Tuesday, August 9, 2011

Car Seats

Car seat safety is one of the most important things you can do for your child.  The most common killer of small children is car accidents.  Having your child in a correct seat, facing the correct direction, with everything else exactly right doesn't guarantee nothing horrible will happen, but it DOES drastically, enormously, raise the chance of a happy outcome.  Here are some of the basics to consider, and why.

The first thing you should do when you buy a seat is READ THE MANUAL.  It contains a wealth of useful and necessary information about the seat you are entrusting your child's life to. 

There's a lot of information, and a lot of points to remember.  You should see how long it's taken me to write this blog entry, and how many revisions I had to make because I forgot something.  Seriously.

If you think you have everything right as is, you should take your seat to a CPST (Child Passenger Safety Technician).  Fire houses and police stations won't really cut it, since they aren't required to know a single thing about car seats or car seat safety beyond "kids should be in one."  A CPST is the best choice by far if there's one in your area.  It should be noted that CPST can sometimes be found at police or fire stations - they are legit.  But Joe Fireman or Billy Policeman without those four letters behind their name are not a valid source of car seat information.
And for the love of Pete, unless your pediatrician is also a CPST, s/he is not a valid source of car seat information.

Need help choosing a seat? Check out my blog post on Car Seat Options for the Savvy Shopper


Correct Seat Installation.
1) the seat should be installed with the "this line level to the ground" line... well, level to the ground.   30-45 degree angle, depending on child's age (see below).  The following link will help you determine if your seat is at the proper recline: Check My Recline Angle!
2) You can use LATCH *or* the safety belt, but you aren't supposed to use both.  Neither is safer than the other - the safest option is the one that gets the best install, so use whichever one gets a better install with your seat and your vehicle.  You can't "borrow" latch anchors from the outbound seats in order to use LATCH in the middle in most cars, but some allow it.  Check your *vehicle* manual.
3) It doesn't matter so much where you position the seat (middle or outbound, back row or middle row), as long as it's in the back seat with a good install.  The middle is safest, but the outbound seats aren't unsafe.  Generally you want to put the "least safe" kid in the middle.  So booster (assuming it's a lap and shoulder belt) --> forward facing --> rear facing.
4) It's okay for the seat to tilt in one direction or the other, as long as it's less than 20 degrees.  More tilt than that and you need to make some adjustments.  The seat should only be able to move one inch along the belt path.
5) Top tether all forward facing seats.  That tether can reduce forward motion of the child's head by 8 or more inches, depending on the child and the crash.  Some models offer a tether for rear facing seats as well.  If your seat has a tether, use it. Tethers can't share anchors.
And the winner is? The tethered seat!


Other things you should know:
** Car seats expire.  No really they do. Besides the fact that newer and better (read: safer) seats are constantly being produced, car seat materials deteriorate over time.  Even though your seat may LOOK fine, there's no way to tell if there is structural damage on the inside of the shell.  Most seats expire after 6-10 years from the day they were made (NOT the day you bought them).  Check your manual or directly on your seat for your seat's manufacture date and when it expires.  Never use an expired seat, as it could be unsafe.  In the following video, the expired seat clearly fails in the crash.

