Our friends at Gugu Guru sat down with Dr. Benjamin Hoffman, a nationally recognized expert in child passenger safety, and a leader in the field of community health and advocacy training for pediatric residents, to answer some common questions parents have about car seat safety.
GG: What are the most common ways parents misuse the car seat, or don’t install the seat properly?
Dr. Hoffman: Misuse patterns vary by type of seat, but in general we see some very consistent patterns. That being said, not all misuse is the same. Some errors are much more dangerous than others, and we often think about critical errors, which experts feel will put a child at significantly greater risk for injury. I generally break errors into 3 categories: Selection errors, positioning errors, and installation errors.
Selection errors involve using the wrong seat for a child. This could be a seat that the child has outgrown in terms of weight and/or length, it could be a seat that is not able to be placed in the correct direction for the child, or is not correct for the age and developmental status of a child. We very frequently see infants who have exceeded the length maximum of a rear-facing only seat/infant carrier.
Positioning errors involve mistakes in fitting the child in the harness of the seat. Frequent errors include having the harness straps too loose, using the wrong harness slot, so that it is too high or too low relative to the child’s shoulders, having the chest clip too low, or not buckling the harness correctly. These mistakes can lead to increased injury risk for kids.
Installation errors describe mistakes in installing the seat in the vehicle. This can be done with either the vehicle seat belt or the LATCH lower anchors, depending on the seat and the vehicle. The most common errors include having the seat too loose in the car, having the seat installed with a seat belt that has not been locked, or using the incorrect lower anchors to install a car seat. These too can lead to an increased risk for injury in a crash. Sadly, the worst misuse is not using a car seat or booster at all- almost half of all kids killed in crashes are totally unrestrained.
GG: What should parents know about newborns and car seats?
Dr. Hoffman: Being a new parent is stressful and exhausting. There is a ton of stuff to learn and to think about, and this is in the context of a newborn baby who has constant needs, cries a lot, and wakes frequently. The birthing process is painful and exhausting, and at hospital discharge, there is a ton of teaching and paperwork that we ask parents to deal with. We know that car seats are hard to use in the best of circumstances, and this is often not the best of circumstances! We studied about 300 new families who delivered in our hospital, looking at how they used their car safety seats with their newborns. What we found was that almost all (95%) of them made mistakes, and that 91% of them made serious errors that would lead to significantly increased risk to the child. We found that families who had worked with a certified child passenger safety technician prior to delivery were 10 times less likely to make mistakes, so this is good advice for parents-to-be. However, 77% of those families still made serious errors, so it is not enough. Practicing with the car safety seat before the baby is born, learning how to install and use it correctly, and then working with a certified technician is the best that any family can do.
GG: There are SO many car seats on the market, how does a parent know what to look for?
Dr. Hoffman: The best advice is to choose the seat that fits the child, fits the vehicle and that the caregiver can use correctly each and every time. In general, for an infant, select a seat with a higher weight and length limit. In general, most car seats for infants have an upper weight limit of 30 or 35 pounds, and 30 or 32 inches. Most babies will outgrow these seats lengthwise long before they hit the weight limits, and this is usually around 12-15 months. All car seats sold in the US must meet stringent federal standards, so we know they are all safe enough. The differences then are features that may affect ease of use.
NHTSA, the National Highway Traffic Safety Administration, has a star-rating system for ease of use for car safety seats, and families can check that out before they buy a car safety seat. This rating does not address safety, just ease of use, based on a number of criteria. While this can be helpful, it does not mean that a particular seat will be right for a particular family. It is always a good idea to make sure that the car seat fits in the car, and most retailers are great about exchanging unused seats if it doesn’t fit well. Many parents rely on the stroller compatibility of car seats as well, and this is something that can factor into a decision.
GG: If most parents make serious mistakes using car seats, what can be done to make them easier to use?
Dr. Hoffman: Manufacturers have made huge strides over the last 10 years in terms of making car seats safer and easier to use correctly. However, if we had a test that was failed by 95% of the people who took it, we have to assume that the problem lies in the test, and not in the test-takers. SO it is with car seats. Disruptive innovation in car seat engineering and design will hopefully lead to products that will change this conversation, and enable parents to use them correctly each and every ride. Simplifying the process of positioning the child in the seat, and installing the seat in the car will mean fewer critical errors, and safer kids.
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Dr. Benjamin Hoffman is a nationally recognized expert in child passenger safety, and leader in the field of community health and advocacy training for pediatric residents. He practices and teaches Portland, OR, where he is very active in community advocacy.