Keeping Our Babies Safe in Motion

Author // Bridget Horan, DC, DACCP

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Although I would love to stay at home all day with my baby, my life requires me to leave home on occasion.

Well actually, my son, Xander, and I usually have to venture out everyday. The one thing I can count on is that when I put Xander in his car seat I have done everything possible to make him safe on our journey. When I was pregnant, I went to register for my baby shower. What a confusing and overwhelming experience to say the least. You have the list of “necessities” and the little sensor gun. Of course, once you got started, the things like bedding, towels, and clothes were easy. You just picked the color scheme you wanted. Then, it was time to pick out the stroller and high chair. These items were also based on the look, color, and ease of setting up and taking down. Now, I was almost done. I had only the car seat left. I remember standing there in the aisle just staring. I had no idea what I needed. There were infant-only seats, toddler seats, convertible seats, and booster seats. There were instructions on them regarding forward facing and rear facing. Did they all fit in every car? Will my baby need the same seat or different seats? Was it based on age or weight? I had to stop and think a minute. I then decided to call a few friends who already have children. After those phone calls, I didn’t know if I felt any better. Each friend had a different brand and style. Each friend had different advice on why their seat was the best. I decided to start with the one that was made for the smallest baby. I chose an infant seat.

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That seems like so long ago. I made a very good choice that day but I have definitely learned a lot since then. I have learned that the best seat for your child is the one that fits your child the best, is used properly, and is used every time you drive. The American Academy of Pediatrics has issued some basic guidelines for Car Seat Safety. There are as follows:

  • Always use a car seat.
  • Read the car seat manufacturer’s instructions and keep them with the car seat.
  • Read your vehicle owner’s manual for important information on how to install the car seat correctly for your specific vehicle.
  • The safest place for all children is in the back seat.
  • Never place a child in a rear-facing car seat in the front seat of a vehicle with an active passenger airbag.
  • The harness system holds your child in the car safety seat. The seat belt or lower anchors and tethers for children (LATCH) system hold the car seat in the car.

All of these may sound like common sense, but many children are unnecessarily injured in car accidents because car seats are used incorrectly or not at all. Children are improperly placed in them or are in a car seat not right for their size. Many safety experts believe that 80–90% of car seats are not installed and/or used properly.1 Nationally, motor vehicle crashes are the leading cause of death for children ages 1 to 14 years. We can take steps to change these statistics.2

In my state, Illinois, the law requires that a child from birth to 8 years of age be transported in an appropriate child safety seat or booster seat when traveling in a vehicle. Children between the ages of 8 and 16 must be secured in a seatbelt.2

There are different types of seats for the different ages and weights your child will grow through. There are infant seats, which your baby should be in from birth until one year of age and 20 pounds. There are convertible safety seats, which should be used rear-facing prior to your child’s first birthday and until your child reaches 20 pounds. Some rear-facing seats may allow your child to remain rearfacing until 30 pounds. The convertible seat should be utilized forward-facing when your child weighs between 20 to 40 pounds and is at least one year old. Most forward-facing child seats have an upper weight limit of 40 pounds and should not be used if your child weighs more than 40 pounds. A belt-positioning booster seat should be utilized if your child weighs approximately 40 to 80 pounds. Some booster seats have upper weight limits of 100 pounds. These are general guidelines, so always check the weight and height limits for the seat that you purchase.2

If you are using a used car seat the American Academy of Pediatrics strongly suggests, be sure to keep a few things in mind. How old is your car seat? Check with the manufacturer for recommendations regarding how long a seat is usable.3 Most seats come with an expiration date. Most guidelines indicate a child safety seat should only be used for 6 years from its manufacture date.2 Has the car seat ever been in a crash? If so, it should not be used. Are there manufacturer labels with the seat name or model number? If not, you should not use it because you will not be able to keep current with recalls. Are there instructions with the car seat? If not, you need to get them from the manufacturer before you use the car seat. Don’t use if the frame has any cracks or is missing parts.3

Now, your next step is to learn how to use the seat you picked out. One of my biggest inspirations for writing this article is that I commonly hear mother’s talk about how excited they are to finally have their children forward facing now because they are twenty pounds. I am very concerned because these children have not reached the age of one year yet. Carefully read the instructions that came with the car seat and the owner’s manual for your specific vehicle when installing the car seat. Fill out and mail the owner’s card that came with the seat. This is how you will be notified if there is ever a safety recall on the seat. If you still have problems getting the child seat to fit properly in your vehicle, you can have your seat checked by a Certified Child Safety Seat Technician. Many police departments, fire departments, and hospitals have trained Technicians to assist in getting the seat installed properly. To locate a technician in your area, go to and click on “Locate a Child Safety Seat Inspection Station” in the Child Passenger Safety section. You can also have your child seat installation checked at a local Car Seat Checkup Event. A list of events can be obtained on the Internet by conducting a search of “Car Seat Checkup Event [your state].” You can also find additional information on child seat safety and laws at the NHTSA website.2

