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Car Safety

The importance of seat belts and car seats:

For children ages 14 and younger, unintentional injury-related deaths occur most often when riding in a car. According to the most recent statistics, among children ages 14 and younger who were killed as occupants in motor vehicle crashes, 53 percent were not using safety restraints at the time of collision.

According to the National SAFE KIDS Campaign, children ages 4 and younger who ride in motor vehicles unrestrained are twice as likely to die or suffer injuries in a car crash.

Car seats and seat belts MUST be used correctly to provide the best protection. The following are safety guidelines:

Infants (birth to age 2 years

The infant car seat should:

  • Be located in the back seat of the automobile

  • Face the rear of the vehicle

  • Be secured with a seat belt

  • Be placed directly on the seat of the car

Always read and understand the car seat manufacturer's instructions and never prop a child up with blankets and/or pillow. Never place an infant in a rear-facing child safety seat in the front seat with an air bag. The new car seat safety recommendations from the American Academy of Pediatrics (AAP) state that all infants and toddlers should ride in a rear-facing car safety seat until they reach age 2, or reach the maximum height and weight allowed by the car seat's manufacturer. 

Toddlers (up to 40 pounds and ages 2 to 4 years)

The car seat should:

  • Be placed in the back seat

  • Face forward

Toddlers should ride in a forward facing car seat as long as they fit well—that is, the child's ears should be below the top of the back of the seat, and his or her shoulders below the seat strap slots.

Children (40 to 80 pounds)

Check in your state when children can begin using safety belts; the regulations differ from state to state.

Children more than 40 pounds and taller than 40 inches should use a booster seat with a lap and shoulder belt (the child's head should not be higher than the back of the car's seat). Another option is for the child to sit on the seat and use a lap and shoulder belt if a proper fit can be maintained.

The booster seat:

The CDC recommends that parents use booster seats when driving with children ages 4 to 8 years, those who weigh more than 40 pounds, and those who have outgrown their child safety seats.

Booster seats are designed to raise children up on the car seat so that the lap/shoulder belts fit properly. The preferred type of booster seat is a "belt-positioning" booster seat and requires a lap/shoulder belt in the back seat of the vehicle. Children should start using a booster seat when they grow out of their convertible child safety seats. This occurs when their ears are level with the top of the back of the safety seat, and their shoulders are above the top strap slots. It also occurs when they reach the upper weight limit for the seat. They should continue to use a booster seat until they are at least 58 inches tall, have a sitting height of 29 inches, and weigh 80 pounds.

Booster seats should always be placed in the back seat of the vehicle, and it is recommended that all children 12 years and younger ride in the back seat.

What are tether anchors?

In an effort to ensure the safety of children in vehicles, manufacturers have a new standardized child safety seat system in new cars to make seat installations easier. Known as the LATCH system (Lower Anchors and Tethers for Children), most new vehicles will be equipped with upper tether anchors for forward-facing child safety seats that have top tether straps. By attaching the top of the child safety seat to the vehicle, it ensures a more securely attached child safety seat, increasing the protection for the child. In addition, new vehicles will be equipped with special child seat anchorage points between the vehicle's seat cushion and seat back, allowing the child seats to be attached to the anchorage points instead of being secured with the vehicle's seat belts.

Replacing child safety seats and seat belts after a crash:

Once a vehicle has been in a severe crash, child safety seats and seat belts should be replaced because they may have become stretched or damaged. Always check with your child safety seat manufacturer concerning questions about the safety of your child's seat.

When car seats are recalled:

Sometimes, child safety seats are recalled for safety reasons. To check if your child safety seat has been recalled, call the seat's manufacturer or the Auto Safety Hot Line at 1-888-DASH-2-DOT. If the seat has been recalled, you will be instructed on how to repair it, or how to obtain parts to repair it.

The importance of shoulder belts:

A lap/shoulder belt offers more protection than a lap belt alone. The shoulder belt prevents forward motion if you are in a head-on crash; it should lie across your shoulder, but may touch the base of your neck. Never place the shoulder belt behind you or under your arm. If your car has only lap belts in the rear seat, you should consider installing lap/shoulder belts. Many cars with lap belts can be retrofitted with shoulder belts for a small cost. Check with your car's manufacturer.

Most experts believe that many injuries could be prevented if child safety seats and lap/shoulder belts are installed and used correctly. Remember to always buckle up when you are in the car, no matter how far you are traveling.

Air bag safety:

When used properly, air bags save lives while presenting minimal risk. Almost all persons who have died from air bag-related injuries were either unrestrained or improperly restrained.

However, air bags do pose risks to children ages 12 and younger. For this reason, the AAP recommends that these children ride properly restrained in the back seat at all times. They also recommend the following:

  • Never place an infant under age 1 or under 20 pounds in the front seat of a car with an air bag. Infants should always ride in a safety seat, facing rear, and in the back sear of the car.

  • Properly restrain all children in the appropriate car safety seats, booster seats, or shoulder/lap belts, based their size (height and weight).

  • Install an air bag on/off switch, only if your child has a special health care need and requires constant observation during travel, and no adult is available to ride in the back seat with the child.

  • When no other arrangement is possible and an older child must ride in the front seat, move the vehicle seat back as far away from the air bag as possible. Keep in mind that the child may still be at risk for injuries from the air bag.

What is the proper use of air bags?

Always buckle your lap/shoulder safety belt as air bags are designed to work with the safety belts.

  • Children under age 12 should be restrained in the back seat. A car safety seat with an infant should never be placed in front of a passenger air bag because the infant's head is too close to the air bag when it deploys.

  • Drivers should sit at least 10 inches from the steering wheel to provide maximum protection and minimize friction from contact with the back as the air bag deploys.

  • Drivers should position their hands at the 10- and 2-o'clock positions on the steering wheel to provide the greatest protection by allowing the air bag to deploy unobstructed.

Who is at risk for falling asleep while driving?

According to the American Medical Association (AMA), experts say that drowsy drivers are just as dangerous as drunk drivers, yet many people do not hesitate to get behind the wheel of the car when they are sleepy. Certain individuals are at particular risk of having a sleep-related car crash. This includes, but is not limited to, the following:

  • All drivers who are sleep deprived

  • All drivers who are driving long distances without rest

  • All drivers who are driving through the night

  • All drivers who are or have been drinking alcohol

  • All drivers who are or have taken medication that makes them drowsy

  • All drivers who are driving alone

  • Young people (under age 25)

  • Shift workers (unconventional schedules contribute to fatigue)

  • Commercial drivers who drive long distances at odd hours

  • Persons with undiagnosed sleep disorders

What are the signs of a sleepy driver?

Signs that you, your driver, and/or other drivers on the road may be too sleepy to be safely driving a vehicle include the following:

  • Eyes closing or going out of focus

  • Trouble keeping head up

  • Continuous yawning

  • Wandering, disconnected thoughts

  • Not remembering driving during the past few minutes

  • Drifting between lanes, tailgating, or missing traffic signs

  • Jerking the car back into the lane

  • Drifting off the road and narrowly missing a crash

Anyone who is experiencing any of these symptoms should pull off the road and find a safe place to nap right away.

Driving while taking medications:

Drivers taking over-the-counter or prescription medications should be especially cautious. These can often cause immediate drowsiness. A recent study found that persons taking common antihistamines and allergy medications had poorer driving performance than those who consumed alcohol. Physicians recommend not driving after taking these medications, or driving with extreme caution if driving is absolutely necessary.


Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Online Medical Reviewer: Roux, Susan L., ARNP
Last Review Date: 04/14/2013
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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