In 2025, Cook Children’s Health Care System saw on average, 38% of children injured in a major vehicle accident were unrestrained or improperly restrained. 

“Many of these resulted in deaths or severe injuries,” said Sharon Evans, trauma injury prevention manager.

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 should be in a child safety seat. A child must be 8 years old or taller than 4’9” to use a seat belt. Failure to properly restrain a child can result in a ticket of up to $250. NHTSA data shows more than 300 children under the age of five have been saved due to their car seat.  

What to know before hitting the road:

According to the National Safety Council more than 54 million vehicles on the road have an open safety recall. Almost one million cars have an open child seat anchor safety recall. The LATCH (Lower Anchors and Tethers for Children) is the built‑in anchoring system required in most vehicles since 2003, designed to secure child seats without relying on seat belts. These anchors keep child seats firmly in place.

• Drive alert: Avoid tired, distracted or impaired driving.
• Check for recalls: Visit the website Vehicle Recall Check by VIN or License Plate | Check to Protect to see if your car has an active recall.
• Secure every passenger: Make sure every passenger is secured by the correct car seat or seat belt on every ride.
• Take breaks: If your children are fussy, don’t let them out of their car seat or seat belt while the car is moving. Instead, stop at a safe location where they can run around and burn off energy.  
• Pack safely: Pay attention to how and what you pack.  Remember everything becomes a flying projectile in a sudden stop or crash.
• Use cargo tools: If you have an SUV, use the cargo cover or net to secure your luggage.

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 five 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.

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It’s a big milestone for parents of young children to turn their car seats to face forward. Some may wonder, when is the appropriate time to do so? Is it when the child wants to look out the window? Is it when the parent wants to see the child? This milestone should be delayed for as long as possible because safety is the top priority. Keep your child rear-facing to help prevent severe injuries during a crash.

“Keep them rear-facing until they reach the maximum weight and height of the car seat,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “Rear-facing is the safest way they’ll ever travel.”

Car crashes are a leading cause of injury and death in children ages 1 to 13. Every year children are rushed to the emergency room to be treated for car-related injuries.  

Check your car seat’s manual -- the most important piece of information will be determining the maximum weight and height limit of their rear-facing car seat. Most car seats will go to 40 pounds rear-facing so your child could be 3 or 4 years old before you turn them around.

Keeping your child rear-facing also protects their spinal cord in the event of a car crash. When they’re rear-facing during a crash, the impact will cause the car seat to dip, protecting their spine and neck.

“You’re keeping their head, neck and spine all in alignment,” Evans said. “The majority of the crash forces are taken on the back of the car seat and less of the crash forces are not transferred to the child.”

Parents may worry that their child’s feet are touching the vehicle seat when the car seat is rear-facing.

“You would think that there is a chance that they would be more prone to having a broken leg, but what we found through research and the American Academy of Pediatrics says that there is no increased risk,” Evans said.

If a child is facing forward during a crash, that is a lot of force to put on a child’s spine and neck.

“If you have that sudden stop, the pressure and force put on their neck can cause severe spinal cord injuries,” Evans said. “During that stop, their head and their arms are all going to come forward and that force can cause broken arms and legs.”

Check the harness straps are at or just below their shoulders and the retainer clip always needs to be at the armpit level, Evans said. Make sure the straps are snug with the pinch test.

After outgrowing a rear-facing car seat, children will move to a forward-facing car seat until at least age 5 based on the weight and height limit for the car seat.

The next seat is a booster seat, which is used until the seat belt fits properly, usually around ages 9 to 12, according to the Centers for Disease Control & Prevention.

FREE CAR SEAT CHECKS

Parents and caregivers can bring their vehicle and car seat for a free car seat check with the Cook Children’s Center for Community Health at 682-885-2634 or go online to freecarseatcheck.org.

Certified technicians will inspect your car seat free of charge and show you how to correctly install and use it. Some locations now offer virtual inspections.Top of Form

The National Highway Traffic Safety Administration maintains a directory of many inspection stations.

Always refer to your specific car seat manufacturer’s instructions (check height and weight limits) and read the vehicle owner’s manual on how to install the car seat using the seat belt or lower anchors and a tether, if available.

More information & resources:

• Car Seat Safety (for Parents) - Cook Children's (kidshealth.org)
• Register your car seat and sign up for recall notices to receive safety updates
• Car Seat and Booster Seat overview from the NHTSA
• Car seat recommendations from the NHTSA
• Child Passenger Safety | Injury Center | Centers for Disease Control & Prevention
• Child Passenger Safety | Pediatrics | American Academy of Pediatrics (aap.org)