Car and Booster Seat

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Injury Prevention Team

Car and Booster Seat

Keeping Kids Safe in the Car

As the parent or caregiver of a child, you may find guidelines on car seats, booster seats and seat belts a little overwhelming. Rest assured you’re not alone. Making sure your child is ready for each new phase is the key to preventing critical injuries. From the rear-facing seat to standard seat belt use and each stage in between, we’re here to address your questions and concerns on car seat and booster safety.

Car Seats and Booster Seats Save Lives

The trauma doctors, nurses and staff at University Hospital know properly installed and secured car seats and booster seats help prevent pediatric trauma. When children aren’t ready to use a seat belt or graduate to a booster seat too soon, they are at a greater risk of seat belt syndrome.

Properly used car seats and boosters keep thousands of children out of our Level I pediatric trauma center every year. Those kids never see the Surgical Trauma Intensive Care Unit (STICU) and they don’t require any rehabilitation after an injury. That’s why we believe so strongly in car seats and support those who use them with education and advice.

University Health is the leader of Safe Kids San Antonio, a coalition of organizations dedicated to keeping your kids safe. Through the coalition, we host car seat checkups and offer free installation education throughout the community. To schedule an appointment to have your car seat checked, please call 210-358-4295 for our next available appointment.

Right Seat at the Right Time for the Right Fit

Car seats and booster seats are designed for children, but each is designed for a specific stage of a child’s development. Often when a child graduates to the next level in food, sports or academics, it’s considered a celebration. That is not true with car seats. Each time your child graduates to the next step, from rear-facing to forward-facing to booster seat to seat belt, he or she loses a layer of protection.

Follow these tips and guidelines so you can be sure your child meets the age and height requirements for each new stage.

After your child turns 5 and reaches any one of these milestones, he or she is ready to move into a booster seat:

  • Your child exceeds the car seat’s height or weight limits
  • Your child’s shoulders are above the car seat’s top harness slots
  • Tops of your child’s ears are above the top of the car seat

To make sure your child is safe in a booster seat, you also will need to check the location of the lap and shoulder belts with your child buckled in the seat. Review the correct belt placement in these booster seat safety tips along with a few other dos and don’ts. A booster seat must always be used with a lap and shoulder belt. It can seriously injure or kill a child if you use a booster seat with only a lap belt.

Additionally, children should not be allowed to tuck the shoulder belt under their arm or place it behind their backs. In a crash, a significant amount of force would be placed on the child's abdomen and could result in serious injury or even death.

As Your Children Grow, Follow These Important Safety Tips

It’s important others who transport your big kids understand booster seat use is a must for your child. Keep using the booster seat with the vehicle lap and shoulder safety belts until your child passes the safety belt fit test. Check your child’s growth periodically. Generally, kids should use a booster until they’re about 57 inches tall and weigh between 80 and 100 pounds before moving out of a booster seat.

Lap/shoulder belts were designed to protect adults, and they often do not fit children well. A high-back booster should be used for smaller children, especially if you do not have the head protection offered by a headrest. A no-back booster can be used when the shoulder belt crosses the chest correctly. This is a good option for older children who still need the protection of a booster.

It’s important to understand when your child should face the rear of the vehicle and when it’s time to transition to a forward-facing seat. The safest child is the one who rides rear-facing. That is why we recommend it until the age of 2. This will provide the best brain and spinal cord protection when they are the most vulnerable to injury.

Typically, your child is ready to face forward at age 2 and should remain in a car seat with a five-point harness until around 65 pounds.

Other Car Seat Guidelines

  • Check your car seat’s label for specific weight restrictions and follow these other car seat guidelines:
  • Rear-facing car seats should never be installed in front of an air bag. This could lead to serious injury, even death, in the event of a crash.
  • Your child is not ready to ride forward-facing when he or she outgrows the infant carrier. You should purchase another rear-facing seat that will allow you to keep your child rear-facing up to 40 or 50 lbs. For the best protection, keep your child rear-facing until around the age of two.
  • All seats should be installed in the back seat of your vehicle. When children outgrow their rear-facing seats, they should be buckled into forward-facing car seats with a five-point harness until at least age 5.
  • Tether forward-facing seats according to your vehicle manual’s guidelines for your child’s weight after you tighten and lock the seat belt.
  • Conduct the inch test and pinch test to make sure your car seat is installed correctly.

A five-point harness car seat provides more protection than a booster seat or seat belt for a small child. Replace your car seat if your child outgrows the weight or height limits. You may need to purchase a forward-facing seat with higher weight limits before your child can be safely moved out of a five-point harness and into a booster seat.

Go over the car seat tips periodically to review the growth milestones that indicate your child is ready to transition to a booster seat.

When It’s Time for Your Child to Use a Seatbelt

Children are not ready to graduate out of a booster seat into the adult lap and shoulder belt until they meet the safety belt fit test.

  • Your child’s knees bend at the edge of the seat when his or her back and bottom are against the vehicle seat back
  • Vehicle lap belt fits across the upper thighs, not the stomach
  • Shoulder belt fits across the shoulder and chest, not the neck

Children should not be allowed to place the shoulder belt under their arm or behind their backs as this will result in serious injury, even death, in the event of a crash. If your child is not able to keep the shoulder belt in the proper place, they should be moved back into a booster seat. This will provide the best protection.

Children could be between 9 and 12 years old when adult seat belts fit properly. Also, a child can be ready to use a seat belt by itself in one vehicle but not another. Conduct the safety belt fit test in all vehicles your child rides in.

When It’s Time to Switch to the Front Seat

Children should ride in the back seat until the age of 13. It is the safest place for them to ride. Children that ride in the front seat before 13 years of age could be injured, or even killed, in a crash due to the airbag deployment. Children under 13 are often too short and the airbag typically deploys at the neck or eye-level, rather than at the chest. This results in injury rather than crash protection.

Once they progress to this stage, teach them the importance of buckling up in every vehicle, every time. Set a good example by wearing your seat belt. When adults wear seat belts, kids do, too!