Many caregivers have had training in the appropriate way to install a car seat or a booster seat, while others try to follow the instructions on the box, and others remain unclear on these issues. Not only do many people not understand the proper way to restrain a child in a car, nor the importance of doing so for a child's safety, but also caregivers of children should know that the state of Tennessee law on child restraints changed in mid-2004 and again in 2005.
Child passenger safety experts at East Tennessee Children's Hospital offer the following information on the proper installation and importance of using a child passenger safety seat and the revised Tennessee law on this important child safety issue.
Q. What is the child restraint law in Tennessee?
A. The current law reads as follows:
- Any child under 1 year old (even if he or she weighs more than 20 pounds) or any older child weighing 20 pounds or less must be in a rear-facing car seat and should be placed in the back seat, if available.
- Children should be in child restraint seats with an internal harness until they are 4 years old or reach the upper weight limit of their child restraint seat (this varies by type of seat). Again, they should sit in the back seat.
- All children ages 12 and under should ride in the back seat (when available).
- Children ages 4 through 8 who are less than 4 feet, 9 inches tall are required to ride in a belt-positioning booster seat, located in the rear seat (if available). Previously, children ages 4 and older were not required to be in a booster seat. The upper weight limit on booster seats ranges from 80 to 100 pounds, depending on the model, so check your child's seat for its specific limit. Read further for what to do if your child weighs more than 100 pounds but is under age 9.
- Everyone must use a restraint. This is a primary law in Tennessee.
- If you need to take the child out of the restraint, you must stop the vehicle.
- The driver of the car is responsible for ensuring children under age 16 are properly restrained. If a child's parent or guardian is in the car but is not the driver, the parent or guardian is responsible, rather than the driver. Fines are issued for violation of the laws.
Q. What are the dangers of not placing a child in a car or booster seat correctly or in a restraint completely?
A. More children in the United States are killed and injured in car crashes than from any other cause, and traffic crashes are the number one killer of children ages 1 to 5. Even with current legislation related to car seats, more than 1,000 infants and toddlers die and another 40,000 are seriously injured each year because they aren't properly restrained, according to National Safety Council data. Shockingly, Tennessee's fatality rate is 50 percent higher than the national average.
Q. What are the basic types of child restraint devices?
A. There are four types of child restraint seats, and they all should be placed in a vehicle's back seat:
Infant seats – These should be used from birth until at least 12 months to reduce the risk of cervical spine injury in the event of a crash. Any child under 1 year old (even if he or she weighs more than 20 pounds) or any child weighing 20 pounds or less must be in a rear-facing car seat. Check the seat for its specific weight limit – some newer infant seats can accommodate a rear-facing baby up to 30 pounds.
Convertible seats – These seats can be used from birth until about age 4, or until the child weighs about 40 pounds. Infants ride rear-facing; later the seat can be converted into a forward-facing seat for toddlers.
Toddler seats – This forward-facing type of seat with an internal harness is used for children 20-40 pounds. Newer seats can be purchased to accommodate a child in a five-point harness up to 90 pounds. The child's size should be such that the ears are below the top of the seat and shoulders are above the seat strap slots.
Booster seats – These seats are used when a child has outgrown a toddler or convertible seat but is still too small to fit properly in an adult safety belt. Boosters require both shoulder and lap belts to be used. Also, an adjustable headrest on the booster or on the vehicle's seat may be needed to accommodate the child's growth.
Q. I recently heard that babies should remain rear-facing until age 2, not 1 year old. Why is this?
A. The American Academy of Pediatrics policy is that toddlers remain rear-facing until age 2. New research indicates that toddlers are more than five times safer riding rear-facing in a car safety seat.
Although most parents are anxious to be able to turn their babies around (to better see them in the car), it is important to make each baby’s safety the biggest priority. Following is the policy from the American Academy of Pediatrics for car seat use with infants and toddlers:
- All infants should ride rear-facing in either an infant car seat or convertible seat.
- If an infant car seat is used, the infant should be switched to a rear-facing convertible car seat once the maximum height (when the infant’s head is within 1 inch of the top of the seat) and weight (usually 22-32 pounds, depending on the model of seat) have been reached for that infant seat as suggested by the car seat manufacturer.
- Toddlers should remain rear-facing in a convertible car seat until they have reached the maximum height and weight recommended for the model, or at least the age of 2.
Q. Why booster seats? Are they really so important that the state made their use a law?
A. Absolutely. The reason for booster seats is simply to better position the child in an adult seat belt. Children less than 4 feet, 9 inches tall, when wearing the adult seat belt, will typically have the shoulder portion across their neck and the lap portion of the belt over their belly button area. If the belt is in this position in a crash, the child could suffer severe neck, abdominal and spine injuries. This common injury is called "seat belt syndrome." By using a booster, the shoulder strap will go across the center of the collarbone and the lap belt will be over the child's bony pelvis, thus preventing these serious injuries.
Q. What if I can't find a booster seat that will accommodate my larger child?
A. This is a concern for some parents. If your child weighs more than 100 pounds, you need to follow the booster seat manufacturers' guidelines. Remember that the law was created for safety, not for punishment. So if your child is under age 9 and not yet 4’9”, a higher weight booster seat may be needed. There are several options on the market, including the EZ-On harness.