** The harness material can't be soaked.  Wiped down sure, but not soaked.  You can't use harsh cleaning chemicals on it either.  The manual should have washing instructions, or you can call the manufacturer.
** In the unfortunate case of an accident, a car seat should be replaced, even if no child was in it during the crash.  There may be unseen damage to the seat from the forces of the crash, and it's just best to replace it.  Most insurance companies will cover the cost of a new, comparably priced, car seat.  Check with your manufacturer or car seat manual if you're unsure whether the seats need to be replaced.
**You shouldn't buy or use a used seat unless you know exactly where it came from.  If you know for sure that it's never been in an accident, that's it not expired, and that it's never been soaked, then you're probably okay.  But Craigslist, Thrift stores, and Free Cycle are never good places to get a car seat.  If you can't afford a car seat for your new baby, most areas offer a free or reduced cost seat option.  Look into that before hitting up strangers.
** Always Check Before You Leave.  You may notice in some of the below "misuse pictures" we are on the road.  It's important to check the chest clip, the seat install, the strap tightness, and everything else I mention before you leave the driveway or parking spot.  But it's also important to glance into the back seat and check periodically during the drive.  My own child has a tendency to move his chest slip around, and sometimes he reaches down and unbuckles the seat belt keeping his seat installed.  He can also undo the crotch buckle, then when he rebuckles it the straps are twisted.  In the cases below, I had to pull over and fix his straps or his chest clip, but I took a picture of it before doing so, for the sake of example.  If you notice your child has screwed something up while you're driving, pull over.  You'd pull over if you noticed your trunk was open, or that your tire was thumping.  Pull over if you notice your child isn't being safe.

Proper incline for newborns. 
A seat with a newborn should be at a 45 degree angle.  Because the child cannot effectively support his/her own head, a seat that's not properly reclined yields to the risk of suffocation if the baby's chin falls to her chest, closing the airway.  To help a convertible seat (or an infant seat without the base) recline to the proper angle, you can use one pool noodle cut into three pieces and taped into a pyramid shape.

Rear face as long as possible.  The AAP now recommends that children remain rear facing in a seat until at least the age of 2, but preferably until the child outgrows the rear facing limit of the seat.  The law is never enough, safety wise.  Before the age of two, the skull and spinal column are not completely fused together.  Think of the uncomfortable head/neck positions we see our babies sleeping in and say "how can that possibly be comfortable?!" It's because their bodies are not completely put together like ours are.  What we call "whiplash" is what happens to a small toddler when they are forward facing.  The difference is that, without the proper amount of development, the tissue connecting the head and neck severs more easily.  "Whiplash" to an adult is "internal decapitation" to a small child, and it is often fatal.  Children in rear facing seats are 5 times safer than forward facing.  There are affordable seats on the market that rear face to 40 pounds.  An older rear facing child learns to sit in a comfortable position, and there have never been reports of a broken leg because they touch the back of the seat.  But, even if breaking a leg was a concern, the alternative is breaking a neck.  Which would you choose?

Harness as long as possible.  A child should be harnessed as long as possible, but at least to the age of 5 or 6.  Most states allow booster seats at 4 or even younger, but the average child is not emotionally ready for a booster seat at that age.  They need to be able to still still, not fall asleep, not lean forward, not lean to the side... if they are out of alignment when an accident occurs, they could easily be injured.  There are seats on the market that harness to 65 pounds, which should accommodate the average six year old.  There is no evidence that a harness is safer than a properly fitting adult safety belt.  The problem is that most safety belts do not fit children under four properly at all.  For more information about correct booster positioning, see this blog post.


Strap tightness.  The straps on the seat should pass the pinch test: if you try to pinch the material of the strap horizontally between your thumb and index finger, it should be tight enough that your fingers slide off, rather than actually being able to pinch it.  If your child's straps look like Heidi's (pictured to the right), they are way too loose.

The danger of loose straps should be obvious - at best your child becomes a projectile within their own seat.  Instead of the straps pinning them against the back of a seat, your forward facing kiddo will fly forward into the straps at the same force as the collision.  Your rear facing kiddo can "ramp up" the back of the seat and hit their head on the top of the shell, or on something else that may be flying by at the time.  Also consider a roll over.  Think about hanging your child upside down in their car seat, and decide them if you should tighten the straps.  Remember the chest clip isn't designed to stay clipped together - it's merely a strap positioner.






Along with strap tightness goes strap position.  The straps of a rear facing seat should be below or in line with the shoulders, and the straps of a forward facing seat should be above or in line with the shoulders.  Straps that are too low could cause spinal compression during an accident, and straps that are too high may not hold your child in securely, and could allow for excessive "ramping up."

