“We're seeing a large amount of counterfeit or non-compliant car seats come on the market, and they are a real safety hazard because they don't meet the testing standards,” said Sharon Evans, trauma injury prevention manager at Cook Children's Health Care System.

Evans says the health care system has seen more than 15 counterfeit car seats since 2021.

The Hidden Cost of "Cheap" Seats

Experts from Cook Children's Health Care System, Viviana Esparza, program coordinator at the Center for Community Health, and Evans warn that while fake seats save money upfront, they fail when it matters most.

“The health and wellbeing of our children is of highest concern,” said Esparza. “The cost of a car seat doesn’t compare to the safety of a child.”

While counterfeit seats appear to be bargains, the price difference is often deceptive. Evans and Esparza recently encountered a knockoff Doona car seat at a safety event that cost $300, compared to the $650 retail price for a legitimate model.

“Often, parents are buying these from third-party sellers on TikTok Shop and Amazon,” Evans explained.

Red Flags: How to Identify a Fake

When shopping for car seats, Evans advises parents and caregivers to watch for counterfeits of popular brands. These knockoffs are often cheaper than their legitimate counterparts anddo not meet regulations to protect a child in the event of a car crash. 

Look for these warning signs:

• Materials: The plastic shell may feel thin, flexible, or even hollow.

• Harnesses: The chest clip may be missing, or the harness straps may not conform to U.S. width standards.

• Missing Documentation: Instructions may be missing or provided only in foreign languages.

• Lack of Labeling: Legitimate seats must have side labels with installation guides, weight limits, and manufacture dates. Fakes often have no labels or labels with poor grammar and typos.

Three Steps to Ensure Your Seat is Safe

• Buy Direct: Buy directly from the manufacturer or a reputable retail store.
• Call the seat manufacturer: They can help you determine if it’s a knockoff and will sometimes ask you to submit photos.
• Certified Child Passenger Safety Technician (CPST): Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake. 

Where to Get Help

Evans recommends parents and caregivers with a new car or booster seat, schedule a free inspection with a CPST.

• Visit freecarseatcheck.org and click “Book your appointment”
• Find a child passenger safety technician at safekids.org
• Find an inspection station through The National Highway Traffic Safety Administration

If you discover the seat is a fake, stop using it immediately. Report the seller to the retailer and file a report at StopFakes.gov or with NHTSA.

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• Expert Tips for a Safe Spring Break: Car Safety
• Going Beyond the Bedside to Keep Kids Safe on the Road

Keeping Warm and Having Fun

“If you are going to be outside, dress appropriately,” said Sharon Evans, injury prevention manager at Cook Children’s Health Care System.

Experts advise caregivers to dress little ones in several thin layers to keep warm and dry. Children are at more risk from the cold because their bodies lose heat more quickly. Insulated boots, mittens or gloves, and a hat are recommended.

Make sure children change out of any wet clothes as soon as they come indoors.

“While playing in the snow or “sledding” be aware of your surroundings, be careful to not run into trees or out into the street and mailboxes can be real dangers,” said Evans.

Know the Signs of Hypothermia 

According to the American Academy of Pediatrics, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin
• Shivering
• A cool chest and stomach are signs that children may be dangerously cold.
• If you see these symptoms, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body.
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin
• Very low energy 

 Warning signs for adults include: 

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech, drowsiness 

Coats & Car Seats

While keeping kids warm is a priority during the winter, it should never come at the expense of car seat safety.

“Stay home and inside if possible. If you must be on the roads make sure everyone is buckled up correctly,” said Evans.

Bulky coats, such as puffy jackets, can create extra space between the child and harness straps or seat belt, which can increase the risk of injury in a car crash.  It is recommended to dress in thin layers and use a blanket or put the coat on backwards after the child is buckled in. 

If caregivers decide to start the car to allow it to warm up prior to entering the vehicle, it is important to make sure the car is in a ventilated area, such as an open garage, and that they lock the vehicle when they are not inside.  This will make sure that a child does not enter the vehicle unsupervised and become trapped in the vehicle.

Evans adds families should have snacks, water, and extra blankets in their car in case you get stranded. 

“If you are stranded and waiting for help on the side of the road, please make sure everyone stays buckled up,” said Evans, “often cars may slide/spin near you and hit your car.”

In addition, just as local officials advise people to stay off the roadways, if possible, ice can make dangerous driving conditions for ATV’s, Golf Carts and Go Karts.

 Safe Sleep

With winter weather, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

“Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

St. John suggests a general rule to follow dress a baby in one more layer of clothing than an adult would find comfortable in the same environment.  In winter months this could mean baby is in a long sleep fleece onesie with a wearable blanket/sleep sack. When dressing baby for bedtime or nap time during the extremely cold temperatures, it may be necessary to add socks, mittens, or hats to baby. Caregivers want to make sure that these items cannot come off during sleep and become a loose item in the crib.  It is also important to make sure baby is not going to overheat.  Signs of overheating can include sweating, a hot chest, or flushed skin.  