Once your child is 4’9” or 9 years old, use the following tips:
- The seat belt should be positioned over the child's pelvis and across the collarbone and sternum (the child must ride in a seat with both a lap and shoulder belt).
- Have the child sit closer to the seat belt buckle so that the shoulder strap will not go across his or her neck.
- The child's legs should bend comfortably at the edge of the vehicle's seat when he or she is sitting all the way back in the seat.
If your child meets ALL of the above criteria, he or she can transition to an adult seat belt. Again, follow the seat manufacturers' guidelines. If you have additional questions or concerns regarding this issue, please visit a car seat inspection checkpoint.
Q. What are some common mistakes that someone should avoid with car safety restraints?
A. The following common mistakes can easily be avoided by taking extra time and care in placing your children in a restraint seat:
- The child restraint is too loose in the vehicle. Properly installed, the seat should not move more than one inch side to side or front to back.
- The harness is too loose on the child. You should not be able to pinch a fold in the harness if it is tightened properly.
- The infant has been turned facing forward too soon.
- The rear-facing seat has not been placed at a correct recline, according to the manufacturer's instructions.
- The retainer clip is used incorrectly.
- The harness straps are placed through the wrong slots.
- You are not using a booster seat with a child who is age 4 through 8 and is less than 4 feet, 9 inches tall (regardless of weight).
- You are using a seat that has been recalled or is outdated.
- A child under the age of 13 is riding in the front seat.
- The belts are positioned incorrectly on the child; remember "belts over bones."
If you still have questions about proper installation, consider going to a safety seat inspection.
Q. How can a caregiver find a safety seat inspection?
A. Checkpoints, which are free, are organized by East Tennessee Children's Hospital and sponsored by Pilot Flying J. At checkpoints, certified child passenger safety technicians will check the installation of your seat(s) and teach you proper installation techniques. Visit our Calendar of Events page for more information.
When you attend a car seat inspection, be sure to bring your child restraint seat instructions and vehicle owner's manual. Also, to make the process more efficient, please install your child restraint seat to the best of your ability before attending the inspection.
Q. Aren't child restraint systems expensive?
A. The cost of a new child restraint device varies according to type, model and place of purchase. The least expensive devices are the nonconvertible infant restraint devices and the harness restraint device. In general, the more features a device has, the more it will cost, although a higher price does not necessarily mean a safer device.
Booster seats needed for children ages 4-8 can range in price from $15 to $50 and are available at most retailers like Wal-Mart, Target, Kmart, Babies R Us and Toys R Us. Visit the American Academy of Pediatrics' Car Safety Seats Guide for a detailed explanation about seats and a list of available seats, including type, price and weight/height the seat will accommodate (scroll down the page to find the list).
To help you decide among the many choices of seats available, visit the National Highway Traffic Safety Administration's Ease of Use Ratings to learn more about how easy or difficult different types of seats are to install and use.
These costs are tiny compared to the medical costs and the pain and suffering of a child who is improperly restrained and who suffers an injury in a motor vehicle crash.
Q. Do you recommend secondhand car seats?
A. If you don't know the history of the seat or if the questions below are not clearly answered, Children's Hospital recommends you get a new seat. Here are some things you should consider if it is absolutely necessary to use a secondhand car seat:
- Is the seat more than 6 years old? Look on the label for the date it was made. If it is more than 6 years old, it should not be used. Check with the manufacturer to find out the company's recommendation, or check the seat itself for an expiration date. Some seats now have an expiration date molded right into the seat, and most of these allow for up to 6 years of use before expiration.
- Was it ever in a crash?
- Does the seat have any visible cracks in its frame?
- Are there any parts missing?
- Does the seat show any signs of weakening? Look for light-colored stress marks, usually on the belt path.
- Does it have a label with a date of manufacture and model number? This is required to determine if the seat has been recalled.
- Does it have the original instructions? If not, call the manufacturer's 1-800 number to request a new copy of the instructions.
If you have questions or concerns, visit a Safety Seat Inspection or visit the Child Safety Seat Inspection Station Locator on the website of the National Highway Traffic Safety Administration to find a certified car seat safety technician in your area.
Q. What if my children don't like safety seats or safety belts?
A. It really is not their choice. Children simply can't understand the risks of a motor vehicle crash and the benefits car seats provide. As an adult and parent, you must insist on children and all passengers using proper restraints for their own safety and protection. Don't start the car until everyone (including yourself) is buckled up. If you make it a habit and start practicing when your children are young, buckling up and getting in a booster seat will not be something "odd" or "not cool," it will simply be part of the ride.
Let's all work to lower the high mortality on Tennessee roads. Parents should start the trend of wearing seat belts by setting an example for the entire family, friends and neighbors. Make it a routine for everyone in the car to be properly restrained and use car seats, booster seats and lap shoulder belts -- every ride, every time. Make sure you use them properly. If you don't make sure your child is safe when riding in a car or van, unfortunately your next trip with your child might be to a hospital emergency department.
Children's Hospital recognizes that families of medically fragile children may need assistance obtaining specialized child safety restraints for safe transportation. The provision of these safety restraints is routinely made possible through our Injury Prevention program, Children's Hospital Home Health Care and a generous grant from the Mount Rest Fund of East Tennessee Foundation.
For more information, contact the Children's Hospital Community Benefits Department at (865) 541-8165.