happy baby in car seatMotor vehicle crashes are the leading cause of death and injuries to children in the U.S. Fortunately, parents who focus on prevention — and pay attention to some crucial details — can make all the difference.

Proper use of child restraints can greatly reduce the risk of a child being killed in a crash — by up to 71 percent for infants under a year old, and by over 50 percent for kids ages 1 to 7, according to statistics cited by the National Highway Traffic Safety Administration. Indeed, child restraints have saved more than 8,000 kids in the last three decades, the agency says.

However, three out of four child safety seats are also improperly installed in vehicles, according to the NHTSA. That’s why UC Davis Medical Center is reminding parents during National Child Passenger Safety Week Sept. 21-28 to take a minute to ensure seats are properly installed.

“One of the most difficult parts of my job is telling a family that one of their loved ones has been seriously injured or killed in a motor vehicle crash," said Edward Panacek, an emergency physician with UC Davis Medical Center. “It is particularly devastating when it is apparent that use of a proper restraint system would have prevented many of those injuries. Prevention is the best medicine.”

Nearly 150 children ages 7 to 9 were admitted to UC Davis Medical Center for injuries from car crashes between 2002 and 2007.

Buckle up to grow up

California State law requires children under age 6 or weighing less than 60 pounds to ride in the back seat of a vehicle in a car seat or booster seat (V.C. 27360). However, the American Academy of Pediatrics (AAP) recommends that children remain in the back seat of a vehicle until age 13 and in a booster seat until the seat belt fits, which is usually about 4’9” tall (usually reached around age eight, according to the NHTSA).

"One of the most difficult parts of my job is telling a family that one of their loved ones has been seriously injured or killed in a motor vehicle crash."
Edward Panacek, emergency medicine physician with UC Davis Medical Center

Studies show that many children are moved out of car seats too soon. Most children are secured in car seats during the first year of life because they appear more fragile and need more protection.  But child restraint use drops for children from 1 to 3 years of age, and a more critical drop in child restraint use takes place for children from 4 to 7. 

Parents may consider this age group to be too big for a child restraint, but they are still too small to use a seat belt without a booster seat.

“Children aren't ready for seat belts just because they are 6 or weigh 60 pounds,” said Cathy Morris, child passenger safety coordinator for the UC Davis Health System’s Trauma Prevention & Outreach Program.

Seat belts are designed to fit adults, not children. A lap belt sitting across the stomach can cause serious damage to the child’s internal organs and spine during a crash. If the shoulder belt is not sitting snugly across the mid-chest and resting on the shoulder during a crash, serious injuries to the brain, face and spine can occur. These types of injuries are known as “seat belt syndrome”

Using a booster seat can greatly reduce these injuries because they lift the child up to help the lap belt fit properly, low and tight across the hips. Booster seats also help shoulder belts fit right (snugly across the mid-chest and resting on the shoulder).

Four steps for kids

Cathy MorrisChildren can be injured or even killed if not correctly restrained properly selected car seat, but choosing the correct seat for your child can be confusing. To help parents remember the best way to protect their children in vehicles — from birth to adulthood — the UC Davis Health System car seat program is modeled after the National Highway Traffic Safety Administration’s four-step campaign:

Step One: Rear-facing
From birth to at least one year of age and at least 20 pounds, babies need special protection and must ride in a rear-facing car seat in the back seat of the car. Infants are at greater risk for injury in crashes because their heads are fragile, and the bones and ligaments that help support the neck are still growing. For the best protection, the American Academy of Pediatrics recommends babies ride rear-facing in a convertible seat to the maximum rear-facing weight limit, which is usually 30 pounds.

Step Two: Forward-facing
When a child is at least one and weighs at least 20 pounds, he or she can ride facing the front of the car in a convertible or combination seat. Most of these seats have a harness limits to 40 pounds, with some ranging up to 65-80 pounds.

Step Three: Booster seats
When a child outgrows the forward facing seat, they need to ride in a booster seat in the back seat. A booster seat will raise a child up so that the lap and shoulder seat belts fit correctly, which will provide the best protection in a crash. Usually a child will need to use a booster seat  until they are 4’9” tall.

Step Four: Seat belts
Remember, seat belts are made for adults.  If you think your child is ready to ride in the car using only the lap and shoulder belts, ask yourself these questions. Does the shoulder belt lie across the middle of the chest and shoulder, not the neck or throat? Is the lap belt low and snug across the upper thighs, not the stomach? Can your child sit against the vehicle seat back with his or her legs bent over the edge of the seat without slouching? If you answer no to any of the questions, your child should still ride in a booster seat.

For more information, refer to Buckle Up to Grow Up, One Step at a Time.

Car seat installation tips

  • Make sure the child safety seat is facing the right direction for your child’s age and size.
  • Never secure a rear-facing baby in the front seat of a vehicle with a passenger-side air bag. Children 12 and under should not be seated next to an air bag. The back seat is generally the safest place for a child of any age.
  • Always read and follow the car seat manufacturer’s instructions and the vehicle’s instructions to ensure the seat is being used correctly.
  • Check and make sure the seat belt or LATCH is routed through the correct belt path on the child safety seat.
  • Be sure that the seat belt or LATCH straps are holding the car seat tightly. To help get a tight fit, put your body weight into the seat while tightening the seat belt or LATCH. If you can move the seat more than an inch side to side or front to back it’s not tight enough.
  • Most vehicles manufactured after 1996 provide seat belts that can secure car seats tightly. Older vehicles may require the use of a locking clip.
  • Get a free child safety seat check to make sure it is installed properly. Find an inspection station in your area (PDF) 
  • Visit Seat Check Saturday (PDF) on Sept. 20.

More resources

The UC Davis child passenger safety program offers:

  • Child safety seat inspections by appointment.
  • Free monthly car seat classes, also available in Spanish every other month. Call (916) 734-9799.
  • Child passenger safety DVD, Buckle up to Grow up: Once Step at a Time, Available in English, Spanish, Russian and Hmong. Call (916) 734-9784.
  • Child passenger tips safety materials in a variety of languages, available on the Trauma Prevention website’s child passenger safety page.
  • Community child safety seat inspection events

UC Davis Children's Hospital is the region's only comprehensive hospital for children. From primary care offices to specialty care clinics, pediatric experts provide compassionate care to more than 74,000 children each year. The Trauma Prevention and Outreach Program focuses on reducing visits to the hospital or doctor's office for unintentional injuries. Its mission is to decrease preventable childhood deaths and injuries through research, education and community outreach.