Making sure your child has a safe ride

Injury is the number-one cause of death among children who are more than a year old, and injuries during car accidents top that fatal list. And what is the number-one reason that children are injured in a crash? Car seats -- or, more accurately, the improper use (or lack) thereof.

Duke Emergency Department nurse Theresa Cromling, RN, who is the Durham County coordinator for the Safe Kids program, says that in order for children to be protected as they ride, parents must be sure of three things:

• The car seat is the correct type for the size and age of the child
• The child is correctly harnessed into the seat
• The restraint must be correctly installed into the car

As with any tool, she says, car seats are designed to be used according to manufacturer’s instructions. “This is a time when being creative is not a good thing,” she says.

Cromling answers a few of the most common car-seat questions:

Where is the safest place to put my child in the car?

The safest position is the middle of the back seat, which gives additional protection in case of a side-impact collision. If the center position is not available, or if you have more than one child to transport, the outboard positions can be safely used as long as you follow the instructions that come with the car seat and the vehicle owners guide for proper installation.

Can I install the seat so that I can see my baby and be able to easily attend to her if she needs something?

Safety advocates don’t recommend that, because in order to drive safely, you shouldn’t be distracted by looking at your child. If your child needs attention, you should stop, care for her, and then get back on the road. You can talk or sing with your child while you’re driving, or you can encourage independent play by giving her books or small toys.

Mirrors installed so that you can see your baby when you drive cause you to DWD -- drive while distracted. Several research studies indicate that DWD can increase your chances of a crash by four times and that your reactions can be delayed as much as driving with a 0.08 blood alcohol level.

What is the best seat for my child?

There is no one seat or manufacturer that everyone agrees is the safest seat. Child restraints sold in the United States have all passed the same rigorous federal regulations to be available for sale. That means these seats have been tested to provide adequate protection for the child in most crashes, when these seats are used according to manufacture’s instructions.

Remember that price may not indicate a safer car seat, but rather more features. Parents should focus on finding a seat that fits their child and their vehicle, one that has features that are important to them for safe installation and proper fit of the child, and one that they will be able to install correctly each and every time they use it.

When can I turn my baby forward facing?

According to the recommendation of the American Academy of Pediatrics and other safety advocates, children should continue to ride rear facing until they outgrow the rear-facing weight limits of the convertible car seat or until two years of age.

Actually, the longer they ride rear facing, the safer they are. When children ride rear facing, all the crash forces are exerted on the back of the car seat. When a child riding forward facing is involved in a crash, all the crash forces are exerted on the child. Their back and shoulders are held against the back of the seat with the harnesses and their head is thrown forward. A child's head is heavy (almost 25 percent of their body weight), their neck muscles are weak, and the spinal column can stretch but the spinal cord does not. This stress placed on the spinal cord can cause irreparable damage leading to grave injuries. Your child is five times safer riding rear facing than forward facing.

Can I use my car seat outside of the car?

Car seats are designed to be used for travel. This is especially so for the rear-facing-only infant seats that allow you to pick up your baby from inside your vehicle and carry them without interrupting their nap. New research is indicating that infants, both those born premature and those born full term, can develop respiratory problems when left seated in their car seats for a prolonged time.

Infants can have increased abdominal pressure when they are seated with their hips at a 45 degree angle. This abdominal pressure can cause the diaphragm to not move effectively, leading to inadequate respiratory effort. Car seats should be used for travel only, not in place of a crib. Research recommends that travel should be limited to 90 minute intervals and babies and parents should be given a break from that seated position. Plan for breaks when traveling for extended periods of time.

Also remember -- when your infant is in their car seat, whether in the car, in the stroller, or at a restaurant, they must always be harnessed snugly. You never know when someone may bump the stroller or chair and cause the car seat to fall. When the infant is properly harnessed into the car seat, their injury may be minimized in the fall.

When can my child ride in a booster seat with the lap and shoulder seat belt?

Booster seats are designed for children who are developmentally old enough to understand the importance of staying "in position" at all times while they travel. This means keeping their back against the back of the seat, never bending forward or to the side to play or harass other occupants, never placing the shoulder strap under their arms or behind their backs, and never slouching down in the seat to place their feet on the seat in front of them.

This sounds like the day-to-day happenings of toddlers and preschoolers who are placed in boosters and lap and shoulder belts prematurely because they meet the 30 pound weight limit for the booster. Children who are out of position when a crash happens can sustain serious injuries -- injuries that may not have happened if they were still riding in car seats with five-point harnesses.

Manufacturers have been pushed to develop higher weight harnessed seats because research supports a safer ride when in a five-point harness. Many car seats now have harness weights to 50, 65, and 80 pounds. Give your child that extra few years of added safe travel -- keep them in a five-point harness until at least five years of age.