 Remember the ABCs of Zzzs:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

Related Stories:

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• What To Know During The Winter Weather This Week
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids

Holidays often mean more car trips as families drive to visit relatives. Sharon Evans, trauma injury prevention manager for Cook Children’s Health Care System, explains that during the holidays, there is an increase in motor vehicle collisions and related injuries.

Texas law requires children under the age of 8 and those under 4 feet 9 inches to be in a child safety seat. Failure to properly restrain a child can result in a ticket of up to $250.  Despite these laws, NHTSA data shows that 46% of car seats are installed incorrectly.

“There are more kids in the car than there are seatbelts and/or car seats, or the car is loaded with gifts and food,” said Evans. “So parents don’t make the child sit in their car seat, booster seat or wear their seat belt.”

Unfortunately, that leaves children unprotected in a crash and often results in severe injuries or death. 

“Don’t skip on safety over this holiday season,” said Evans, “make sure you and your children are buckled up correctly on every ride, no exceptions.”

A Child Passenger Safety Technician (CPST) can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

The Injury Prevention Collaborative offers free car seat checks with a CPST. Additionally, assistance is available to families who may need a car seat. To schedule an appointment, please call 682-885-2634 or click the link. You must have your child with you, unless you are an expectant parent.

Know the Four Stages of Car Seats

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. Experts highly recommend keeping your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height, then move into a booster seat.

3. Booster

Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. 

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Although the law states that children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches in height and should therefore remain in a booster seat until closer to 10 or 12 years old.

Firearm Safety

According to the 2024 Community Health Needs Assessment of households with guns in our eight-county service area, approximately 1 in 5 children live in a home with guns that are not always safely locked away.

Between 2022 and 2024, Cook Children's Health Care System in Fort Worth treated 179 individuals for firearm-related injuries. 10 were fatal and 169 were non-fatal. The majority of fatalities were from handguns and 136 were unintentional firearm injuries.  

The Aim For Safety program focuses on educating about firearm safety to decrease the number of youth injured or killed by a firearm.

The program shares these safety tips:

• Safe Storage
  • Store firearms unloaded and in locked locations, out of reach of children.
  • Use cable locks and gun boxes.
  • Secure ammunition separately.
• If You See a Gun
  • Stop.
  • Don't touch.
  • Run away.
  • Tell a grown-up.
• Safe Play
  • Ask the parents of your child's friends if they have guns in their homes and how they are being stored.
  • If you are asked about your guns, don't be offended.
  • Never aim BB guns or pellet guns at another person.

Poison Prevention

More than 800 children are treated at Cook Children's Health Care System every year due to accidental poisoning, and 65% of those poisonings are medication-related. According to the 2024 Community Health Needs Assessment, 1 in 2 children live in homes where medications are not always locked up and 4 in 7 children live in homes where cleaning products are not always stored in a locked area.

Tips for Poison Prevention

• Safe Medication Dosing
  • Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
  • Double dosing is NOT twice as effective, and in many instances can cause internal damage.
  • Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
  • Print the medication schedule to keep the right dosage for your family.
• Safe Storage
  • Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
  • Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
  • Remember, when visiting friends and family, it is ok to have an open discussion about safe storage.
• Safe Disposal
  • Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
  • The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
  • Removing any unused or expired medication in the home can reduce the risk of access.

Safe Sleep

Each year in the United States, 3,500 babies die unexpectedly during sleep, according to the Centers for Disease Control and Prevention (CDC).  In Tarrant County, between 2018 and 2022, there were 124 deaths due to Sudden Unexpected Infant Death (SUID).

Sudden Unexpected Infant Death (SUID) can happen in any sleep environment, but it is less likely to happen if the baby is in their own crib, bassinet, or portable crib," explained Samantha St. John, safe sleep program coordinator at Cook Children's Center for Community Health.

Caregivers should remember the ABC's of Safe Sleep:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

The holiday season is full of fun and festivities but with all the excitement, accidents can happen. By taking a few simple safety steps, families can reduce the risk of injuries and focus on what matters most: enjoying time together.

Food Safety & Allergies

The holidays often revolve around food and family gatherings but for children with food allergies, celebrations can be stressful. A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting.

Tips for parents:

• Communicate clearly with teachers, nurses, family members, and friends about your child’s allergies before the event.
• Bring safe dishes your child can enjoy.
• Always have epinephrine auto-injectors on hand. It is the first-line treatment for anaphylaxis, which works to reverse the life-threatening symptoms.
• Practice at home so your child knows what to do if a reaction occurs.

With a little bit of preparation and awareness, families can enjoy a safe, joyful, and worry-free holiday season.

Car Safety

During this busy travel season, make sure everyone is buckled up correctly. According to the National Highway Traffic Safety Administration (NHTSA), motor vehicle crashes are the leading cause of death for children. NHTSA estimates car seats and proper installation of them have saved more than 11,600 children under the age of five since 1975. 

