This week (9/15/13-9/21/13) is Child Passenger Safety Week. Car crashes are the leading cause of death for children in the United States. The best thing you can do to help protect your child in the event of a car crash is to put him or her in a safety seat that is right for his or her age, weight, and height, and that is properly installed in the back seat of the car.
Children aged 1 through 3 should be kept in a rear-facing car seat as long as possible, until he or she reaches the maximum height and/or weight limits. Convertible seats, which have higher weight and height limits, can be used in the rear-facing position and then converted to the forward-facing position once children outgrow the rear-facing seat.  Your child is ready for a forward-facing seat with a harness, still in the back seat of the car, when he or she reaches the weight or height limitations specified by the manufacturer for your rear-facing seat. They should stay in the forward-facing seat with a five-point harness until they outgrow the weight and height limits specified by the manufacturer. When your child exceeds the size limits on his forward-facing seat he is ready to use the car’s seat belt, but must still sit in a belt-positioning booster seat so that the seat belt is secured properly. The safety belt should be across the chest and shoulder and across the top of the thighs, and the back seat of the car is still the safest. Typically children are able to transition to a regular car seat belt when they are approximately age 8 or 4’9″ in height.

A common mistake in the use of child car seats is fitting the harness too loosely. The harness should be snug enough that you cannot pinch any extra material on the child’s collarbone. The straps should be at or above the shoulder for forward-facing seats and at or below the shoulder for rear-facing seats.

Make sure car seats are properly installed by following the manufacturer’s instructions carefully. Most vehicles made after 2002 have lower anchors that are part of the LATCH system (Lower Anchors and Tethers for Children), to which car seats may be attached. These lower anchors have a weight limit of around 40 to 48 pounds, depending on the vehicle. Once your child has reached the weight limit, the car seat should be installed using the seat belt rather than the lower anchors. Be sure to check your vehicle’s owner’s manual for weight limits on the lower anchors. Once the seat is installed, check to make sure that it can’t move more than an inch from side to side along the belt or lower anchor. To ensure you’ve installed the car seat correctly, have it inspected by a certified child passenger safety technician.

If your child has special needs, choosing the correct seat and having it properly fitted can sometimes be more complicated. Often conventional car seats (such as those described above) are suitable for children with special needs, but not every car seat is suitable for every child. There are many different special needs car seats and seating adaptations, depending on the particular needs of your child. Here are a few ideas:
A conventional car seat (such as those described above) may be appropriate for your child, as long as he or she does not try to unfasten the restraint. Children with developmental disabilities who have impulsive behaviors can be distracting or dangerous in a moving car, especially if they try to escape their car seats. You might also consider using an upright vest such as those made by E-Z On. There are various models that can have either front or back closures, to keep children with behavioral problems from unfastening their restraints in the car.
There are also several options for children with low muscle tone or poor head control who need extra postural support or must travel in a reclined position. Infants who must lie flat (often due to prematurity), can be secured in an infant car bed such as Angel Guard. E-Z on also makes a modified belt that can secure an older child who needs to lie down in the car, as may be the case if he or she has been placed in a hip spica cast or HALO vest. There are many manufacturers who make car seats that provide extra postural support or head support, with many different positioning tool options.
Our occupational therapist Michelle Nigl-Chang CPST is a Certified National Car-seat Technician with enhanced training for special needs seating, and can help with questions you might have about choosing the right seat for your child and having it properly installed. The National Highway Traffic Safety Administration and the Safe Kids Coalition also offer car safety seat checks, visit their websites for more information about events in your area.
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