Car Seat Danger Can Occur Outside of Vehicles

< Oct. 21, 2009 > -- A new study reveals good news and bad news about infant car seats: while these safety devices have saved countless young lives, they are also responsible for thousands of injuries when improperly used outside of motor vehicles.

The study was reported this week at the annual meeting of the American Academy of Pediatrics (AAP) in Washington, DC.

More than 43,000 infants in the US required emergency room care between 2003 and 2007 after falling in car seats that were improperly placed on tables, counters, and other elevated surfaces. Accidents were even reported after seats rolled over on soft surfaces, such as beds and sofas, the study discovered.

"In our hospital, we saw some fractures caused by these falls, and decided it was probably a wider problem," says study author Dr. Shital Parikh, a pediatric orthopaedist at Cincinnati Children's Hospital Medical Center. "These injuries are not common compared with some other causes, but they are significant enough to take notice."

Car Seats Unattended

Accidents occur when unrestrained babies, especially those older than 2 months, rock and fidget inside an unattended seat, causing the device to tip over or fall, says Dr. Peter Richel, chief of pediatrics at Northern Westchester Hospital Center, in Mount Kisco, N.Y.

According to Dr. Parikh, the most common injuries during the five-year period were to the head, followed by fractures and dislocations. Three babies died.

The study comes two months after another study advised parents to remove their children from infant car seats after a car trip because the seats can compress the chest and lower levels of oxygen.

Despite these problems with car seats outside of vehicles, experts agree that car seats are critical inside a vehicle to protect children from injury in a collision, just like seatbelt restraints protect adults.

Younger Infants Most Affected

Dr. Parikh's study found that 62 percent of the accidents involved infants younger than 4 months old. About half the accidents occurred at home, and 8 percent of the infants had to be hospitalized, says Dr. Parikh, who based his findings on data from the US Consumer Product Safety Commission.

"Babies older than 2 months are capable of real movement," says Dr. Richel, who was not part of the study. "We as physicians and health-care providers have to be aware of these kinds of accidents when we advise parents."

To prevent harm, Drs. Richel and Parikh recommend that car seats be used only in cars and only when the infants are properly restrained.

"The best thing is for babies to come out [of the car seat] when you come home," Dr. Richel says. "Barring any danger to the child, such as an aggressive dog, put the car seat directly on the floor."

Better Car Seats Needed

Dr. Parikh also recommends that car-seat manufacturers do a better job of informing consumers about the danger of misusing their products, including offering explicit printed instructions. Car seat companies should also strive to engineer more stable seats, he adds.

In related news, researchers confirmed earlier reports that booster seats significantly reduce the risk of crash injury in children ages 4 through 8.

According to the study, reported in the journal Pediatrics, children in belt-positioning booster seats were 45 percent less likely to sustain injuries than similarly aged children in standard vehicle seat belts. Booster seats with and without backs provided similar protection.

Always consult your child's physician for more information.

Infant and Child Safety Seats

Proper restraints for children riding in motor vehicles depend on the child's age and size. Restraints to keep a child safe in the car include:

• infant safety seats
• child safety seats
• child booster seats
• properly used safety belts

The key to keeping your child safe is to use an age-appropriate child restraint that is properly installed and properly used.

Infant and child safety seats come in many shapes and sizes. Some are not compatible with certain vehicles. The best child safety seat for a family is the one that is easy to use for the parents or caregivers, fits in the vehicle's seats, is compatible with the vehicle's seat belts, and is the proper size for the child.

As many as 85 percent of child safety seats are found to be improperly installed and/or used when vehicles are stopped and checked, according to studies from the National SAFE KIDS Campaign Car Seat Check Ups. Some of the most common mistakes in installing or using child safety seats include the following:

• safety belt not holding the seat in tightly and/or not in locked mode
• harness straps not snug and/or routed correctly
  harness retainer clip not at armpit level
• locking clip not used correctly
• car seat recalled and not repaired (includes booster seats)
• infants placed rear-facing in front of an active air bag
• children turned forward-facing before reaching 1 year of age and 20 pounds

Parents and caregivers should carefully read their vehicle owner's manual and the instructions that come with the child safety seat to ensure proper installation and use of the seat. The National Highway Traffic Safety Administration (NHTSA) recommends doing the following quick safety seat assessment:

• Is your child riding in the back seat? (The back seat is the safest place in a crash.)
• Is your child facing the correct way? (Infants up to age 1 and 20 pounds should face the rear.)
• Is the child safety seat held tightly in place by the seat belt?
• Does the harness buckle snugly around your child?
• If your child is between 40 and 80 pounds, is he/she in a booster seat for better seat belt fit?
• Does your older child fit properly in the vehicle's seat belts? (The shoulder belt should rest over the shoulder and across the chest, and the lap belt should fit low and tight over the upper thighs. The child should be tall enough to sit with knees bent at the edge of the seat - at least 58 inches tall and 80 pounds.)

Once a vehicle has been in a severe crash, child safety seats and seat belts should be replaced because they may have become stretched or damaged. All child safety seats are replaced by insurance companies. Always check with your child safety seat manufacturer concerning questions about the safety of your child's seat.

Always consult your child's physician for more information.