Best Car Seat for Your Child

• Rear-facing: For infants through preschoolers. Supports the head, neck, and spine until your child reaches the seat’s height or weight limit.
• Forward-facing: For preschoolers through school-age kids. Please keep them in a 5-point harness until they outgrow it.
• Booster seat: For kids who’ve outgrown a harness but aren’t ready for a seat belt. Ensures proper belt fit.
• Seat belt: The final stage is when your child is at least 4 feet 9 inches or 57 inches tall and the belt fits snugly across the hips and shoulder.

Free Car Seat Checks

Texas law requires children to ride in a safety seat until age 8 or 57 inches tall.
The Injury Prevention Collaborative offers free car seat checks by a certified Child Passenger Safety Technician (CPST). A CPST can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

Call 682-885-2634 or click this link https://freecarseatcheck.as.me/schedule/d3206e82.

Those without appointments will be seen on a first-come/first-served basis. You must have your child with you, unless you are an expectant parent.

Halloween is a fun time where kids and caregivers can let their imagination take hold. Children and adults alike dress up as various characters. A mix of spooky and fun costumes will adorn the streets of North Texas this year, and Cook Children’s Health Care System wants to make sure families are not spooked by any preventable mishaps.

Sharon Evans, trauma injury prevention manager and Laura Romano D.O., hospitalist at Cook Children's, share their expert tips to stop the scariest spooks of the night: preventable injuries.

Pedestrian safety:

Research shows children do not have the cognitive ability to safely cross the street, unsupervised, until they are ten years old.

Evans shares that most pedestrian injuries occur between 3 p.m. and 7 p.m., especially as Daylight Saving Time ends. Pedestrians who are distracted (on the phone, listening to music, etc.) are four times more likely to be injured or killed.

Evans emphasizes that parents are role models and can set a good example by putting down the phone when walking.

“Follow the same rules you want your child to,” said Evans.

• Look left, right, and left again before crossing the street. Then remind them to continue looking until safely across the street.
• Watch for cars backing out or pulling into driveways.
• Put phones, headphones and devices down when crossing the street. It is particularly important to reinforce this message with teenagers.

Dr. Romano adds these pedestrian safety tips for everyone:

•  Make sure your child stays on the sidewalk and crosses at crosswalks or at corners.
• Slow down: Remember to drive very slowly, particularly when coming home from work in the evening.

Trick-or-Treat: Staying Safe in Costume

Your child’s costume should prioritize visibility and mobility to prevent common trip-and-fall injuries.

•  If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening, as dark costumes can be hard to see.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight or wearing glow sticks to help them be visible.
• Make sure to purchase costumes that are labeled “flame-retardant”. For any DIYers, nylon and polyester are materials that are known to be flame-retardant.
• Use caution with wigs, masks, or other accessories that may cover your kids’ eyes, nose, and mouth, making it difficult to see or breathe.
• Prevent falls by avoiding ill-fitting shoes and costumes that may become tripping hazards.
• Only use make-up products that are “non-toxic”. Test a small area of their skin a few days before use.
• The use of colored contact lenses could lead to eye infections or injuries—stick to only prescription contact lenses!

Tips for Teens

• Sending a responsible adult is always a good idea.
  • Older kids who can go trick-or-treating by themselves should only visit houses they know and follow routes that parents preapprove.
• Trick-or-treat in large groups, not alone or with just one other friend.
• Arrange specific check-in times throughout the evening.
• If your teen is driving to a party, make sure they are driving slowly and know to watch out for little kids.

By Laura Romano, D.O., hospitalist at Cook Children's Medical Center- Fort Worth

 The season of the Great Pumpkin, falling leaves, and fun Halloween costumes has officially arrived! My kids are so excited to show off their Halloween costumes this year. If you see a Fairy Princess and Thomas the Tank Engine wandering around your neighborhood, make sure you say hi!

 As kids get ready for trick-or-treating, there are some important things parents can do to keep them as safe as possible! Here are some answers to some frequently asked questions about Trick or Treating!

 Prepare your little ones for Halloween

• Trick or treating can be fun, but slightly intimidating for little ones. Practice trick-or-treating with your kids. Have them come to your door and say “trick or treat!” and practice saying please and thank you!
• Practice handing out candy. Handing out candy is my daughter’s personal favorite. You MUST take candy from her before you are allowed to leave our yard. She will follow you.
• Talk about what they might see on Halloween and walk around the neighborhood beforehand.

For older kids

• Sending a responsible adult is always a good idea.
• Older kids who can go trick-or-treating by themselves should only visit houses they know and follow routes that are pre-approved by parents.
• They should avoid going by themselves or with just one other friend, and instead go in large groups.
• Arrange specific check-in times throughout the evening.
• If your teen is driving to a party, make sure they are driving slowly and know to watch out for little kids.

