Car Seat Safety: TBSTP Position Statement

When making any decisions about car seats, we must always start with two facts.

  1. Rear facing is far safer than forward facing. (yes even in Australian car seats)

  2. The majority of car seats are not installed or used correctly, which significantly diminishes their ability to protect your child in a crash.

We must also consider the reality – driving whilst your child screams inconsolably (and you desperately try to calm them) is far more distracting than many things governments have deemed unsafe enough to outlaw whilst driving. Obviously you can’t outlaw kids! But you can certainly limit your car travel as much as humanly possible.

This is clearly easiest for those in the city, as public transport is more widely available. For those in rural and remote areas or who have no option but to use the car, consider what other steps you can take to limit how much you need to drive alone. Take someone with you wherever possible so that you or your partner can sit in the back next to bub.

If you have limited your driving as much as possible and are still finding any drive a nightmare, before you make any changes please consider the following.

General Safety

Putting a blanket or muslin over the car seat to block light also means that there is no ability for you or other adults to check on your child’s head position. Positional asphyxiation does happen in car seats. Additional, baby could knock the blanket down onto their face creating a suffocation risk.

There are many post-purchase devices that are sold to desperate to help their baby cope in the car. Not all of these are safe, and some will void the warranty of your car seat. If you were to be in a crash and the seat does not perform correctly the car seat manufacturers are not liable as you have introduced unsafe accessories.

It is always recommended to get your car seats professional installed by an accredited/authorised fitter at an authorised restraint fitting station. If your baby goods store offers a fitting service please check the qualifications. Take the opportunity to learn from the experts how to install your seat/s and get them checked regularly . Please don’t assume you know or are doing it correctly, check you are.

Flying with a car seat in checked luggage is a risk, if you must do it, get a padded bag. It’s actually far safer for your child to be in their car seat for the flight anyway, so if you’re flying domestically or to a country where your car seat is legal, book bub a seat and take it on board.

Second-hand car seats are a risk too.

If you are going to use a second-hand seat you should ensure it comes from someone you know and trust, get it checked over for general wear and tear (there is however no ability for seats to be tested for crash safety without destroying them in the process), check the used by dates, that it meets current compliance guidelines and run a search for any recalls or known defects.

When you have finished with your car seat you should take it to your regions safe disposal locations. These may be at an emergency services station or a government run service.

Babies should not be given a bottle whilst in a car seat. It’s a aspiration risk. Period.

Never put your child in their car seat swaddled or whilst wearing a parka/snowsuit or towel/dressing gown.

“The primary safety feature of the harness is to keep a child secured in the seat so he rides with the seat but does not move within his harness. The force of a crash will cause the thickness of the coat to flatten, ensuring that the child will move within the harness and increasing the chance for injury. By putting a child in a coat before securing the harness, you compromise the primary safety feature of the harness.”

You can visualize this by strapping your child into her car seat with her coat on and pulling the straps snug, then unbuckling her, taking her coat off, and rebuckling the car seat. See the slack in the straps? When your child’s coat flattens during a crash, that’s how loose the straps will actually become. If you wouldn’t buckle your child in with the straps that loosely, you shouldn’t let your child’s wear her coat in the car seat.”

If you are using a car seat cover as a coat replacement, then this must be the type that only goes over the child, as material under the harness can interfere with the safety of the harness.

Finally, car seats are not safe sleep spaces: “A car seat is designed to protect your child during travel. It’s not for use as a general seat or replacement crib in your home. Sitting in a car seat for lengthy periods poses health risks. It can affect your child’s ability to breathe, contribute to the development of a flat spot on the back of your baby’s head and worsen gastroesophageal reflux disease (GERD) — a chronic digestive disease. In addition, a child can easily be injured by falling out of an improperly used car seat or while sitting in a car seat that falls from a table.”

General Placement

“The back seat is the safe place to ride in the car for anyone. Period.

The middle back is the safest point for anyone.

BUT not all middle seats have ISOFIX or Tether points, and the shape/size of the middle seat may not allow a good install with the shape and size of your car seat.

Which means the safest spot is the spot where you get the best install.

So provided that your car seat can be properly installed in the middle seat the least protected child should be in the middle seat.

Obviously if you have more than one child, you need to have someone on the sides.

There’s two schools of thought here:

Give the youngest child the middle because they are the most vulnerable, or give the forward facing toddler the middle because they are the least protected. There doesn’t seem to be a set answer to this question, as different organizations recommend different approaches.