The placement and fitting of the belts on your child in the seat is so important. Please read the manual of the seat and the car to determine where the belts go. The car seat harness should be adjusted so you can only slip one finger underneath the strap at your child’s chest. The harness retainer clip should be positioned across the chest at the armpit level.4 These guidelines are in place to keep your children safe. My frustration regarding the mothers who have turned their infants’ car seats forward too early, is that, although their children may weigh 20 pounds it does not mean they have the musculoskeletal system of a one-year old. The forward direction dramatically increases the probability of serious cervical spine fractures and neurological deficits.5 This is all the more reason to leave your infant rear facing as long as possible. Infants are not necessarily “little adults.” Their skulls are more fragile, their heads are proportionately larger, and their rib cage is thinner. Because they have small stature and their musculoskeletal system is not fully developed, they need the added protection of the car safety seats. According to the National Safety Belt Coalition, car seat restraints provide a “ride-down” benefit during rapid deceleration which works to allow the child’s body to stop as the vehicle is slowing, reducing the forces on the child’s body and preventing contact with hard surfaces inside the vehicle, with other occupants, the road, or other vehicles. They also act to spread crash forces over the broad area of the body, thereby reducing forces on any particular part of the body, and distributing these forces to the strongest parts of the skeleton such as the hips, back, and shoulders.1 Even our bigger children need special accommodations when riding in our cars. According to SafetyBeltSafe USA, young children who are placed in vehicle belts rather than booster seats are 59% more likely to suffer devastating injuries, including severe damage to the brain, liver, spleen, and spinal cord. Most children need to use a booster seat from about age 4 until at least age 8–10 for maximum protection and improved comfort in the car. Answer this 5-step test the next time you and your child ride together in the car to determine if he or she should still be in a booster seat.6

The 5-Step Safety Belt Test

  1. Does the child sit all the way back against the auto seat?
  2. Do the child’s knees bend comfortably at the edge of the auto seat?
  3. Does the belt cross the shoulder between the neck and arm?
  4. Is the lap belt as low as possible, touching the thighs?
  5. Can the child stay seated like this for the whole trip?

If you answered “no” to any of these questions, your child needs a booster seat to make both the shoulder and lap belt right for the best crash protection. You can also find additional information at

After reading this, there is no reason not to have your child in their car seat every time they are in a vehicle. It does require extra planning sometimes. You have to think ahead when you are traveling. You need to decide if you are going to take your child’s car seat on the plane with you, or are you going to arrange for a car seat for the rental car. I have never had a problem getting a car seat, both an infant and a toddler seat, when I have rented a car. In my experience, limo and taxi services don’t have car seats available because they are not legally obligated to. It is necessary to bring your own. Hopefully, after reading this article, you will take the time to do the extra planning.

Another tempting scenario occurs when your baby is crying too hard in the car seat while you are traveling and you don’t think you can stop anywhere. It really isn’t worth it to take your child out of his seat. Your child is safer crying in the seat than out of the seat. I can’t begin to count the amount of times I pulled over into a parking lot to take care of my crying infant. I would just jump in the back seat and nurse him. It usually didn’t take longer than 10–15 minutes. He was soothed and ready to ride again. Some other helpful tools for the fussy car rider are to be sure he is comfortable in his seat and that nothing is pinching or too tight. Have some car toys handy, play soothing music, use a window shade if the sun is a problem, and sometimes even a window slightly open to allow a little airflow will calm your baby down. You can try to plan your car rides during naptime, and if all else fails, plan your trips when someone else is home to watch your child.

No matter how careful we are and how well we plan, accidents happen. Although accidents can be devastating for the whole family, our small children are especially at risk. According to the American Chiropractic Association Council on Occupational Health, the weight of the head of a child makes the cervical spine much more vulnerable to injury. The infant has little control in the muscles of the neck, and the head can bounce from side to side and fall forward, which can cause serious spine and neck injury.7 Children have more flexible upper bodies and shoulders. This is why it is so important to have the belts fastened correctly. Consequently, the head and cervical spine of a newborn are the most likely to be injured.8 Be sure the harness comes all the way up, over the shoulders. This is also why there is a need for these specially designed child safety seats. A study conducted by the Centers for Disease Control and Prevention in Kentucky and reported in Nation’s Health found a 37% drop in infant fatalities since 1982, ever since the state law mandated the use of child car seats.7 Of course, these fatal injuries are the ones we want to protect our children from the most. It has been noted that some soft tissue injuries and strains to the neck and low back may be caused by the seat belts themselves. Even though these spinal injuries can be very serious, a child under the age of 4 is still 10 times more likely to be killed if they are unrestrained.9 Because of these injuries, it is important to have any injury, no matter how small you think it is, assessed by your chiropractor. Your chiropractor can examine your child and determine the extent of the injury along with developing a treatment plan for the resolution of such injury. Injuries can even occur when there is no collision. It has been found that sudden swerves, stops, and turning corners cause movements of children in a vehicle and subsequent injury.9 Even though your child may not complain of pain, he may have other symptoms indicative of cervical spine injury. A wide range of pediatric symptomatology may result from a suboccipital strain including fever of unknown origin, loss of appetite, sleeping disorders, asymmetric motor patterns, and alterations of posture.10 Your chiropractor can determine if any of these symptoms may be caused by injury to your child’s spine. So, if you were ever in an accident, it would be in the best interest of your family to have everyone in the car get their spine checked as soon as possible.

The qualities of our child safety seats are constantly improving, as are the vehicles we ride in. This article is not meant to scare you from ever taking your child in the car, but to educate you on how to keep your children securely fastened and protected in the car as possible. I hope when you are finished with this magazine, you will find the manual to your car and car seat and be sure your seat is properly installed.

Buckle up and set a good example for your children by using your seat belt every time you drive. Happy travels to you and your family.

Pathways Issue 14 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #14.

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