Straps shouldn't be twisted, as this can reduce their functionality, creating weak points, and make them feel tighter than they really are.  If a strap or two is twisted, your baby may not be as safe as you think.

In the picture of Luke (above left), the right side strap is twisted and his chest clip is too high.  And notice that, even though he is nearly four, he is still in a harnessed seat.  Since he still moves his chest clip around, and even takes it off, he's simply not ready for a booster, as most kids his age aren't.  Just wanted to mention that while I had the picture in sight. ;)

Chest clip.  This seems to be the most easily ignored factor for parents, but it's still important.  It's called a CHEST clip - not a neck clip, or a belly clip.  It goes between armpit and nipple level.  The chest clip is only designed to hold the straps in the correct position, and it can/will break apart or slide down in the case of a crash.  But before it breaks, it will cause a lot of force to the area directly behind it.  This is why you want the area behind the chest clip to be your child's sternum, rather than the soft belly encasing soft organs, or the slightly more delicate clavicle bones.  And since it's holding the straps in the correct place for them to best absorb the forces, you want the chest clip in the proper place so that the straps, in turn, are in the proper place.  Consider the following pictures:
Right
Wrong

Correct Seat size.  This may seem obvious, but you need to make sure your child has not out grown his/her seat by weight or height.  Weight limits are clearly given in your manual and typically right on the seat.  Current weight limits on the market are as follows:
Infant seats will rear face to 22, 30, or 35.
Convertibles rear face to 35 or 40 and harness to limits between 40 and 80.
Combination seats (harness to booster) harness to limits between 40 and 85.  Make sure you have a seat appropriate for your child's weight.

http://www.car-seat.org/showthread.php?t=30201
To determine if your child has outgrown his/her rear facing seat, you need to look from the side, not the front, top, or back.  Draw a line perpendicular to the shell/back of the car seat over the top of the child's head (#1). Then draw a second line out from the top of the shell/back, parallel to the first line (#2).  Now measure the distance between the two lines. When there is *less than one inch*, the rear facing restraint is outgrown by height.




After market products.  Don't use them.  This includes head rests/supports, the fuzzy things you put on the straps, seat protectors for your car; the BundleMe, and anything that didn't come with your seat.  Using these products could interfere with the function of your seat, not to mention void your warranty.  You'll notice that NONE of the products on the left are even made by car seat manufacturers.  These products have not been crash tested, and have not been proven safe.  It's better to just not use them.  If you feel like the straps are digging into your child's neck, you can cut the toes off of an infant sock and slide it onto the harness to protect the neck.  But bulky puppy dogs that push the chest clip down to the belly are a no go for many reasons already stated.  Before you buy, check to make sure it's a safe product.



Secure your projectiles.  If your car has a trunk, you should probably just store everything in there.  But since SUVs and Minivans are more and more popular these days, it can be difficult for many people to secure potential projectiles.  Anything that is harder than a stuffed animal or blanket should be secured.  Toys given to children to play with should be soft and squishy.  Avoid giving sippy cups and bottles when the car is in motion.  The risk of projectiles seems obvious: velocity x mass = force.  A five pound purse moving at 30mph can be fatal, and even a small sippy cup can cause serious and traumatic injuries. Imagine that five pound purse hits your child.  Imagine that it hits your child in the face.  Secure your purse, gallons of milk, first aid kit, water bottle, etc.  Yeah, it's a pain in the butt, but it's important.  It is also important to secure your animals.  If you can't crate them in the car then you can shop around for some animal friendly harness systems (they sell them at PETsMART).  Not only is it safest for your pet to not become a projectile, but it's safer for everyone in the car.
Wrong.  This adorable puppy can become a projectile.


Now that you're full of all kinds of information, here's a quick summation of some of the main points:
Photo courtesy of Madeline410 at Justmommies.com
Photo courtesy of Madeline410 at Justmommies.com

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