If you live and a country where it is legal to do so, *and* have a car that can have the front airbag disabled, the front seat is an option for rear facing children. Carseat.se as links to the Swedish research on front seat use for rear-facing car seats, (but it is all in Swedish) where apparently approximately 80% of families with more than one child use the front seat for a baby.

http://www.carseat.se/rearfacing/position-in-vehicle/front-seat-safety/

Rear vs Forward facing.

As stated before the safety increase for a child in a rear facing seat that has been professionally installed and is regularly checked is safer than forward facing.

This remain true until your child’s spine has ossified, which is why in Sweden the culture is to keep kids rear facing until age 4.

“before age two, none of the cartilaginous spaces (in the spine, and pelvis) have completed ossification. Those pieces of cartilage have the ability to stretch up to two inches. Yet only 1/4″ stretch is enough to rupture the spinal column, resulting in paralysis or death (McCall, Fassett & Brockmeyer 2004). Additionally, a child’s immature spine is responsible for supporting a much larger proportion of body weight than an adult’s more mature spinal column. According to Thomas Turbell of the Swedish National Road and Transport Research Institute, “A nine-month-old baby’s head comprises 25% of its total body weight, while in an adult the head weighs 6%… accident research has shown that rearward facing children’s car seats reduce serious injuries by 92%.” (Rear Facing: The Way Forward) The difference in proportion of head to body only adds to the need to safeguard the spinal column.”

This Norwegian PSA demonstrates the issue in video. 
as does this news footage from the USA.

And you can read a complete rundown of the science here:

https://csftl.org/why-rear-facing-the-science-junkies-guide/

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In many countries the legal minimum varies. In those with low legal minimum ages, it can be difficult and expensive to find a car seat that allows for extended rear facing. Australia only recently introduced a type A4/G car seat that allows rear facing till age 3 and forward facing with built in harness up to 7 years, and our laws still state that babies can be turned forward facing at 6 months.

This is well below other OECD nations.

The USA also has a lot of state by state variability, with some states allowing forward facing at a year, and others mandating the federal recommendations of rear-facing for two years. Some states list no rear facing age limits, but do have proper use clauses which require parents to keep the child rear facing until they meet the height *and* weight requirements of the car seat itself. This can cause a lot of confusion for parents.

Whilst car seats do vary in design and safety features to meet the government regulations of each country at least in the USA the manufacturer’s self-certify that their products are compliant and the government only does spot checks.

Additionally “The laws of physics and crash dynamics don’t change based on your state’s/country’s car seat law. A child who is restrained according to best practices will be well-protected and in compliance with the laws in any state/country. Children who are not optimally protected are at higher risk of injury, even if they are in compliance with the law. Consider using your state/country car seat law as a bare minimum, and then go beyond it for the best possible protection.”

Rearward facing at 2 years   – Image Credit- Hannah MacLellan Hackett

Rearward facing at 2 years – Image Credit- Hannah MacLellan Hackett

Example of leg position for rearward facing child as they grow  – Image Credit – Elise Bosaid

Example of leg position for rearward facing child as they grow– Image Credit – Elise Bosaid

img_3098.jpg

Forward facing vs Booster seats

The Transition to a booster seat is another period when the law may not reflect best practice. Car seat manufacturer Britax is campaigning for an end to low-backed booster seats as they offer very little in the way of crash protection.

Video demonstrating the difference.

A high backed booster is always safer. A high backed forward facing car seat with an in-built harness is best practice for children under 4 (law in Australia) and who can’t sit correctly in a lap-sash booster. What’s the difference? http://infasecure.com.au/blog/car-seats-booster-seats-difference/

“when children should still absolutely be rear-facing (i.e., under 4), [A harnessed forward facing car seat is absolutely safer] simply because children who are boostered too early are at tremendous risk for suffering abdominal injuries or submarining out of their car seats.

So what about kids over 4?

Even beyond 4, “children who don’t sit properly will be safer in harnessed seats (which force them to sit correctly) than in boosters, where they can move themselves out of safe positions. However, once children are mature enough to sit properly (i.e., straight up in the centers of their seats), there is no safety difference between harnessed forward-facing seats and booster seats.”

“Once children move into a booster seat and there is only a single seatbelt securing them, their body will be thrown around more in a crash and they are also at risk of submarining. Submarining happens if a child who is too small to use a seatbelt and they slide down and out of their car seat. The crotch strap on a seat with a harness helps prevent this dangerous situation from happening.”