Trick or Treat: Give me something good to eat

• For little kids: Avoid candies or treats that are small and might be a choking hazard.
• Check the candy: Practice going through the candy haul with your kids before allowing them to eat any.
  • You want to look for candy that may have been tampered with or look-alike food items that might contain illicit substances like THC or CBD.
• Giving out candy: I always try to make sure we have a peanut-free option for kids! We keep a separate bowl with non-peanut candies like Skittles or Smarties.
• Allergies: Regardless of your child’s allergy status, inspect all candy before they eat any. You want to look out for food allergens like peanuts or candies that are made in nut-containing facilities.

Too much candy?

As a Reese’s lover, my answer is that there is never too much candy. However, as a mom, I try to remember that the combination of sugar, chocolate, and the excitement of Halloween can lead to an upset stomach. Try to limit the intake to just a few pieces on Halloween night.

Keep It Reel: Staying Safe in Costume

• If possible, avoid all black costumes, particularly if your kids are trick-or-treating later in the evening. Dark costumes can be hard to see in the evening.
• If your child is wearing a dark costume, make sure that your child is bringing a flashlight to help them be visible or wear glow sticks.

SUID can occur in infants younger than a year. It includes three causes of death: sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB) and unknown/undetermined reasons. 

“SUID can happen in any sleep environment but is less likely to happen if the baby is in their own crib, bassinet, or portable crib,” explains Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

St. John shares how families can prepare and keep their little one safe as they build their baby registry. The U.S. Consumer Product Safety Commission (CPSC) requires that products include clear labeling with information such as age recommendations, safety warnings, usage instructions, and manufacturer details to help ensure safe use and inform caregivers of potential hazards.  St. John adds that while some items may be marketed to help ease parenthood, they may not be safe.

Safe Sleep:

Weighted sleep sacks: Weighted sleep sacks are often advertised as providing extra comfort to a baby by imitating a parent’s hand resting on the infant’s chest.  However, according to the CPSC, the additional weight on the baby’s chest may hinder movement and breathing, which could increase the risk of SUID.

Alternative: Parents should use unweighted wearable blankets or sleep sacks to keep the baby warm and allow the baby to take full, deep breaths. 

Bumper pads: Crib bumper pads are a common piece of décor for the crib. Due to the significant risk associated with crib bumper pads, the Safe Baby Sleep Act bans the manufacture and sale of this product in the United States. Between 1990 and 2016, bumper pads were responsible for at least 107 infant deaths, according to the CPSC.  Even alternative products that claim to be breathable still pose a risk of suffocation and strangulation.

Lounger: A baby lounger is a portable, cushioned space for a baby, often called an infant lounger, a lounge pillow, or newborn lounger.  Though these products are made for the baby to use while awake and supervised, we often see infants sleeping in these loungers while in their crib, bassinet, or on the couch.  According to the American Academy of Pediatrics (AAP), infants are at risk of suffocation if they roll into the cushioned side of the lounger and their nose and mouth become blocked. 

When in use: Caregivers need to supervise while the baby is awake.  The lounger should be placed on the ground to avoid the risk of falling.  Manufacturer instructions and guidelines should be followed.   

Pillows: It is a common misconception that babies need a pillow in their beds for comfort.  Adding this soft product to their sleep space can increase the risk of suffocation and SIDS. 

Alternative: Save the pillows for when the child is over the age of one and it is developmentally safe.  This includes wedge pillows, regular pillows, anti-roll pillows and head shaping pillows.

Stuffed animals: Toys should never be placed in a baby’s sleep space, as they can increase the risk of suffocation.  Stuffed animals make great décor for the nursery but are not safe for the baby to snuggle with while sleeping until they are over the age of one.

Toys with button batteries: Infants learn by exploring and putting items in their mouths. If swallowed, toys with small button batteries can get stuck in the throat and be a choking hazard or can travel through the digestive tract, causing serious or life-threatening injuries within three hours.  Parents need to inspect toys to ensure the battery case is securely closed, there are no loose or broken parts, and the case is sturdy enough to withstand continued use without the batteries falling out.

Blankets: Blankets are a popular registry item because they are cozy, cute, and useful during cuddle time and for tummy time on the floor.  However, blankets can cover the baby’s face and increase the risk of suffocation while sleeping. 

Alternative: To keep the baby safe and warm, use a wearable blanket or sleep sack.

Swings/rockers/bouncers: Baby swings, rockers, and bouncers are great products on a registry because they can help soothe the baby and allow the baby to enjoy independent time in a different position or location.  For sleep, these products are not a safe place for infants because the incline of the product makes it easier for the baby’s head to fall forward, which can block their airway and increase the risk of suffocation. 

When in use: Swings, rockers, and bouncers are great for supervised awake time, but not for naps or overnight sleep. 

Safety over comfort

In 2024, the CPSC report on Injuries and Deaths Associated with Nursery Products among Children Younger than Age 5, stated more than 60,000 children visited the emergency department in 2023 due to injury related to a nursery product such as an infant carrier, bouncer, swing, or other items. St. John emphasizes that when caregivers are determining which products to purchase, safety should be top of mind.

