Car seats: Size and age matter
Just weeks from delivering her daughter Asia, now 5 months old, there was something other than labor, delivery or even looming motherhood that terrified Brandye Reed: the car seat.
How to get the contraption correctly fastened into her mini-SUV eluded not only Reed, but also her boyfriend, his parents and her parents. The family stood with instructions in hand, facing straps, hooks, buckles, bases and big warning labels bearing the words: “Incorrect installation could result in death or serious injury.”
“Nobody could figure out how to get the seat fastened to the car the right way. It was so overwhelming, it made me just want to say forget it,” Reed says.
Instead, she and her mother made the trek from Sylmar to Childrens Hospital Los Angeles where a technician helped them install the seat. Reed is far from alone in her desire to protect her child -- and her frustration in trying to do it properly.
A 2004 study, the most recent available, by the National Highway and Traffic Safety Administration found faulty installation and other gross misuse in more than 72% of child passenger seats for kids less than 80 pounds.
And a study published earlier this month in the journal Pediatrics found that it would be tough or impossible to find an appropriate child safety seat for more than 283,000 of U.S. children ages 1 to 6 because of the combination of their age and weight.
“The majority of the kids at risk are 3-year-olds who weigh more than 40 pounds,” says lead researcher Lara Trifiletti, an investigator in the Center for Injury Research and Policy at Columbus Children’s Research Institute in Columbus, Ohio. “There are a few car seats available that could accommodate most of these bigger toddlers, but in our study we found that they were the most expensive seats. They were priced in the $240 to $270 range. That’s out of reach for many of the families who need them.”
Safety-seat experts stress that the seat must be appropriate for the size and age of the child -- although it also must fit the car properly.
“Many of these parents leave their heavy children in seats in which they exceed the maximum weight,” says Trifiletti. “What we know about car seat testing is that the seats are not tested above the weight ranges.”
It’s anybody’s guess, she says, how well a seat would protect a child who is too heavy.
Although many parents of heavy toddlers move the children to “booster” seats earlier than their age would indicate, that may not be a safer option. A booster seat, as the name suggests, merely positions the child higher, so a regular seat belt hits in appropriate spots.
“Putting a 3-year-old in a booster seat isn’t developmentally appropriate,” says Dennis Durbin, a pediatric emergency room physician at Children’s Hospital of Philadelphia. “The types of harnesses on car seats are designed so young kids can’t get out at will. With a booster, they can easily get out.”
Children shouldn’t be moved to a booster until they are at least 4 years old, even if they meet the minimum weight requirements for such a seat, says Durbin, co-principal investigator of Partners for Child Passenger Safety, the largest study ever conducted on children in automobile crashes.
He acknowledges that the ultimate solution is to address the childhood obesity problem. “But right now we need to solve the car seat issue. These kids deserve to be protected adequately,” he says.
Manufacturers are taking note, Trifiletti says. Since the completion of her study, two new car seats for heavier children have been introduced at less than $150.
Adding to parental confusion over car seat use is the misconception -- and now mixed messages -- about the age when children should be placed in forward-facing car seats.
For years, the American Academy of Pediatrics, the National Highway and Traffic Safety Administration and child safety experts have said that children must remain in rear-facing car seats until they are 1 year old and at least 20 pounds.
“People still aren’t familiar with the fact that children need to be both 20 pounds and a year, though,” Durbin says. “We’ve found that fully one-third of children are turned forward-facing well before their first birthdays. When they’re 9, 10, 11 months, parents are turning these kids around.”
Now, new research indicates this message needs to be altered. Researchers in Sweden and in the U.S. have found that children should be placed in rear-facing car seats for longer than the first year. A study at the University of Virginia Automobile Safety Laboratory last year found that children 2 and younger who were placed in forward-facing seats were more than four times as likely to be injured in side crashes than children in rear-facing seats. The study was presented in October at an American Academy of Pediatrics meeting.
More than two years ago, the Swedish research alone prompted the American Academy of Pediatrics’ commission on injury, violence and poison prevention to add this wording to the safety seat guidelines: If a car safety seat is designed for children at higher weights in the rear-facing position, the child should remain rear facing until reaching the maximum weight -- as long as the top of the head is below the top of the seat back -- for optimal protection.
“This is a very complicated communication issue though,” says Dr. Gary Smith, commission chairman. “For the past five years we’ve worked to get the message about ‘one year and 20 pounds’ out. Now we’re just not sure we can change the message without leading to total confusion.”
But Dr. Jeffrey S. Upperman, associate trauma director at Childrens Hospital Los Angeles, says hospital admissions data suggest that even now a fair chunk of Angelenos aren’t using car seats.
“Basically what we’ve seen over the last three years is that almost 20% of our patients coming in the door involving crashes were not in a restraint at all,” Upperman says. “I’m curious about whether we’re culturally communicating these safety issues. Are we getting even the basic message across to everyone? I’m not so sure.”
Reed has gotten the message though. “It took about an hour watching a video and working to get the seat in and make sure I could install it myself. But it was worth it,” she says.
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Get help installing your safety seat
The National Highway Safety and Traffic Administration estimates that the lives of 451 children were saved because of child restraints in 2004 (the most recent statistics available). For help selecting and installing car seats, contact:
* The Car Seat Program at Childrens Hospital Los Angeles: Make an appointment with a safety seat technician to learn about transporting children safely, find out how to install your seat or simply to get your current seat checked. Call (323) 669-2487.
* The American Academy of Pediatrics: For what to look for in a car seat and tips on how to use it properly, go to www.aap.org/family/carseatguide.htm.
* Safety Seatbelt USA: This Altadena-based nonprofit is dedicated to child passenger safety and offers a guide to safety seats (with links to manufacturers for replacement parts and recall information), an exhaustive FAQ section on restraints and common issues, plus information on safe air travel and child passenger laws. Go to www.carseat.org.
* The Children’s Hospital of Philadelphia: A multimedia website addresses questions about appropriate restraints and correct installation. View a brief video, listen to installation instructions and browse quick tips (in English and Spanish) at www.chop.edu/carseat.
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-- Victoria Clayton