Your child should therefore remain harnessed for as long as possible given the weight and height restrictions of the car seats available in your country. The NHTSA (USA) recommend keeping children in a forward facing harnessed seat until 8.

If harnessed Forward-facing seats that go up to age 8 are not available where you live, then a high backed booster with a lap-sash is the next best option p to age 8 and beyond.

Harnessed Forward Facing 5 year old- Image Credit- Nicole Gorring

Harnessed Forward Facing 5 year old- Image Credit- Nicole Gorring

Booster Seats vs Adult seats

The transition to an adult seat should only be made once your child can pass *all* 5 of the 5-point test. https://www.britax.com.au/tips-advice/does-your-child-pass-the-5-step-test/

Australian law also states children must be 145cm tall to use an adult seatbelt.

That means from 8 until they can pass all 5 steps and meet the minimum height requirements, they should be in a booster. Yes that might mean they are in a booster till 13. That’s the law in some countries anyway.

Children should also sit in the back. “The back seat is the safer place to ride in the car for anyone. Period.

So all children should remain in the back seat of the car until they are driving. As best practice, CPS technicians recommend keeping kids in the back seat until they are a minimum of 13 years old.”

All seats in cars are designed for adults. That means the seatbelts, and airbags are designed with a minimum height and weight in mind. “The Centers for Disease Control, the National Highway Traffic Safety Administration and, most likely, even your airbag and car manufacturer recommend keeping children under age 13 in the back seat.”

“Air bags are designed for a 140-pound man wearing a seat belt. (I know fellow women under 140 pounds, we don’t fit the ideal range either kind of like seat belts are not designed for us, much less pregnant women. But what are car manufacturers to do? They have to use some average.)

Airbags are not designed for children who are much lighter and smaller. As such airbags can cause serious injury to children below the height requirement by hitting them in the face, chest, neck or head at speeds of between 90 to 210 miles per hour.

Nationwide, more than 100 children have been killed by air bags in recent years, and many of these deaths were in slow-speed collisions that should have been minor….” Bone density is also an issue here “Kids may be as big as adults on the outside but their skeletal system is still developing.

According to a study in Paediatrics Child Health, children who are 12 years old or younger have iliac crests that are less developed than those of adults. (The iliac crest is the point part of the hip bone which keeps the seat belt properly positioned on the hips.) This can allow the seat belt to ride up over the abdomen, causing seat belt syndrome.

Children’s breast bones, or sternum, are not fully developed yet either. While this may not fully develop until a few years later, waiting until at least 13 gives it more time to get stronger. Without a mature skeletal system, a child in at increased risk of injury.”

What about travelling?

Taxis, buses and mini-van shuttle services are exempt from car seat laws in many jurisdictions. However most still allow you to use your own car seat if it’s on you.

That’s great for when you’re heading to or from the airport and are taking a car seat with you anyway, but what about the rest of the time?

Some places now have taxi services that cater specifically for families, such as

http://www.bubstaxi.com.au/

https://www.sydneybabytaxi.com.au/

Some airport transfer companies will provide a car seat as well. There are also baby goods hire companies in most major cities.

All car hire companies should have car seats. The problem can be ensuring that they are the right type for your child and fitted correctly. Installation design varies widely across borders, and every type of car seat is different. Trying to work out how to install a car seat that you’ve never seen before after a 12 hr flight is bad enough when you speak and read the language. Throw in a foreign language and negotiating with hire companies can be very difficult! It’s a good idea to triple check the details, and the local laws. If you can find out in advance what type of car seat will be provided, you can at least google or youtube the instructions. Some car hire companies will pre-install the seat, but not all of them – check so you know and can prepare. Triple check that you are going to be given an appropriate car seat for your child’s age, trust us, you don’t want to be stuck in Germany with a 2 year old and a high backed-standard seat belt booster because of language barriers.

If you travel domestically (or to countries you can take your car seat to) a lot, you can get a trolley that converts your car seat into a wheeled seat for your child, meaning you can push it, and them through the airport.

Some car seats are better for travel than others. See the links at the bottom for some comparisons.

For children 4+ there are also alternatives to car seats that are available and legal in some countries such as the:

RideSafer Delight Travel Vest (USA only)

https://csftl.org/ridesafer-delight-travel-vest-review/

https://saferide4kids.com/product/ridesafer-travel-vest/

Mifold Grab and Go Booster (USA, Canada, European Union)

http://www.mifold.com/

Trunki BoostAPak (EU only)

Boostapak

BubbleBum (USA and EU)

https://www.bubblebum.co/us

Summary

As tempting as it is to assume that following the law will be enough to keep your child safe, this is simply not borne out by science. Once again, the laws of physics do not vary state or country. Neither does spinal development, and “Without a CT scan, there is no way to know what stage of development your child’s spinal column is in.”