When looking at items for vehicle safety with a baby, she suggests:

Mirrors/Cameras: Caregivers need to be mindful that these products can become detached in an accident and cause injury to anyone in the vehicle. Any loose and unstored items in the vehicle can become a projectile in a car crash. Mirrors and cameras are often added to registries because parents want to be able to see their baby while they are rear-facing in their car seat. 

Car Seat Accessories: Items such as car seat covers, head support inserts, and toys are not often approved products by car seat manufacturers because they can affect the safety of the child in the car seat. Parents should check their car seat owner’s manual before registering for these additional accessories.

Counterfeit car seats: Fake car seats may not have a manufacturer date, model number, warning label, or instruction manuals.  Caregivers can schedule an appointment to have their car seat checked by visiting www.freecarseatcheck.org.

Vehicle Seat protectors: Vehicle seat protectors are advertised as being able to help protect the fabric of the vehicle seat.  However, many child safety seat manufacturers do not allow the use of these seat protectors.  When registering for this product, parents need to be sure the car seat manufacturer approves the use of vehicle seat protectors.

Free car seat checks

Texas law requires kids to ride in a safety seat that fits by weight and height until age 8 or at least 57 inches tall.

The Injury Prevention Collaborative offers events where you can make an appointment with a certified technician. We offer FREE car seat checks and assistance to families who may need a car seat.

Click the link or call 682-885-2634 to book your appointment. Those without appointments will be seen on a first-come/first-serve basis. You MUST have your child with you, unless you are an expectant parent.

In 2023, 43% of children killed in car crashes were unrestrained, according to the National Highway Traffic Safety Administration (NHTSA). Texas law requires children under the age of 8 and those under 4 feet 9 inches to be in a child safety seat. Failure to properly restrain a child can result in a ticket of up to $250.  Despite these laws, NHTSA data shows that 46% of car seats are installed incorrectly.

 A Child Passenger Safety Technician (CPST) can help ensure a child is safely and correctly secured in their car seat. Cook Children’s Health Care System has 66 CPSTs across North Texas.  

CPSTs at Cook Children's work with patients and their families to ensure a safe discharge from the hospital. Nurses screen patients during admission to confirm they are in the correct car seat or booster. If a family needs a car seat, it is provided free of charge, and a CPST then educates them on its proper use and installation.

“We also provide special needs seats to patients who may have a spica cast and cannot sit up for their conventional car seat, or car beds for premature infants or those that need to lie flat at discharge,” said Sharon Evans, trauma injury prevention manager.

NHTSA data shows more than 300 children under the age of five have been saved due to their car seat.

Texas has only three special needs CPST instructors, and one of them is here at Cook Children's. The hospital also has 24 CPSTs with special needs training. These specialists assess children and families’ needs and order the correct special needs car seat for safe transport upon discharge.

In addition to those efforts, Cook Children’s Center for Community Health hosts events throughout the year. At these fitting stations, caregivers make an appointment to have their car seat checked, or if they need a car seat, it is provided free of charge. 

“The caregivers learn at these events how to correctly install and use their car seat to ensure the child’s safety,” explained Evans.

To become a nationally certified CPST, an individual must attend a four-day CPST course and pass both written exams and a hands-on skills assessment.

“These employees take on extra job responsibilities above and beyond their normal job description just to ensure the children are transported safely,” said Evans.

Know the Four Stages of Car Seats

Trauma Injury Prevention and the Center for Community Health share some tips on keeping your little one safe.

1. Rear-facing

Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. According to Evans, it is highly recommended by experts to keep your child in a rear-facing car seat for as long as possible, as it is the safest option available.

2. Forward-facing

Forward-facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height before moving to a booster seat.

3. Booster

Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. Evans said many kids between the ages of 4 and 8 get seriously injured due to being put in seat belts too soon.

4. Seat Belt

A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Though the law states children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches of height—and should therefore remain in a booster seat—until closer to 10 or 12.

Stay Vigilant for Counterfeits and Fakes

As you are shopping for car seats, keep in mind that many popular brands are being knocked off to create counterfeits. These knockoffs are often cheaper than their legitimate counterparts, but are significantly less likely to protect your child in the event of a car crash.

• Make sure you buy it directly from the manufacturer or a reputable retail store.
• Call the seat’s manufacturer. They can help you determine if it’s a knockoff and will sometimes ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake. 

Texas surpassed its number of hot car deaths from 2024 on July 14, according to the Texas Department of Health Services (DSHS). A sixth and seventh fatality was reported in August in North Texas.

The increase contributes to the more than 20 hot car deaths reported nationwide this year as of August 26. Vehicular heatstroke is the second-leading cause of vehicle-related deaths in children under 15, trailing only car crashes.

Experts from Cook Children's Health Care System, Viviana Esparza, program coordinator at the Center for Community Health, and Sharon Evans, trauma injury prevention manager, emphasize the preventable nature of these tragedies.

“It can happen to anyone but it is 100% preventable,” Esparza said.

