During National Child Passenger Safety Week, WVU Medicine Childrens is highlighting the importance of child passenger safety, and the tremendous benefit it has to our patients and their families.

According to the National Safety Council, it is estimated that that car seats reduce the risk of fatal injury by 71% for infants younger than 1 year old and 54% for toddlers (1 to 4 years old) in passenger cars. Although these numbers prove that the proper use of car seats is vital for children, there is an alarming rate of misuse, around 74%, according to the National Digital Child Seat Check Form.

As parents, caregivers, friends, and family, we must ensure we take the proper steps to make sure the youngest members of our families are safely and correctly restrained in the vehicle.

There are several considerations that should be made when determining if a child is in the right car seat. These include seat selection, direction, location, harnessing, and installation. By taking these steps, caregivers can be confident in their child’s seat and its ability to protect them on the road.

Selection: Choosing your child’s seat can be a daunting task. There are many to choose from, each one with unique features, claims, and price points. Rest assured, the right seat for your child is the one that aligns with their age, height, weight, and developmental level.

Infant Seats:

The smallest of seats begins with the infant seat. Infant seats typically begin at 4 lbs. and work well for small infants. These seats also come with a base that remains in the vehicle, while the seat itself can be removed and transported to and from the car. Many parents choose an infant seat for the convenience of not carrying a small infant back and forth.

Convertible Seats:

Convertible seats are seats that will both rear face and forward face. Some of them labeled as “all-in-one” or “grow-with-me” seats will even go into further modes, such as harnessed booster, high-back booster, and no- back booster. Convertibles usually start around 4-5 lbs. and max out around 100 lbs.

Yes, this means that if infants meet the height and weight requirements and can reach the lowest harness height, they, too, can use a convertible seat from birth! Many parents move to a convertible seat when the infant gets too heavy to carry around. However, the infant must switch once he or she maxes out the infant seat.

Combination Seats:

Combination seats are seats that forward face only, but still have a five-point harness. These often turn into high-back and no-back boosters as well once the child maxes out the harness. While children should max out the rear-facing benefits before turning to a forward-facing seat, a combination seat can be a great option if the convertible seat needs to be used by a sibling or is close to expiration.

Booster Seats:

Booster seats are the last stage of the car seat journey; however, they are just as important as the infant seat.

Booster seats raise a child to the correct height so that the vehicle’s seat belt fits the child properly. This is extremely important, because vehicles and seat belts are designed to fit adults, not children.

High-back boosters are usually the first step for older kiddos, so that they can learn how to place the seatbelt properly and still have extra support. No-back boosters provide the same support but are more reliant on the child to make sure they keep the seatbelt on correctly and in the proper position.

Direction:

Parents often ask when their children can face forward. While the answers some give will vary, the correct answer is when the child is at LEAST 2 years old and has maxed out the height or weight limit of their convertible seat. For many children, they can safely rear-face until they are 4-5 years old. Best practice is to make sure that your child maxes out every stage before moving onto the next one!

Location:

The best source of information about installation is located in the car seat manual. Often, it will provide recommendations for where the seat should be installed in the vehicle. However, any seating position in the backseat will work if proper installation can be achieved.

Harnessing:

Proper harnessing and/or seatbelt positioning can make a significant impact on the effectiveness of the car seat in an accident. By following the manual provided for the seat and best practice tips, you can ensure your child is harnessed correctly.

To Secure an Infant/Toddler (Rear- and Foward-Facing):

1. Place your child in the car seat with the child’s back flat against the car seat.
2. Place the harness straps over the child’s shoulders. The harness straps should lie flat, should not be twisted, and should be placed through the slots located at or below your child’s shoulders when rear-facing or at or above your child’s shoulders when forward-facing.
3. Buckle the harness and the chest clip and tighten until snug. The harness is snug enough when you cannot pinch any extra material at the shoulder.

Bulky clothing or blankets can prevent a snug harness fit. Always buckle the child in the seat first, and then place coats or blankets over the harness.

Never add padding under or behind the child unless it is recommended for use by the car seat manufacturer.

4. Place chest clip at armpit level. This holds the harness straps in place on the child’s chest and shoulders.

Booster Seat:

Center the booster seat on one of the car’s back seats and attach it as the manual instructs.

Guide the car’s shoulder belt and lap belt through the loops or hooks provided on the booster seat.

Tighten the lap belt low and flat against your child’s thighs.

Make sure the shoulder strap doesn’t touch your child’s neck but crosses the middle of their chest.

Installation:

Installing the seat or base of a car seat can be one of the most daunting tasks. However, there are many ways to ensure your child’s seat is installed correctly and ready to ride.

Seat Installation (Rear- or Forward-Facing) Latch or Seatbelt

Read your car seat’s instruction manual and your vehicle owner’s manual. Every seat and vehicle are different, which affects the way you will install your particular seat.

Place the car seat base or seat itself in the back seat of your vehicle.

Carefully thread the seat belt or anchors through the correct belt path. Check to make sure there are no twists in the seat belt or anchor belt.

Buckle the seat belt or connect the anchors to the corresponding locations.

If using the seatbelt, lock the seat belt.

Press down firmly on the center of the seat and tighten. The base should not move side-to-side or front-to-back more than 1 inch. Make sure your seat or base is installed at the correct recline angle; most car seats have built-in angle indicators or adjustors to assist you.

While this information may be overwhelming, we all have a common goal in mind: to keep our children as safe as possible. When you have questions about your child’s seat, turn to a car seat expert or a Child Passenger Safety Technician (CPST).

At WVU Medicine Children’s, we strive to ensure that all families have the proper tools they need to be successful. The Injury Prevention Program is staffed with three full-time Injury Prevention Specialists who are trained CPSTs.

If you have a question or concern about your child’s seat, please contact the Injury Prevention Program between 8:30 am and 4:30 pm Monday through Friday by phone at 304-554-8519 or by email at WVUMChildrensInjuryPrevention@WVUMedicine.org.

Child restraint use estimates: Boyle, L. (2023, March). The 2021 National Survey of the Use of Booster Seats (Report No. DOT HS 813 396). Washington, DC: National Highway Traffic Safety Administration.