Is Your Child Safe in the Car?

Car seats are notoriously tricky: It feels like best safety practices are always being updated, and installing the seats seems to leave a lot of us sweaty and still stumped. "I've personally done more than 5,000 car-seat checks and seen only 14 seats that were installed correctly," says Benjamin Hoffman, M.D., a certified Child Passenger Safety Technician and associate professor of pediatrics at the Oregon Health & Science University, in Portland. Although we can't help you feel around for that tricky latch, we can make sure you have a grip on when and where to use each kind of seat. Lock down your knowledge by answering these questions.

1. It's time to switch to a front-facing car seat when
A. Your child is age 1 and weighs 20 pounds.
B. Your child is age 2 or reaches the seat's weight or height limit.
C. Your toddler's legs appear crowded by the rear-facing seat.

Answer: B. At age 2. Experts used to advise doing the switcheroo around a child's first birthday, but recent research shows that children under 24 months are five times more likely to die or be seriously injured if they're in a front-facing seat. So just last year, the American Academy of Pediatrics (AAP) issued new recommendations. "A rear-facing car seat does a better job of supporting a young child's head and immature neck and spine because it distributes the force of a collision over the entire body," says Parents advisor Dennis Durbin, M.D., a pediatric emergency physician at the Children's Hospital of Philadelphia (CHOP). Worried about your toddler's scrunched-up legs? Don't be. There's no evidence that they're more likely to be injured in a rear-facing seat. Plus, it's much easier to fix a broken leg than a broken neck.

2. The safest place for a car seat is in the backseat and
A. In the center
B. On the right
C. On the left

Answer: A. The center. One CHOP study found that center-seated kids were 43 percent less likely to be injured in a crash than those who rode by the windows. "It's farthest away from any potential impact," says Dr. Hoffman. If you have more than one child,
Dr. Hoffman recommends placing the one who needs the most protection (based on age, size, and health) in the center-rear position. If your family uses two car seats, try placing one in the center and the other next to it. If this isn't possible, it's fine to leave a space between the two seats as long as they're properly installed, says Dr. Hoffman.

3. True or False: If your car has a LATCH system, you should use it.

Answer: True. LATCH (which stands for Lower Anchors and Tethers for Children) is designed to make installation easier and safer: Available in all new vehicles since 2002, it attaches the car seat directly to the vehicle without relying on seat belts. "You can generally get a tighter attachment this way," says Dr. Durbin. Used properly, the LATCH system shouldn't let you move the car seat more than an inch from side to side or back and forth. Not all cars have attachments for the middle seat, but Dr. Durbin recommends using the system even if it means placing your car seat in a side position. Be sure to use the top tether: It will limit the motion of the car seat and your child's head in a crash and reduce the risk of injury.

4. A rear-facing car seat's harness should be
A. Threaded through the slots at or below your child's shoulders
B. Tight enough that you can't pinch any fabric between your fingers
C. Smooth and untwisted from front to back

Answer: A, B, and C. (Trick question!) In a rear-facing seat, the harness straps should be adjusted so they're threaded through the slots at or below shoulder level. (In a front-facing seat, the harness straps should be at or above shoulder level.) After your child is strapped in, use the "pinch test" to ensure the harness is tight enough. (The "two fingers" rule -- being unable to slip more than two fingers between your child's collarbone and the straps -- is outdated.) And straps should be smooth. "I see twisted harness straps all the time, which decreases their ability to hold your child securely in a crash," says Dr. Hoffman.

5. When the infant car seat's in the vehicle, the handle should be
A. Up
B. Down
C. It depends on the model.

Answer: C. Check your individual seat's instructions. "Most say to click the handle down when the carrier is installed in the vehicle and flip it up when you take your baby out of the car, but it depends on the model," says Dr. Durbin. If you no longer have the instructions, look online: Most of the manufacturers post electronic copies on their website.

6. True or False: If your baby launches into a crying fit while your vehicle is moving, it's better to take her out of her car seat for a minute or two to comfort her than to risk having her distract the driver.

Answer: False. Though it's tough listening to your baby cry, never remove her from her seat -- not even for a minute -- while the car is moving. Her safety depends on being properly restrained at the moment of a crash, and you can't control that timing. "If you feel you must take your baby out of her safety seat, the driver should find a safe place to pull over," says Dr. Durbin. Remove your baby to comfort or feed her and then hit the road again when she's calmer.

