One of the hardest things you may have to do as a parent is to properly secure your child into his/her car seat. I am of a generation who did not have car seats; we did not even have seatbelts in the car when I was really little. My girls had car seats, but those seats were nothing like what is available today. I remember moving back to Indiana from Tennessee when our oldest daughter was not quite 18 months old. We had our car so packed full of our belongings that her car seat would not even fit. It was soft items in the backseat, so we rationalized she would be just as safe while sitting down lower in the seat while utilizing the seatbelt. This would have been just a lap belt, before shoulder harness seat belts were installed in the backseat of a car. Besides, would she really be safer sitting up higher in a car seat? Car seat safety experts would quickly say how wrong we were to have traveled eight hours with her in that position.
Both my kids survived riding in what would now be deemed unsafe car seats. We were also fortunate to have never been in an accident. According to Durbin and Hoffman (2018), vehicle accidents are the leading cause of death for kids four years old and older (p.1). Durbin and Hoffman’s 2018 “Child Passenger Safety” report gives best practice recommendations for using car seats for children of different ages or sizes. These recommendations are fairly similar to the National Highway Traffic Safety Administration’s [NHTSA] (2020) recommendations. Durbin and Hoffman (2018) give guidelines based more on the weight and height of the child (p.2), while the NHTSA’s (2020) website is geared more to the child’s age. The NHTSA (2020) mentions the child’s size as being a factor; however, the graphics are more reflecting the child’s age as the main reason for changing the way a child faces in a car seat and even the type of car seat. Both agree that children should remain rear facing for as long as possible (Durbin and Hoffman, 2018, p. 2 and NHTSA, 2020).
Our daughter was very particular about when she allowed her children to turn from rear facing to forward facing. I felt bad for my grandkids. While rear facing may be safer, their poor little legs were all squished up against the seat back because they could not stretch them out. My daughter followed the car seat manufacturer’s guidelines for the child’s weight as to when she could allow them to face the front. Durbin and Hoffman (2018) mention rear facing car seats are made for children until they are 40 pounds (p.2). Our grandchildren’s car seats said 30 pounds. I know both of them are glad for that guideline.
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For my husband and me, we always felt so dumb when trying to get the car seats into our car, and then getting the grandkids securely harnessed into the car seats. If either of these two are not correct, injury or death can occur if in an accident. The first thing is to get the correct seat for your vehicle in order to securely fasten it into your car. Not all car seats fit in every kind of car. The NHTSA website (2020) is very helpful to suggest the appropriate car seat based on the child’s birthdate, weight, and height. Enter the information and a list of different car seats will be listed.
These car seats have all met the NHTSA’s safety and crash standards. Once the correct car seat is purchased, it now must be correctly installed into the car. The “Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge” report lists eight different car seat installation errors (Hoffman, Gallardo, & Carlson, 2016, p. 51). This report looked specifically at car seat use or misuse for newborn babies leaving the hospital. The highest percentage of errors was for “> 1-inch motion of CSS” (Table III, p. 51). This means the car seat itself moves more than one inch in any one direction. Approximately 14.7% of these parents worked with a child passenger safety technician prior to the birth of their child (Table II, p. 51).
Even with professional help, 47% of those parents made some type of installation error (p. 51). Now that the car seat is securely and properly installed, it is time to properly secure the child. This is another whole set of errors. Positioning errors were made by 76% of the parents or caregivers studied (Hoffman, Gallardo, & Carlson, 2016, p. 51). “If a product is used incorrectly 95% of the time, then we must consider that product to be inherently flawed in some way” (Hoffman, Gallardo, & Carlson, 2016, p. 53). If the product meets safety and crash standards, therefore not the product, it must be user error. Parents, caregivers, and grandparents need to be properly trained to use child passenger seats correctly.
Will, Decina, Maple, & Perkins (2015) did a research study to find out what is the best way to help people understand the proper use of child passenger seats. They realized how difficult it can be for some people to understand how to properly install a car seat and then correctly position a child into that seat. In this report, “Effectiveness of Child Passenger Safety Information for the Safe Transportation of Children,” Figures 1-4 (pp. 10-11) illustrates the four different informational flyers participates viewed for information.
The participants were given pre and post-tests to assess which flyers were most helpful in understanding the importance of child passenger seat safety. “What this study has revealed is that the most advantageous way of framing CPS recommendations is to explain the injury risks behind the information.” (Will, Decina, Maple, & Perkins, 2015, p. 7). Figure 3: Risk Reduction Rationale (p.11) showed the most success with participates having a better understanding following the research. This flyer tells participates not only how to secure the car seat and child, but also why this position is the safest.
Parenting is hard enough without the added stress of not knowing whether or not the child is properly sitting in his/her car seat and if the car seat itself is safe. The NHTSA (2020) website is a great resource for parents, caregivers, and grandparents to become instructed on how to pick a car seat and then install it, along with proper sitting directions for the child. Durbin and Hoffman (2018) echo the need for better education and instruction for the area of child passenger safety. They state pediatricians as a great resource for parents (p. 4). A pediatrician can be helpful to a parent with the proper installation and sitting arrangements of car seats. As a nurse, we too, can be helpful.
References
- Durbin, D. R., & Hoffman, B. D. (2018). Child Passenger Safety. Pediatrics, 142(5). doi: 10.1542/peds.2018-2461
- Hoffman, B. D., Gallardo, A. R., & Carlson, K. F. (2016). Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge. The Journal of Pediatrics, 171, 48–54. doi: 10.1016/j.jpeds.2015.11.047
- [email protected]. (2020, February 21). Car Seats and Booster Seats. Retrieved February 21, 2020, from https://www.nhtsa.gov/equipment/car-seats-and-booster-seats?view=full%C2%A0
- Will, K. E., Decina, L. E., Maple, E. L., & Perkins, A. M. (2015, February). Effectiveness of child passenger safety information for the safe transportation of children. (Traffic Safety Facts Research Note. Report No. DOT HS 812 121). Washington, DC: National Highway Traffic Safety Administration.