She notes that 52% of hot car child deaths occur when a child is forgotten. According to kidsandcars.org, parents can suffer from exhaustion due to lack of sleep, stress, and changes in their normal routine. Any one of these can cause a parent or caregiver's memory to fail at a time when you least expect it.

“Parents need to realize this can happen to anyone,” Evans said. “They aren’t bad parents but they get distracted or there’s a change in their routine. Make it a habit to put something you need in the back seat with the child.”

Twenty-five percent of hot car child deaths are due to a child gaining access to an unlocked vehicle or a child getting the keys. Evans recommends teaching toddlers and preschool-aged children to honk the horn if they become trapped, enabling them to draw attention to the vehicle.

Esparza says the third most common is knowingly leaving a child in a vehicle for a quick errand. DSHS emphasizes that a cracked window does not protect a child or pet from heatstroke.

“A car heats up about 20 degrees in 10 minutes and the temperature just keeps growing after that, often reaching 130-140 degrees in 30 minutes to an hour,” Evans said.

Esparza encourages families to remember the acronym A.C.T. to prevent heatstroke:

• A: AVOID heatstroke and other heat-related injuries by never leaving your child alone in a car, not even for a minute. When the vehicle is at home, keep the doors locked and keys or key fobs out of a child's reach.
• C: CREATE reminders. Place an item you need, such as a bag, wallet, or cellphone, in the back of your car or next to your child. This is especially important if you're not following your normal routine. If your child is with a care provider, ensure vehicle-related procedures are in place, such as vehicle searches or locking vehicles when not in use. Use technology to your advantage and use apps or other communication methods to stay connected with your childcare provider.
• T: TAKE action. If you see a child alone in a car, call 9-1-1. Emergency personnel want you to call, and they are trained to respond swiftly to these situations. One call could save a life.

 People will see temperatures from 7 degrees to 17 degrees, with wind chills as low as minus 10 degrees. Families need to take precautions. 

Keep Warm 

Babies less than a year old should not sleep in a cold room because they lose body heat more easily than adults, according to the Centers for Disease Control and Prevention (CDC). Yet, it is important to keep infants warm safely. 

• Do not have any pillows or other soft bedding in the crib or bassinet.  
• For sleep, dress babies in footed pajamas, one-piece wearable blankets, or sleep sacks. 
• Make sure newborns are dressed appropriately. Dress them in layers and cover their heads, hand,s and feet. 
• For the most warmth, dress your little ones in wool instead of cotton.  
• Essential winter items include hats and gloves, as well as sweatshirts or T-shirts that can be layered under overcoats or jackets. 
• It is important to remember to take off winter coats and jackets when the child is in the car seat.  

Know the Signs of Hypothermia 

 According to the CDC, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin, shivering, and a cool chest and stomach are signs that children may be dangerously cold. If you see these signs, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body. 
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin 
• Very low energy 

 Warning signs for adults include: 

•  Shivering, exhaustion 
• Confusion, fumbling hands 
• Memory loss, slurred speech, drowsiness 

Winter Heating Safety  

Keeping warm in frigid temperatures is important, but do so safely. Make sure to have functioning carbon monoxide detectors and fire alarms installed in areas that will wake you up. If you are unable to keep safely warm in your own home, check local resources for warming shelter information. Seek medical attention if you suspect carbon monoxide poisoning. 

•  Use electric space heaters with automatic shut-off switches. 
• Keep heat sources, like space heaters, at least 3 feet away from drapes, furniture, bedding, or other flammable materials. Never cover your space heater. 
• Do not leave children unattended near a space heater. 
• Make sure that the cord of an electric space heater is not a tripping hazard, but do not run the cord under carpets or rugs. 
• Avoid using extension cords to plug in your space heater. 
• Use fireplaces, wood stoves, or other combustion heaters only if they are properly vented to the outside and do not leak gas from the flue or exhaust into the indoor air space. 
• Do not use anything, such as a barbecue grill or propane tank to heat your home. 
• Do not run a vehicle inside of a garage attached to your home. 
• Do not heat your home with a gas oven or stovetop. 
• Do not burn charcoal inside your home. 

 Signs of carbon monoxide poisoning can include: 

• Headache 
• Nausea 
• Dizziness 
• Vomiting 
• Upset Stomach 
• Chest Pain 
• Confusion 

Car safety in frigid temperatures

Proper car seat use is one of the most critical ways parents can keep their young children safe when driving during inclement weather conditions.  

 Here are a few safety tips to consider: 

• Do not strap your children into their car seats with their heavy coats on. In a crash, padding from a coat or thick layers will flatten out, leaving room under the car seat harness. This increases the risk of a child slipping through the straps and being thrown from the car seat. Instead, dress your child in thin layers. Once buckled up, slip the coat on backward with the sleeves on the child’s arms. This way, the coat acts as a blanket and does not affect the fit of the harness. 
• Give yourself extra time to get where you are going. Do not forget to account for traffic.  
• Pack an emergency bag for your car. It’s a good idea to have blankets, warm clothing, hats, and gloves available in case you become stuck in winter weather. You will also want to have nonperishable snacks packed away. 
• Avoid overpasses if possible. Plan alternate routes to your destination and avoid high-traffic areas when possible. 
• Give yourself enough space from the car in front of you to gradually brake. When weather conditions are poor, give yourself double the time it normally takes to come to a complete stop. 

