CRASH! Was Your Child Buckled Properly?

Car seats and vehicle restraints for children save lives when used properly

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Car accidents are still the leading cause of death in children aged 1 to 17. But using the proper restraints for children helps protect them a great deal.

A recent study outlined the most current recommendations and research on car restraints for children.

The study noted that 46 percent of children who died in car crashes had no restraints at all (no car seat, booster seat or seat belt).

The key to keeping children safe in vehicles is ensuring that parents know and follow the recommendations for child safety restraints.

"Buckle up your children correctly."

The paper, led by Walter H. Truong, MD, of Gillette Children's Specialty Healthcare at the University of Minnesota, reviewed current research and recommendations related to children's injuries in car accidents.

Currently, children 1 year old and younger should sit in rear-facing car seats. Rear-facing car seats should continue to be used until the child weighs 20 pounds.

Children aged 1 to 4 who weight 20 to 40 pounds can sit in forward-facing car seats in the back seat of the car.

The authors noted one study found that significant injury to children was about 76 percent more likely in children seated in forward-facing car seats than in rear-facing car seats.

A rear-facing car seat is estimated to be about 93 percent effective in preventing injury to a child in a crash. A forward-facing car seat is estimated to be 78 percent effective.

The longer a child can remain rear-facing, therefore, the greater amount of protection that child is receiving, the authors noted.

In side crashes, the risk of injury in forward-facing car seats was about five and a half times greater than in rear-facing car seats.

"The safest position for a child is the rear center seat because side impact crashes are more likely to cause serious injury and fatality, with the greatest risk associated with perimeter seating," said Dr. Truong in a prepared statement.

Children aged 4 to 8 should sit in booster seats in the back seat at least until the child is 4 feet 9 inches tall.

Until age 8, children are not sufficiently protected if they are using only seat belts without a booster seat.

The problem with using only seat belts in children aged 4 to 8 is that improperly used seat belts can cause injuries in a crash.

Younger children can get severe bruises in their hips and abdomen, experience abdominal injuries, fracture the pelvis or injure the spine if they are using an improperly positioned seat belt instead of a booster seat during a car accident.

However, the authors found that not all parents of children within this general age group were following recommendations.

For example, the authors described the findings of one study that surveyed parents of children aged 4 to 6.

In that study, only 46 percent of parents knew that children aged 4 to 6 should travel in a booster seat. The study did not report on parents of children aged 6 to 8.

While 97 percent of parents reported restraining their children aged 3 and younger, only 42 percent of parents with 4- to 6-year-old children were following recommendations for car restraints for their children.

After children have outgrown booster seats, they should use safety belts. The back seat continues to be the safest place for children until at least age 12 to prevent injuries caused by air bags.

The authors report that children under 10 years old were 34 percent more likely to be killed during a car accident if they were in the front seat of a car with dual air bags.

"This data should be a wake up call to any adult with a child riding in their car," said dailyRx expert Chris Galloway, MD, who specializes in emergency medicine.

"Using appropriately sized and positioned car restraints save lives and prevents injuries," Dr. Galloway said. "Period, no excuses, and it's the law."

The study was published in the June issue of the Journal of the American Academy of Orthopaedic Surgeons.

One author, Dr. Cole, has received grant or consulting funds from Synthes and has stock or options in Bone Foam. The other two authors have no conflicts of interest. Information on funding was not provided.

Reviewed by: 
Review Date: 
June 13, 2013
Last Updated:
August 7, 2013