Care Safety for Children & Infants
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
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.
View our community events calendar for dates, times and locations of upcoming child car seat safety inspections
in East Tennessee, sponsored by Pilot Flying J.
Child Passenger Safety Questions & Answers
What is the child restraint law in Tennessee?
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.
What are the dangers of not placing a child in a car or booster seat correctly
or in a restraint completely?
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 are not properly restrained,
according to National Safety Council data. Shockingly, Tennessee's
fatality rate is 50 percent higher than the national average.
What are the basic types of child restraint devices?
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 child 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.
I recently heard that babies should remain rear-facing until age 2, not
1 year old. Why is this?
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.
Why booster seats? Are they really so important that the state made their
use a law?
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.
What if I can't find a booster seat that will accommodate my larger child?
This is a concern for some parents. If your child weighs more than 100
pounds, you need to follow the booster seat manufacturer’s 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 manufacturer’s guidelines.
If you have additional questions or concerns regarding this issue, please
visit a car seat inspection checkpoint.
What are some common mistakes that someone should avoid with car safety
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
If you still have questions about proper installation, consider going to
a safety seat inspection.
How can a caregiver find a safety seat inspection?
At checkpoints, which are free, certified child passenger safety technicians
will check the installation of your seat(s) and teach you proper installation
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.
Aren't child restraint systems expensive?
The cost of a new child restraint device varies according to type, model
and place of purchase. The least expensive devices are the non-convertible
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 Pediatric’s
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).
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.
Do you recommend second-hand car seats?
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 second-hand 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
toll-free number to request a new copy of the instructions or visit the
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.
What if my children don't like safety seats or safety belts?
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.
Setting A Safe Example
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.