In honor of Child Passenger Safety Week (Sept. 15-20), we asked Cook Children’s Trauma Injury Prevention Coordinator, Sharon Evans, for insights on how to keep your kids safe in the car.

Know the Four Stages of Car Seats

Knowing how to properly restrain your child in the car at every phase of their growth is crucial to their safety. 

1. Rear-facing
Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. According to Evans, it is highly recommended by experts to keep your child in a rear- facing car seat for as long as possible, as it is the safest option available. 

2. Forward-facing 
Forward facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height before moving to a booster seat. 

3. Booster
Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. Evans said many kids between the ages of 4 and 8 get seriously injured due to being put in seat belts too soon. 

4. Seat Belt
A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Though the law states children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches of height—and should therefore remain in a booster seat—until closer to 10 or 12. 

Important Reminders for Car Seat Safety 

These tips will help you do your due diligence for proper car seat and seatbelt usage before hitting the road.

• When selecting a car seat for your child, ensure it fits in your vehicle properly before purchasing it.
• Thoroughly read and closely follow all manufacturer instructions for your car seat to ensure it is installed correctly.
• Infant car seats should always be rear-facing, and never used forward-facing.
• Make sure the harness is tight enough using the pinch test—if you can pinch the harness between your thumb and forefinger, it is too loose.
• Always lock the vehicle's seatbelt.
• Regularly check the maximum height and weight limits of your car seat to ensure your children are transitioned to the next one in a timely manner.
• For older children who are using booster seats or seat belts, ensure the belt is across the pelvic area and the shoulder belt strap is placed across the shoulder. It should never be placed along a child’s neck or abdomen, under the arm, or behind the back, as it could cause severe injury in a crash.
• Always make sure you are wearing your own seatbelt to set an example for your kids.

Stay Vigilant for Counterfeits and Fakes

As you’re shopping for car seats, keep in mind that many popular brands are being knocked off to create counterfeits. These knockoffs are often cheaper than their legitimate counterparts but are significantly less likely to protect your child in the event of a car crash. Below are some red flags to watch out for when shopping, as well as ways to check the authenticity of your seat. 

Red Flags: 

• A great deal on a car seat. If it’s “too good to be true,” it probably is.
• Do not purchase from someone on social media or from a yard sale.
• Do not purchase from e-commerce sites, which allow for third-party sellers and can lead to a counterfeit car seat.
• A safety warning label with symbols and pictograms, but no detailed written information
  
  

Check for Authenticity

• If you haven’t yet purchased your car seat, make sure you buy it directly from the manufacturer or a reputable retail store.
• Call the seat’s manufacturer. They can help you determine if it’s a knockoff and will sometimes ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake. 

Evans strongly recommends anyone with a new car or booster seat does a car seat check with a child passenger safety technician. These professionals, many of whom are also nurses and physical therapists, educate caregivers/patients/families on car seat safety and know what is required for car seats to meet the Federal Motor Vehicle Safety Standard 213. Here are a few ways to schedule a free car seat check:

• Visit freecarseatcheck.org and click “Book your appointment” 
• Find a child passenger safety technician at safekids.org
• Find an inspection station through The National Highway Traffic Safety Administration

For additional information about car seat safety, visit the Texas Department of State Health Services.

The National Weather Service previously warned of widespread freezing rain and sleet across North and Central Texas, which left roadways wet and slick.

Going into the weekend and early next week, temperature highs will range in the teens up into the 30s, and some areas are expected to see 2-7 inches of snow. If you don’t have a reason to leave home, please stay inside, stay safe and stay warm. If you have to go out, have a plan in place and rid yourself of any distractions so you can focus on the road.

Proper car seat use is one of the most critical ways parents can keep their young children safe when driving during inclement weather conditions.

“The injuries we see from car wrecks are because parents are making the same mistakes over and over with car seats,” explains Sharon Evans, trauma injury prevention coordinator at Cook Children’s.

The American Academy of Pediatrics recommends parents keep their children rear-facing as long as they fit within the height and weight requirements printed on their car seats. Evans says another prevalent issue is the lack of transitioning children into booster seats.

“Children should be in a booster seat until they’re 4-foot-9. We often see parents letting them go into a seat belt too early,” Evans explained.

She reminds parents to keep children calm and quiet when traveling, whether that means playing their favorite music, letting them bring a safe toy, or talking with them before leaving home. “Children can read your emotions,” she said. “If you’re uptight, they will be able to sense it.”

