Download this handout as a .PDF

Most parents are now aware of the laws in each state mandating infant seats that are rear facing until the child is one year old and at least 20 pounds.  Most parents are also aware that their children are safest if they continue to use a car seat during the toddler years; this is also required in many states.  And since 2011, the AAP has recommended that children stay in rear-facing seats until they turn 2.

Delaware law mandates rear-facing seats for all car passengers under 12 months of age.  For older children, Delaware law requires children to ride in a proper car seat through 7 years of age or 65 lbs.  Children 8 years old (or 66 pounds) through 15 years old must ride with a seatbelt, even in the back seat.  The fine for violating the law is $25.00.  All children under 12 years old or 65 inches tall are still required to sit in the back seat if there are active airbags in the front passenger seating position.

However, the law specifies only minimal protection; in fact, pediatricians recommend stricter guidelines.  Some children are removed from car seats and booster seats at too young an age.  People say eagerly that a child is ready to "graduate" to a forward-facing seat.  But in fact, moving to a forward-facing seat is not an improvement - it's a step backwards in safety.

Here are some general recommendations for child auto restraints beyond infancy, from the National Safe Kids Coalition:

• All children under 2 should remain in rear-facing seats, until age 2.  If your child seems cramped, get a bigger rear-facing seat.  (Parents often over-estimate how "cramped" their kids are in a rear-facing seat.)  In fact, it's safest to keep the seat rear-facing as long as possible, even after the 2nd birthday, as long as the child tolerates it.
• Until the child is 80-100 pounds, and over 4' 9" tall, a child should sit in a car seat (with integrated belts) or a booster seat.  (This is the Safe Kids Coalitions' recommendation, even though Delaware law requires a booster seat only below 65 pounds.)
• Once the child has grown past 4' 9", then a seat belt may be tried, if the belt position is examined.  The Safe Kids Coalition urges you to try the "Safety Belt Fit Test.  Click here: http://www.safekids.org/safety-basics/pre-teens-and-teens/on-the-way/booster-seat-and-seat-belts.html
• Avoid using a "Velcro" seat belt adjuster, or belt clip.

Position within the car is also important.  At any age (and especially for children 12 and under), the rear seat is 2 to 3 times safer than the front seat. This is because of the greater amount of structural steel around the rear wheels, which protect the rear compartment.  The middle position of the rear seat is the safest of all.

Should school-age children use booster seats?

An average 11 year old child weighs 80 pounds and is 4' 9" tall.  Many parents are surprised to hear the recommendation that elementary school children should continue to use a booster seat. However, the determining factor for the safety of a seatbelt is not the child's height and weight as such. Rather, the important factor lies in the way that the seatbelt restrains the child.

How can I know if my car seat, or seat belt, fits my child safely?

This can be determined by inspecting the seatbelt when the child is strapped in and comfortable.  The greatest safety is found when the lap belt restrains the child across the bony projections of the lower hips, and the shoulder belt restrains the child across the collar bone, shoulder, and ribs. If the lap belt restrains the child across the soft tissues of the belly, or if the shoulder belt restrains the child across the soft tissues of the neck, then an injury from the seatbelt itself is much more likely.  The knees should bend comfortably at the edge of the seat., with the back against the seat back.  If any of these conditions are not met, then the child needs a car seat or a booster seat.

A car seat inspection can determine whether the seat is installed correctly; check:
http://ohs.delaware.gov/carseat and click the "where" button.

How can I convince my school-age child to use a booster seat?

Parents sometimes object that peer pressure may make a school-age child unhappy about using a car seat.  Our response, of course, is that a parent's role must be to enforce safety rules, and educate the child.  When bike helmets were first introduced, similar concerns about resistance from children were voiced; but bike helmet use is now the norm.

In addition, it is important that the adults always use seat belts on every trip.  This is not only for their own safety, but also because of the role modeling that parents can provide. Teenagers who have not seen their parents wear seat belts are much less likely to wear them themselves, during the "New Driver" period when they are at highest risk.

How important are seat belts and car seats for short errands?
    
Many adults make the mistake of using seat belts for themselves and their children only for long trips. Unfortunately, most accidents and injuries actually occur within a few minutes of home, doing errands such as shopping. It should be a universal rule that the children are properly restrained for any car ride, no matter how short the trip.

Copyright © David Epstein, MD, 2001, 2007, 2011
 

Download this handout as a .PDF