The Beyond Sleep Training Project encourages all parents to view the laws as a minimum standard. We will therefore delete comments that suggest turning a baby forward facing in order to reduce crying.

“Rear facing is not a choice to be made based on parenting style or opinion; it’s one based on scientific fact. The more we know about physics and physiology, the better we’re able to protect our kids from severe injury as a result of a crash.” – Car Seats For The Littles

Further Reading/References:

Australian car seat laws; http://www.kidspot.com.au/health/family-health/safety/are-aussie-car-seat-laws-putting-our-kids-in-danger/news-story/d0a94625ab47a6625c8588ed4826b3ba

Why Rear facing is safer
http://safeseats4kids.aaa.com/faqs/why/why-is-rear-facing-safer-than-forward-facing/

Why Rear Facing is Safer – The Science Junkies guide
https://csftl.org/why-rear-facing-the-science-junkies-guide/

US Laws state by state
https://www.thespruce.com/us-car-seat-laws-by-state-4082814

Rear Facing Downunder – Types of seats available in Australia
http://www.rearfacingdownunder.com/carseatguide.htm

The Swedish Car Seat Approach
http://www.carseat.se/the-swedish-rear-facing-car-seat-approach/

A guide to Swedish Car Safety For Americans
https://www.thecarcrashdetective.com/a-guide-to-swedish-child-car-seat-safety-for-americans/

Volvo- Children in cars safety manual

http://www.carseat.se/images/volvo.pdf

Car seat safety – ten mistakes to avoid
https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/car-seat-safety/art-20043939?pg=2

Where should you put your car seat?
https://saferide4kids.com/blog/where-to-put-your-car-seat/

5 times safer

http://thecarseatlady.com/5-times-safer/

Why ride rear facing?
http://thecarseatlady.com/why-ride-rear-facing/

NHTSA on FF v’s Boosters
https://www.nhtsa.gov/equipment/car-seats-and-booster-seats

The UK’s new (2017) car seat laws
https://www.express.co.uk/life-style/cars/773583/new-car-seat-law-2017-UK-child-booster-rules-explained

When can kids sit in the front?
https://lifehacker.com/when-kids-can-stop-using-a-booster-or-sit-in-the-front-1699205255?IR=T

https://www.whichcar.com.au/car-advice/how-old-must-a-child-be-to-sit-in-the-front-seat

Coats
https://www.education.com/magazine/article/coats-car-seats/

https://www.consumerreports.org/car-seats/the-dangers-of-winter-coats-and-car-seats/

http://msue.anr.msu.edu/news/why_winter_coats_and_car_seats_are_a_dangerous_combination

Cars with Inflatable seat belts
https://www.britax.com.au/service-support/inflatable-seat-belt-policy/

Is a harness child seat safer than a seatbelt child seat?

https://www.racv.com.au/membership/member-benefits/royalauto/motoring/information-and-advice/is-using-a-child-car-seat-with-a-harness-safer-than-a-seatbelt.html

Best car seats for pre-schoolers
https://www.thecarcrashdetective.com/best-car-seats-preschoolers/

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Travel and car seats

https://www.wheressharon.com/x-featured-discussions/best-travel-car-seats-best-travel-booster-seats/

https://travelswithbaby.com/blog/best-car-seats-travel/

http://adventurebaby.com/best-travel-car-seat/

https://pintsizepilot.com/faa-approved-car-seat-on-airplane/

https://csftl.org/car-seats-travel/

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Research findings

https://www.sciencedirect.com/science/article/pii/S0386111214000260

https://www.ncbi.nlm.nih.gov/pubmed/18450877?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Folksam research findings
https://www.folksam.se/media/Rapport_Bilbarnstolar_2016_Eng_K3_tcm5-33085.pdf

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Worried about “rebound” or “twisting” of a rear-facing car seat in a rear-end crash?
Read:
https://www.washingtonpost.com/local/trafficandcommuting/study-of-rear-end-crashes-finds-head-injuries-from-rear-facing-child-seats/2015/11/01/589095e2-7cf4-11e5-b575-d8dcfedb4ea1_story.html

And:

https://www.consumerreports.org/cars-rear-facing-car-seats-are-still-the-safest-way-for-young-kids-to/