7. To keep your child both safe and warm during winter's cold weather, you should
A. Bundle him into his coat tightly before securing him into the car seat
B. Cover him with a blanket or his winter coat after securing him in the car seat
C. Use a product meant to keep kids warm in car seats

Answer: B. Coats off, please. "You don't want anything that's going to increase the distance between your child's body and the harness straps," says Dr. Durbin. And no warmers: Car-seat safety experts advise against using anything that didn't come with the seat itself. These aren't regulated by the National Highway Traffic Safety Administration (NHTSA), so it's hard to know exactly how safe they are. "They may claim to meet federal safety standards, but there are no standards that cover these products," says Dr. Durbin.

8. The right time to switch to a booster seat is when your child
A. Turns 4
B. Weighs 40 pounds
C. Outgrows the weight limit of his front-facing car seat

Answer: C. Take it to the limit -- and don't rush. By graduating to a booster seat, you'll give up the 5-point harness, which diffuses the force of a crash on your child's body. (NASCAR drivers use a 5-point harness, Dr. Hoffman points out.) Booster seats work by lifting your child up high enough to fit in the car's seat belts instead. They're available in two styles: a high-back booster, which provides needed head support if your vehicle seat is low, and a backless booster. (Buying ahead? Some manufacturers also offer combination seats, which work as forward-facing seats and boosters, or three-way car seats, which can be used rear-facing, forward-facing, and as a booster.)

9. You'll know your child is ready to give up the booster when she
A. Reaches age 8
B. Fits an adult seat belt, usually at around 4'9" tall
C. Won't stop complaining about riding in a car seat

Answer: B. Sad news for small fries: Your 8-year-old may soon be a tween, but if she's not tall enough to fit an adult-size seat belt (which usually happens at 4'9", according to the AAP guidelines), she's not ready to give up that booster. "The key is to make sure the seat belt fits your child securely at the right places," says NHTSA administrator David Strickland. The shoulder belt should lie snugly across the shoulder, not the neck; the lap belt should fit across the upper thighs, not the tummy; and she should be able to place her feet flat on the car floor while sitting back against the seat. Although it's not common, a slow grower may not get there until age 12. Don't cave even if your kid whines: In kids ages 4 to 8, boosters reduce the risk of injury by 45 percent compared with just using a seat belt. If the seat or headrest supports his noggin, you can ease his embarrassment by using a backless booster, which is less conspicuous than a high-back model.

10. True or False: It's fine for your 10-year-old to sit in the front passenger seat as long as the air bag is turned off.

Answer: False. The NHTSA recommends that children under 13 always ride in the back, partly because they're more likely than an adult to be injured by an air bag's sudden, explosive inflation. But even if your vehicle has an on-off switch for the front-passenger air bag (and most don't), it's too risky to turn it off. "Drivers tend to forget to turn them back on," says Strickland. If you absolutely must put a child under 13 in the front seat (say, because the kids you're transporting outnumber your back seats), slide it as far back from the dashboard as possible, and put your biggest or tallest passenger there -- strapped in, of course.

11. It's illegal to transport a child in a taxi or an airport shuttle without a car seat
A. Everywhere in the U.S.
B. In some states
C. It depends on the driver.

Answer: B. Some states require that young children ride in car seats in taxis and shuttles, while others don't. "To make things even more confusing, some cities have their own regulations," says Strickland. The best advice: No matter where you are, be sure your child is properly restrained every time she's in a moving vehicle. Four out of ten kids killed in crashes are completely unrestrained," notes Strickland. "Even for a short taxi ride, it's not worth the risk." If you expect to ride in taxis while on vacation, Strickland recommends taking along a car seat. Airlines don't typically count them as baggage, so it's likely your car seat will fly free (though be sure to check with your carrier before heading to the airport).

Safety First

Buying Your First Car Seat

Since your baby may arrive early, Parents advisor Ari Brown, M.D., coauthor of Baby 411, recommends that you start car-seat shopping around your sixth month of pregnancy. You'll want to get either an infant-toddler car seat (also called a convertible seat) or a smaller infant seat. The first offers savings: You'll be able to use it longer. But babies under 20 pounds might be better off in infant-only seats, which are specially contoured for newborn bodies, says Dr. Brown. They are also convenient: Most double as carriers, clicking in and out of a base that's kept in the car so you can move your dozing baby without disturbing her. Most standard-size strollers can accommodate them, or you might consider a ready-made car seat/stroller combo. When your child outgrows the infant seat, though, you'll need to switch to a convertible seat, which can go both backward and forward, notes Dr. Brown.

Do This to Be Safe

Get your car-seat installation double-checked by a certified Child Passenger Safety Technician (CPST). Find an inspection station near you at seatcheck.org or call the Department of Transportation's Vehicle Safety Hotline at 888-327-4236.

Originally published in the September 2012 issue of Parents magazine.