As a nurse you can play an important role in teaching a parent about car seat safety. This education actually starts at birth before the baby goes home in its first car ride from the hospital. This lecture will concentrate on the main concepts you need to know as a nurse and for exams.
Don’t forget to take the car seat safety quiz after reviewing this material.
First let’s talk about the types of car safety restraints available. There are four types of car safety restraints that can be used in a motor vehicle:
- Rear-facing restraint
- Forward-facing restraint
- Booster Seat
- Seat Belt
The type of car safety restraint used for a child in a motor vehicle depends on the following factors:
- Child’s height and weight
- Look for signs that the child fits properly in the car safety restraint….which we are going to cover.
- Child’s development (do they have any special needs or disabilities, can they following instructions etc.)
- The manufactures height and weight limits of the car safety restraint
- Stress to the parent to become very familiar with the instruction manual of the car safety restraint that they have purchased to use for their child.
- The manual will explain height and weight limits, expiration date of the equipment, how to install and secure the child in the restraint.
- As a side note, to help guide parents in selecting a car safety restraint the National Highway Traffic Safety Administration has a website that helps the parent determine what type of device the child should be in. The parent just has to type in their child’s age, height, and weight.
- EDUCATE: When selecting a car safety restraint the parent should avoid ONLY going by an age parameter (especially when upgrading the restraint) but rather a combination of the child’s height, weight, and device limits as noted above.
- The manual will explain height and weight limits, expiration date of the equipment, how to install and secure the child in the restraint.
- Stress to the parent to become very familiar with the instruction manual of the car safety restraint that they have purchased to use for their child.
Car Seat Safety Lecture
General Guidelines to Remember about Child Car Safety:
- The back seat in the safest place for a child 12 and under.
- Apply parental locks to the doors and windows.
- After installation: A rear-facing and forward-facing car seats should NOT move no more than 1 inch from side-to-side or front to back.
- Don’t dress the child in bulky clothes when in a restraint because it affects how the device works to secure your child and it could increase the risk of suffocation.
- State laws vary among states for car seat safety, and they usually enforce the bare minimum for guidelines to follow when using child car safety restraints. The American Academy of Pediatrics guidelines are the best to follow because they are based on recent evidence and research that is designed to help keep kids safe while in a vehicle.
4 Types of Car Safety Restraints
Rear-facing Restraints: These restraints sit your child backwards in the vehicle in a 5-point harness.
- Start using these devices at birth. Their use extends until a child is a toddler or preschooler.
- The most recent guidelines by the AAP state to start your infant out in this type of restraint and to keep them in this type of restraint until they outgrow the rear-facing restraint, which is typically around 4 years of age.
- What happened to 2 years? In 2018, the AAP removed the age criteria and now recommend keeping the child in this type of restraint until they outgrow the rear-facing restraint.
- There are different types of rear-facing restraints (all are 5-point harness) with different height and weight cutoffs.
- Example:
- Infant rear-facing restraint (like the one here…it has the base that stays in the car and is designed to be mobile in that you can carry it around): limits for this model include: 5-22 lbs. and 19-29 inches
- Convertible rear-facing to forward-facing restraint (stays in the car…not mobile): this model’s weight limits is up to 50lbs. for rear-facing and 65 lbs. for forward-facing
- Educate parent about knowing the manufacture’s limits for the restraint, but LOOK for these SIGNS that the REAR-FACING restraint fits the child:
- Head is at least 1 inch BELOW the top of the restraint
- Straps of harness at the shoulders should be at or BELOW the child’s shoulders.
- Should not be able to detect slack in the harness when you attempt to pinch it
- Chest clip when buckled should rest at the level of the armpits
- Normal as the child grows to not have as much leg room
- You may start to notice that the legs come into contact with the back of the seat. It’s not recommended to switch a child to a forward-facing restraint because of this issue alone. Many car seat manufactures are now adding extension panels to this area to provide more room.
- Example:
Forward-facing Restraints: These restraints sit your child forward in the vehicle in a 5-point harness.
- This type of car safety restraint is used once the child outgrows a rear-facing restraint.
- Starts using during the preschooler years and extends until school-age.
- Used until the child outgrows the forward-facing restraint.
- Typically children outgrow this device by 6, but this can vary.
- Know the manufactures limits for the restraint but LOOK for these SIGNS the restraint fits the child properly:
- Helix of the ears (top part of the ears) are BELOW the head of the restraint
- Straps of harness at shoulders should be at or ABOVE the child’s shoulders
- Should not be able to detect slack in the harness when you attempt to pinch it
- Chest clip when buckled should rest at the level of the armpits
Booster Seat Restraints: These restraints sit your child forward in the vehicle using the car’s seat belt system (both the shoulder and lap belt is used together).
- This type of car safety restraint is used once the child outgrows a forward-facing restraint.
- Starts at school-age and extends until the child is ready for a seat belt.
- Used until the child can securely and properly use the car’s seat belt. Typically when the child is 4’ 9” and is about 8-12 years of age (every child is different).
- LOOK for these SIGNS the child is ready for this restraint and it fits the child:
- Developmentally ready? Obey instructions and sit still in the car (won’t try to unbuckle self or move around in the car).
- Look at the shoulder and lap belt position:
- Shoulder belt should sit across the middle of the collar bone and chest (NOT around the face or neck).
- Lap belt should be positioned on the lower part of the hips (not on abdomen) on the upper legs
- NOTE: the lap belt should go UNDER the arm rest on both sides of the booster seat NOT above it.
Seat Belt Restraints: The child sits forward in the vehicle using the car’s seat belt (both the shoulder and lap belt should be used together).
- This type of car safety restraint is used once the child outgrows the booster seat.
- Starts at preteen age and extends for entire lifetime.
- Typically started when the child is 4’ 9” and about 8-12 years of age (every child is different).
- LOOK for these SIGNS the child is ready for the seat belt:
- How the seat belt looks on the child? Similar to how it looked when the child was using a booster seat.
- Proper position of the shoulder strap in that it sits across the shoulder on the middle of the collar bone and chest. The lap belt should sit across the lower part of the on the upper thighs (not on the abdomen).
- Look comfortable and proportional? Back is against the seat, legs dangle down and bend over the seat, and they are developmentally mature enough.
- This seat belt does NOT fit the child yet:
- How the seat belt looks on the child? Similar to how it looked when the child was using a booster seat.
References:
Resources | Motor Vehicle Safety | CDC Injury Center. Cdc.gov. (2021). Retrieved 4 February 2021, from https://www.cdc.gov/transportationsafety/child_passenger_safety/resources.html.
The Right Seat. National Highway Traffic Safety Administration. (2021). Retrieved 4 February 2021, from https://www.nhtsa.gov/campaign/right-seat.