Accidents waiting to happen

Healthy child - October 2005


Dr. Alyna Chien

It breaks my heart to see children ride in cars without car seats and seat belts. Unfortunately, it is pretty easy to spot families that allow their children to ride without being properly seated and belted—it happens every time I’m out in Chicago, either on foot or in my own car. I wish I could have a conversation that would convince these families to properly seat and belt their children every time they ride in a car. Since I can’t personally have these conversations, I hope you will.

Why bother? The first and foremost reason is that car seats and seat belts work. Children who are not properly buckled in are twice as likely to get hurt or die from a car accident as those who are. Another reason for concern is that car accidents are easily serious or fatal. Car accidents are the No. 1 reason young people die; the National Highway Traffic Safety Administration estimates that car accidents result in 602 injuries and four deaths to children 14 and younger each day.

How do car seats and belts work? During an accident, people in the car keep moving even though the car has stopped or changed directions. If a restraining device is not used, people will keep moving until they slam into something that stops them—the back of a front seat, the dashboard or the windshield. In the worst-case scenario, an unrestrained person can be thrown from the car. People who are thrown from a car are four times as likely to die as those who are not.

Car seats and seat belts work together by distributing the force of an accident across the parts of the body that can withstand it the best.

General recommendations

Whenever possible, passengers of any age should ride in the back seat of the car—backseat riders are less likely to sustain injuries during an accident. Most accidents happen near the home when traveling less than 30 mph, so remember that each time you head off in the car.

The principles of good car seat fit are the same for all ages:

 A car seat should not rock if it is properly installed.  - Make sure the belts apply greatest pressure at the collar, breast and hip bones—if they touch mainly at the belly and side of the neck, the seat or harness needs to be adjusted.

- The seat belt or car seat’s harness should fit firmly across a child’s body. If you can get more than a finger’s width between the child and the harness straps, tighten them.

If you are unsure about car seat fit, help is available through the manufacturer, your pediatrician, the local hospital, the local police department or a car safety seat technician (visit the National Highway Traffic Safety Administration Web site,

Age-based recommendations

Infants. Babies should be in car seats that face the rear of the car, should recline 45 degrees and have a five-point harness. This protects their heads and necks and keeps them from sliding out of the car seat during a sudden stop.

Toddlers. Children should be both 1 year old and 20 pounds before the car seat faces the front of the vehicle. Although their necks are stronger, they are not strong enough to control their heads during an accident. Toddlers should use a five-point harness but can ride without being reclined.

Preschoolers and kindergartners. When a child reaches 40 to 50 pounds, at 3 to 7 years of age, he or she will be able to transition to a booster seat. The booster seat helps position the adult seat belts across the child’s hips and lap instead of across the stomach. It also positions the shoulder belt at the collarbone instead of at the neck or the sides of the face.

Elementary and middle schoolers. Children need to stay in their boosters until they reach 4 feet 9 inches, the height for which regular seat belts are designed. Depending on how your child grows, this is anywhere between 9 and 14 years of age.

What you can do

We need only to look to the local news to remind ourselves of the risks of driving. Keep this risk in mind for the time you don’t feel like fighting with the car seat or with the child you are trying to get into it. All children resist riding in their car seat at some point, but these are the moments to stand strong and calmly explain that it is for their safety. Tell them that you won’t drive unless all passengers are properly buckled. It is better to leave late than to never arrive at all.

Lastly, if you come up with a good way to approach strangers on the road, let me know. In the meantime if you spot someone driving with unrestrained children in the car, call the Be a Buckle Buddy Hotline at (888) 800-2642 so those drivers will receive a special information packet. Also, support stronger legislation—in Chicago, riding without proper restraints nets a measly $50 ticket and isn’t tied to fixing the problem.

Stronger laws with stiffer fines or other consequences may cut down on the number of accidents waiting to happen and save young lives.

Alyna Chien is the mother of two, a pediatrician and a Robert Wood Johnson Clinical Scholar at the University of Chicago’s Department of Pediatrics.

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