Child Safety Seat

Aka: Child Safety Seat, Child Car Restraint, Car Seat, Child Restraint System

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II. Background

  1. Car Seats first came into use in the U.S. in the 1930s, but were not nationally mandated until 1985

III. Epidemiology

  1. Use per National Traffic Safety Administration (NTSA)
    1. Children under age 5 are unrestrained in 51% of cases
    2. Safety seats are misused in 80% of cases
  2. Child Safety Seat efficacy in Motor Vehicle Accidents
    1. Car Seats reduce infant deaths by 71%
    2. Car Seats reduce toddler deaths by 54%
    3. Booster Seats serious injury risk in ages 4-8 years old by 45%
    4. Reduces hospitalization by 69%
    5. Durbin (2011) Pediatrics 127(4):e1050-66 [PubMed]
  3. Non-MVA related injuries occur when Car Seats are used for unintended purposes
    1. Of Car Seat related injuries, 88% occur outside a motor vehicle
    2. Trauma from falls from elevated surfaces (e.g. grocery carts, tables)
    3. Strap related Strangulation or positional asphyxia
    4. Desapriya (2007) Int J Inj Contr Saf Promot 14(3): 196-8 [PubMed]

IV. Precautions: Three quick rules of thumb

  1. Backwards is best (until age 2 years and 20 pounds)
  2. Weights to change Car Seat: 20-40-80
  3. Boost until big enough (80 pounds, 57 inches)

V. Types: Safety Seats

  1. Infant Car Seat
  2. Child Convertible Car Seat
  3. Booster Car Seat
  4. Built-In Car Seats
  5. Adult Safety Belt

VI. Precautions: Not-Acceptable Seats (Car Seats to Avoid)

  1. Infants Seats
    1. Century 590 (throw away the base)
    2. Evenflo On My Way 206 (only use with the base)
  2. Convertible Seat
    1. Kolcraft Traveler 700 (only use facing rearward)

VII. Precautions: General

  1. Never use rear-facing seats in front of an airbag
  2. Use only properly fitting seats and restraints
  3. Never use child seats in side-facing seats
  4. Attach Car Seat firmly to car
    1. Side-to-side motion should be no more than 1 inch
  5. Harnesses
    1. Should be snug and unable to pinch harness lengthwise
    2. Avoid bulky clothes under harness (too loose)
    3. Keep flat and without knots
    4. Do not iron or heat dry harnesses (weakens strap)
    5. Harness clip should be placed at level of axilla
    6. Harness straps should be in reinforced position only
      1. Except in rear-facing Car Seats
  6. Only use safe Car Seats
    1. Throw out any Car Seat that has been in a crash
    2. Avoid use of Car Seats that are older than 6 years
    3. Constantly check for product recalls
  7. Replace Car Seats after any MVA more than a minor accident
    1. Vehicle could not be driven away
    2. Vehicle door nearest the safety seat was damaged
    3. Injury among vehicle occupants
    4. Airbags deployed
    5. Visible damage to the Car Seat

VIII. Precautions: Adult Seat Belt use

  1. See Adult Safety Belt
  2. Booster Seats should be used from age 4-8 years old (until height >=57 inches)
    1. Premature use of the adult Shoulder-Lap belt risks neck extension and flexion injuries
    2. See Seat Belt Syndrome

IX. Resources

  1. NHTSA Auto Safety
    1. http://www.nhtsa.dot.gov/people/injury/childps/
    2. Phone: 1-888-DASH-2-DOT or 1-888-327-4236
  2. SafetyBeltSafe USA
    1. http://www.carseat.org
    2. English Phone: 800-745-SAFE or 800-745-7233
    3. Spanish Phone: 800-747-SANO or 800-747-7266
  3. History of Car Seats (Michelle Pratt)
    1. https://safeintheseat.com/the-history-of-car-seats/

X. Reference

  1. (Sept, 1995) Consumer Reports [PubMed]
  2. Biagioli (2002) Am Fam Physician 65(10):2085-90 [PubMed]
  3. Biagioli (2005) Am Fam Physician 72(3):473-8 [PubMed]

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