East Tennessee Children's Hospital

In the past few years, some laws concerning child passenger safety have changed. Here is information for parents about the importance of car seats and booster seats, updates on the laws and helpful hints for learning the basics about child passenger safety.

Parents, grandparents and child care professionals place children in cars, vans and other vehicles every day. Where in the car should children of different ages ride? Should children be in car seats, booster seats or seat belts?

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.

Dr. Mick Connors, child passenger safety expert at East Tennessee Children's Hospital, offers 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.

What are the recent changes to the child passenger restraint law in Tennessee?
What are the dangers of not placing a child in a car or booster seat correctly or in a restraint completely?
What are the basic types of child restraint devices?
Why booster seats? Are they really so important that the state made their use a law?
What if I can't find a booster seat that will accommodate my larger child?
What are some common mistakes that someone should avoid with car safety restraints?
How can a caregiver find a safety seat checkpoint?
Aren't car restraint systems expensive?
Do you recommend secondhand car seats?
What if my children don't like safety seats or safety belts?

Q. What are the specific changes to the child passenger restraint law in Tennessee?

A. Here are the law's provisions:

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 and weigh 40 pounds. 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. Seats are designed only for children up to 100 pounds. Read further for what to do if your child weighs more than 100 pounds.

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 the National Safety Council. Shockingly, Tennessee's fatality rate is 50 percent higher than the national average. To me and other pediatricians, it is very simple: putting a child properly in a car or booster seat can be the difference between life and death if the child is involved in a wreck.

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 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.

Convertible seats – These seats can be used from birth until about age 4, or until the child weighs about 40 pounds. Infants ride backward; later the seat can be converted into a forward-facing seat for toddlers.

Toddler seats – This forward-facing type of seat is used for children 20-40 pounds who are able to sit without support. The child's size should be such that the ears are below the top of the seat and shoulders are below 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 a vehicle safety seat.
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 his/her seat belt. Children less than 4 feet, 9 inches tall, when wearing their 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 "lap belt syndrome." By using a booster, the shoulder strap will go across the chest 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 but is above the weight guidelines for booster seats, 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, if available).

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.

Again, follow the seat manufacturers' guidelines. If you have additional questions or concerns regarding this issue, please visit a car seat checkpoint or contact your local police department or visit the Safe Kids website.
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.

The harness is too loose on the child.

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 12 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 checkpoint.

Q. How can a caregiver find a safety seat checkpoint?

A. Checkpoints, which are free, are organized twice a month by the SAFE KIDS Coalition of the Greater Knox Area and the Knoxville Police Department. They are staffed by NHTSA-trained and SAFE KIDS Worldwide-certified child passenger safety technicians who will check the installation of your seat(s) and teach you proper installation techniques. When you attend a car seat checkpoint, be sure to bring your carseat instructions and car owner’s manual. Also, to make the process more efficient, please install your carseat before attending the checkpoint.

Checkpoints are offered the FIRST Saturday of most months at Beaty Chevrolet on Parkside Drive in Knoxville. Hours are 10 a.m. to 1 p.m.. For additional information, call the SAFE KIDS office at (865) 215-5175.

Checkpoints are offered the SECOND Saturday of most months at Rusty Wallace Honda on Callahan Road in Knoxville. Hours are 10 a.m. to 1 p.m. For additional information, call the the Knoxville Police Department at (865) 215-8620.

Check the SAFE KIDS website for specific dates.

If you live outside the Knoxville area, check with your local police department for assistance.
Q. Aren't car 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. I would recommend a car seat with a five-point restraint. These generally range from $40 to $100.

Booster seats needed for children ages 4-8 can range in price from $15 to $50 and are available at most area retailers like Wal-Mart, Target, Babies R Us and Toys R Us. Visit the American Academy of Pediatrics' Car Safety Seats Guide at http://www.aap.org/family/carseatguide.htm for a detailed explanation about seats and a list of available seats, including type, price and weight/height the seat will accomodate (scroll down the page to find the list).

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. Here are some things you should consider if it is absolutely necessary to use a secondhand car seat:
Is the seat more than 5-6 years old? Look on the label for the date it was made. If it is more than 5-6 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.

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.

Is it less than one year old?

If you don't know the history of the seat or if these questions are not clearly answered, I would recommend getting a new seat. If you have questions or concerns, visit a Safety Seat Checkpoint or call the local law enforcement agency in your area to have the seat inspected before you begin using it.

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.

Trust me, if you haven't seen someone injured in a motor vehicle crash, you don't want to. Buckle up and be safe.

Let's all work to lower the high mortality on Tennessee roads. Parents should start the trend of seat belt wearing 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. 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.
For more information about the law, visit NHTSA or contact the Children's Hospital Community Relations Department at (865) 541-8165.

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Revised 9-20-07