The Medical Minute: Protecting our most precious cargo

February 11, 2004

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

According to the National Highway Transportation Safety Administration, more than half the children killed in car accidents are not in appropriate restraints -- seat belts or car seats. About one in five were improperly restrained and one third were riding in the front seat. Children do not make the decision to put their lives at risk -- parents do. Three-quarters of children who ride unrestrained are with an unrestrained driver. This is National Child Passenger Safety Week -- a good time to reduce the chance that your child will be among the 622 children injured or the four children who die on our roadways each day.

The safest practice is to have all children ride in the back seat until age 13 to avoid injury from the front seat air bag, which was designed to protect an adult-sized body. Starting at about age 8 or when your child is 4 feet 9 inches, he or she may be ready to use an adult lap-shoulder belt combination. You can tell your child is big enough if he or she can sit back against the seat with knees comfortably bent at the seat's edge and, while in that position, the lap belt stays over the thighs and the shoulder belt crosses the shoulder between the neck and arm. If so, he or she may stop using the booster seat. Of course, the child must be able to stay there the entire trip. Always use a shoulder strap -- without it, the child's forward momentum during a crash can damage internal organs.

Booster seats are recommended for children who weigh from 40 to 80 pounds. Backless booster seats are for vehicles with high back seats and head rests. Use high-back booster seats for all other cars. There are some combination seats that can be converted from a child safety seat for when your child is below 40 pounds to a booster seat later. Be sure to read your instructions to make sure the seat is properly installed and secured. Improper installation can prevent the seat of providing proper protection for your child. The booster seat is designed to put your child in a position to use the car's lap and shoulder restraints. If your car has lap only belts in the back, see your car dealer or an AAA office to discuss optional shoulder restraints available.

For a child between 20 and 40 pounds -- usually starting about a year old -- a forward- facing car seat is appropriate but only in the back seat of the car. These seats vary by manufacturer but can include a five point harness that secures the entire child in the seat, an overhead shield that secures much like a safety harness in an amusement park ride or a T-shield which is kind of a cross between the other two. Any of these is acceptable as long as the manufacturer's specifications are followed to assure proper function in an accident. There will likely be a Lower Anchors and Tethers for Children (LATCH) system to anchor the seat to the car. It must be used to keep the seat and child restrained in an accident. If your car seat is converts from a child infant carrier, be sure to follow directions exactly. If your car or van has a built-in child safety seat, read the manual to be certain you use it properly.

For your newborn up to about age 1 or 20 pounds, a rear-facing safety seat in the rear car seat is mandatory. Follow instructions for threading the seatbelt or LATCH system to secure the safety seat at the proper angle of about 45 degrees. In cold weather place blankets over your secured infant, not under the restraints or the straps may not hold the child. Never place an infant carrier in the front seat. Even in a minor accident, the air bag may deploy and can seriously injure or kill an infant in a car seat placed up front.

If you have a second-hand car seat, check it thoroughly for cracks, poor operation or missing parts. Do not use it if it was in an accident as it might have been weakened. Reject it if it does not have instructions -- you may not have it installed correctly without them.

Special needs children may have different requirements. Easter Seals, Inc. at (800) 221-6827 offers programs about car seats for special needs children in Pennsylvania, Georgia, Kentucky, Missouri, New Mexico, West Virginia and Texas. Premature infants may be smaller and have different positioning requirements. When a premature infant is discharged, his or her car carrier needs should be discussed with the hospital staff before traveling.

If all this has you confused or uncertain that you are doing everything correctly, don't despair, help is available. This week, the Pennsylvania State Police are sponsoring car seat check up events to see if your car seat is properly installed.

Visit for the schedule. If you miss it or are from another state, you can find a list of regular inspection stations by zip code at or by phone at (888) 327- 4236. At Penn State Hershey Medical Center, inspections can be arranged by calling (717) 531-SAFE (7233) for an appointment. You can find a certified Child Passenger Safety technician near you for questions about installation of a car seat at

Remember, too, that your child learns by example and needs you to be whole and healthy so be sure to use your seatbelt every time the car is in motion.

(Media Contacts)

Last Updated March 19, 2009