Lisa Chan, M.D.
Imagine you are late for work. You still have to get the baby to daycare, the toddler to preschool, and the oldest to first grade. You realize the infant and booster seats need to be put into the car. The children often fight you when you place them into their infant seat, booster seat, and seatbelts. Yikes, there is just not enough time and all destinations are within a mile of home. You think, "I know people say to use car seats and seatbelts, but are they really necessary all the time? Do car restraints really make a difference? Is it worth the time and effort to put these unwilling children into their car seats and seatbelts? Maybe just this once I'll put all the kids in the back seat without their car seats and put the baby in the seven year old's lap. No big deal, right?"
WRONG!
Car accident is the leading cause of death in children ages 14 years and under. Studies have shown that proper use of infant seats, booster seats, and seatbelts prevents injuries and death. Educational programs have been developed by federal and local agencies with the goal to maximize use of these car safety devices.
Despite public efforts to encourag use of car safety devices, we continue in our emergency department to see children in car accidents who are not properly placed in infant seats, booster seats, or seatbelts. In fact, 24% of children who were in a car accident and who came to our emergency department were not in any car safety device. Emergency Physicians and Medical Examiners see the sad reality of not using infant seats, booster seats, and seatbelts properly. Severe injuries and deaths occur more often in these children than in children properly placed in child safety devices.
My colleagues at University Medical Center and I have studied the effects of not using car safety devices, and the results are heart breaking. Injuries and death were compared between children who were in car safety devices and children who were not. Compared to children who were appropriately placed in car seats and seatbelts, children not in appropriate car seats and seatbelts had to stay in the hospital an average of 20 times longer.
We found:
• Internal abdominal organ damage was 20 times more likely in children who were not in appropriate car seats and seatbelts.
• Internal chest organ damage was 13 times more likely in children who were not in appropriate car seats and seatbelts.
• Broken bones were eight times more likely in children who were not in appropriate car seats and seatbelts.
• Need to stay in the hospital was 15 times more likely in children who were not in appropriate car seats and seatbelts.
• Surgery was 13 times more likely in children who were not in appropriate car seats and seatbelts.
• Need for blood transfusion was 28 times more likely in children who were not in appropriate car seats and seatbelts.
• Bleeding in the brain only happened in children who were not in appropriate car seats and seatbelts. Children in proper car seats and seatbelts did not have this injury.
• Placement on a breathing machine was only needed in children who were not in appropriate car seats and seatbelts. Children in proper car seats and seatbelts did not need to be placed on a breathing machine.
• The only deaths occurred in children who were not in appropriate car seats and seatbelts. None of the children in proper car seats and seatbelts died.
Our study also revealed that children older than four years old are more likely to be improperly placed in car safety devices than younger children. Although virtually all four to eight year olds should be placed in booster seats, many parents mistakenly believe that it is safe to use only a seatbelt once their child reaches four years old.
The NHTSA recommends that all children age 12 years and under should ride in the back seat. Children who are big enough to use only a seatbelt should always use both the shoulder and lap portion of the belt. Using only a lap belt can cause severe internal abdominal organ damage and broken spine.
What you should know:
• Proper use of car safety devices keeps kids safe from serious injury.
• Proper use of car safety devices prevents needless childhood deaths.
• Use the right device for your child's size (see table).
• ALWAYS, ALWAYS, ALWAYS... place your child in the proper car safety device.
| Weight | Type of Car Seat | Seat Position |
|
Infants
(birth to 1 year) Under 20-22 lbs. |
infant-only or rear facing
infant-toddler (convertible) |
Rear-facing only |
|
Toddlers
(over 1 year) 20-40 lbs. |
Infant-toddler (convertible)
Harness straps should be at or above shoulder level |
Forward-facing |
|
Young children
(4-8 years) Over 40 lbs. unless under 4'9" |
Belt positioning booster seat. Lap belt should fit low and tight across the lap/upper thigh area and the shoulder belt should cross the chest and shoulder. | Forward-facing |
Dr. Lisa Chan is a board certified emergency physician. She is Associate Professor of Emergency Medicine at the University of Arizona. She has cared for pediatric trauma patients in Level one trauma centers for over 14 years.
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