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.

In his veto statement, Gov. Abbott called the bill “an unnecessary invasion of parental rights and an unfortunate example of over-criminalization.”

Texas law already requires children younger than 8 years old or shorter than 57 inches to be secured in a car seat and that the car seat be installed according to the manufacturer's instructions. The current law does not specifically mention car safety guidelines for children under 2 years old.

Following the veto, Chris Turner, D-Grand Prairie, who authored the bill said to The Dallas Morning News: “The governor’s veto sends the irresponsible message that it doesn’t matter if a child under age 2 is rear-facing. It does matter, because it is proven to save young lives.”

In much of the medical community, the talk among experts has shifted away from the age of the children to simply keeping them safely in a rear-facing car seat as long as possible. In 2018, the American Academy Of Pediatrics updated its recommendations on car seats for children. The AAP recommends children remain in a rear-facing car safety seat until they reach the highest weight or height allowed.

Benjamin Hoffman, M.D., FAA, the lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention, said newer car seats allow children to remain rear-facing until they weigh 40 pounds or more, meaning most kids can remain rear-facing past their second birthday.

“It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride,” Dr. Hoffman said. “Car seats are awesome at protecting children in a crash, and they are the reason deaths and injuries to children in motor vehicle crashes have decreased. But that also means we just don’t have a large enough set of data to determine with certainty at what age it is safest to turn children to be forward-facing. If you have a choice, keeping your child rear-facing as long as possible is the best way to keep safe.”

Nationally, car crashes remain a leading cause of death for children. The American Academy of Pediatrics states that over the last 10 years, 4 children under 14 died each day.

Last year at Cook Children’s, 37 kids, who were 2 years of age and under, were involved in motor vehicle crashes, including five deaths (the most in at least five years). According to Cook Children's Trauma team, there have been 205 children in that age range invovled in wrecks and 12 deaths since 2014.

Spinal cord injury is a major concern for children who have transitioned from rear-facing to forward-facing or booster seat too soon. Melodie Davis, director of the Pediatric ICU, Transitional Care Unit and Rehabilitation Care Unit at Cook Children’s, said a young child’s head is so heavy as a toddler that it whips and causes damage.

“Properly used car seats protect children from injury and death,” Davis said. “Infants and toddlers are at risk for head, neck, and spine injuries during car crashes because their heads are large and heavy compared to their bodies. When placed rear-facing, the car seat can better support these high-risk areas because the seat is able to absorb the force of the crash. Unfortunately, we see significant neck injuries with cord damage in incorrectly used car seats. Another common injury includes traumatic brain injuries because of the force of the crash. Following proper car seat use guidelines can significantly decrease injuries and death in children.”

Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent, according to the AAP. Parents are suggested to check the instruction manual and the labels on a car safety seat to find the manufacturer’s weight and height limits. When a child is approaching the limit, it’s time to think about transitioning to the next stage.

“We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies,” said Dr. Hoffman.