Here are more tips for parents to consider before getting behind the wheel:

1. Leave enough time for your commute. Give yourself extra time to get your children to school and yourself to work, accounting for other drivers on the road.
2. Don’t strap your children into their car seats with their heavy coats on. In a crash, padding from a coat or thick layers will flatten out, leaving room under the car seat harness. This increases the risk of a child slipping through the straps and being thrown from the car seat. Instead, dress your child in thin layers. Once buckled up, slip the coat on backward with the sleeves on the child’s arms. This way, the coat acts as a blanket and doesn’t affect the fit of the harness.
3. Pack an emergency bag for your car. It’s a good idea to have blankets, warm clothing, hats, and gloves available in case you become stuck in winter weather. You’ll also want to have nonperishable snacks packed away.
4. Avoid overpasses if possible. Plan out alternate routes to your destination and avoid high traffic areas when possible.
5. Give yourself enough space from the car in front of you to gradually brake. When weather conditions are poor, give yourself double the time it normally takes to come to a complete stop.

With so many people out on the road, it means more opportunity for danger.

From Dec. 20 to Dec. 31, 2018, the Trauma Department at Cook Children's reports 17 children were admitted at the Medical Center for injuries related to motor vehicle crashes and an additional 29 children were treated and released after a visit to the Cook Children's Emergency Department. One wreck during that time frame included a fatality and a total of three children died during the entire month of December.

“Unfortunately, we've seen children die around the holidays," said Debbie Wheeler, a Child Life specialist for the Emergency Department at Cook Children's. "With other traumas, we’ve seen young kids live by the grace of being properly restrained in the correct car seat. I really want to encourage parents to travel safely this holiday season, especially for everyone in the vehicle to be buckled up appropriately. It is really sad to see a patient hurt and have injuries that could possibly have been prevented if they were in a car seat, a proper car seat, or a seat belt.”

Motor vehicle injuries are the leading cause of death among children in the United States. Many of those deaths could have been avoided if parents took the extra time to make sure their children were properly restrained.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s extremely frustrating because she has seen wrecks where one child who was properly restrained lived and the other child not buckled died.

“Honestly, it’s just so infuriating,” Evans said. “These crashes are preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt."

Holiday Injuries Treated at Cook Children's (Dec. 20-31, 2018)

The Centers for Disease Control and Prevention (CDC) found that in one year more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time. Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention Specialist at Cook Children’s. “These are people who love their kids, and they want to hold their baby. A lot don’t want to hear their baby cry, and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high and can be a deadly mistake.”

Texas law states that “all children younger than 8 years old, unless taller than 4’9”, are required to be in the appropriate child safety seat system wherever they ride in a passenger vehicle. The safety seat MUST be installed according to the manufacturer’s instructions.”

That means that when a child reaches his or her eighth birthday – no matter their height, it is legal for the child to use only the adult safety belt in the passenger vehicle.

However, the Texas Department of Public Safety states on its website that best safety practice is: “if the child is not yet 4’9”, they are better protected if they continue to use the appropriate child safety seat system until they can fit properly in the adult safety belt.”

“From a safety standpoint, I encourage parents to follow the best safety practice guidelines,” Evans said. “Graduating to a seat belt too early does keep children in the car if they crash, but when the seat belt doesn’t fit properly, it can cause serious injuries. That is something else we are seeing right now at Cook Children’s – children in a halo brace for severe neck injuries because they were in seat belts too young and too early.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

Over the course of a week, there were three different auto pedestrian injuries, where a child was hit by a car and ended up in Cook Children’s Pediatric Intensive Care Unit.

Once the school year ends, Sharon Evans, Trauma Injury Prevention coordinator, calls this time of year “the 100 deadly days of summer” because kids are so much at risk. They are spending more time on their own or with friends and often times without adult supervision.

"Kids are out because they are playing with their friends, going to the ice cream truck or riding their bike. In other words, it’s just kids being kids. But that’s also when children are getting hurt," Evans said. “We are asking parents to make sure their child knows how to cross the street, mainly that they wait until the driver actually motions to them to cross the road. Just because you think the driver is looking at you doesn’t actually mean they ‘see’ you.' These days everyone is so busy or distracted, even while behind the wheel, you can’t take anything for granted."

Studies show children don’t have the cognitive ability to safely cross the street until they are 10 years old.

So even though they can ride a bike and do multiplication tables doesn’t mean they can safely cross the street, Evans said. While they may ride or walk on the sidewalks, you still have the danger of cars backing out and/or turning into driveways. During the summer, Evans said the medical staff at Cook Children’s sees an increase in backovers. 

“With our larger cars and SUVs, you often can’t see the child and that’s where the backovers happen as you are leaving,” she said. “Of course this disaster is even worse because the injury is usually caused by a parent or family member.”

Evans asks parents to be extra aware that kids are out during this time of year and to be on the lookout for them. She adds distracted driving plays into this too.

“Drivers need to be extra aware that kids are out and about,” Evans said. “It’s up to us, as the adults, to be on the lookout for them. Of course, distracted driving plays into this too. We also need to make sure we are all driving the speed limit or below the limit in neighborhoods, around parks or just anywhere kids may be outside and playing. Really it’s up to all of us to be careful and watch out for kids."