over the edge of the seat.
• Riding in the back seat is safest . It lowers the risk of fatal injury by 30% -- 46%!

Over 12 Years of Age and over 4 feet 9 inches:

• Your child can ride in the front seat wearing a seat belt and with the air bag “on.”
• Your child will be safer if s/he does not ride in a car with a new teenager driver . Teenage drivers have more than five times as many crashes as older drivers, and their risk of crashing goes up when they carry passengers.

Teenage drivers:

• Driving is a privilege, not a right ! Your teen must:
• wear a seat belt
• be responsible for the safety of his/her passengers
• must never drive under the influence of drugs or alcohol
• Teen drivers are at greater risk of crashes due to inexperience and immaturity .
• They are five times more likely to be in a crash, and are at fault > 80% of the time.
• Although teens account for about 7% of US licensed drivers, they are involved in 15% of fatal crashes.
• Teens are especially at risk at night, beginning at about 9 pm .
• Even if s/he doesn’t have to be home by 9 pm , s/he should not drive after that time for the first year.
• Transporting passengers also greatly increases the risk
• especially when the passengers are teens
• and when 3 or more passengers are riding in the vehicle.
• With a learner ’ s permit ,
• your teen should drive only under adult supervision for at least 6 months,
• including some supervised driving at night and in bad weather.
• Once s/he gets a license , s/he should not carry passengers for 6 months.