Four-year-old Anton Skeen was sleeping in the front passenger seat of the family’s sport-utility vehicle, which was not equipped with an air bag. He was wearing a seat belt. His mother, Autumn, was driving. Skeen’s car flipped three times. Her seat belt held her secure, but Anton was thrown from the vehicle and killed. The state patrol found his seat belt still fastened, but because of his size, the belt couldn’t hold him properly.
Like many parents, Skeen, who lives in Walla Walla, Wash., didn’t know that children who are getting too big for child safety seats, usually around age 4, should graduate to booster seats, not seat belts. And they should stay in booster seats until they fit a seat belt properly, usually around age 9.
Fewer than 5 percent of children who should be in booster seats actually are, said Dr. Flaura K. Winston , a pediatrician and biomechanical engineer at Children’s Hospital of Philadelphia and director of TraumaLink, the Center for Interdisciplinary Pediatric Trauma Research.
Most parents have been skipping a step and making a potentially deadly mistake, moving children directly from child safety seats to seat belts when they turn 4, generally considered the point at which they have outgrown a child seat.
Or, even more inappropriately, they put their children into seat belts at 2, Winston said. “When the next child is born, they give the car seat to the baby. They are really far off from what is considered best practice.
“When I talk to my patients and tell them that the best practice, based on research from hospitals and universities and the National Highway Traffic Safety Administration and American Academy of Pediatrics, involves using a booster seat, the parents say: `You’re kidding. You mean I’ve been doing something that could potentially hurt my child?’ Especially when you describe seat-belt syndrome and what could happen, that really grabs their attention.”
Seat-belt syndrome describes two types of injuries that can occur in a crash when a seat belt doesn’t fit a child correctly: ruptured internal organs and fractures of the lumbar spine or spinal cord injuries, which could result in paralysis.
When lap/shoulder belts fits a child properly, his knees bend comfortably over the edge of the seat and his back is right up against the back of the seat. At that point, the lap belt is over the bones of the hips and low on the lap, not riding up around the waist. The shoulder belt sits across the clavicle and shoulder.
When children are put in seat belts too soon, the thighbone isn’t long enough to enable the knees to bend comfortably over the edge of the seat while the back is resting against the seatback.
“We’re talking about a geometry problem,” said Kathleen Weber, director of the Child Passenger Protection Research Program at the University of Michigan Medical School. “If kids can’t comfortably fit in the seat, they are going to slouch. The child’s pelvis slides under the lap belt and then it pulls up around their waist.”
This places the lap belt directly over the delicate liver, spleen and stomach.
“If you’re in a crash, all the forces of the crash are concentrated on that belt, and they are (transferred) right to those livers and spleens and stomachs,” said Winston.
When the shoulder belt doesn’t fit properly, it can slide off or be uncomfortable. If it is uncomfortable, the child or parent may slip it behind a child’s back. Without the upper body restrained, the child’s body bends rapidly or jackknifes over the poorly positioned lap belt in a crash, forcing the spine to bend where it isn’t built to bend, resulting in a fracture of the lumbar spine or spinal-cord injuries.
“We had a child at our hospital last year who was wearing a seat belt in a crash and was paralyzed,” said Winston.
Head injuries are another problem, she said. If the upper body isn’t restrained properly, children get concussions and skull fractures when the head hits the knees or strikes the vehicle’s interior.
The lap belt is crucial, said Weber. Yet parents mistakenly focus on the fit of the shoulder belt, worrying if it rubs the child’s neck.
Of course, it’s not a good thing if the shoulder belt is across a child’s nose or throat. But that’s a giveaway that a child should be in a safety or a booster seat.
But as long as the shoulder belt is over the clavicle, there isn’t a problem just because the belt rubs on the child’s neck, said Weber.
“Accident data do not indicate that children have neck injuries other than maybe an abrasion on the side of the neck,” said Weber.
You have to change a child’s geometry so he or she fits into a lap belt the way it was designed to fit an adult, which is to restrain people using their strongest body parts, the bones of the pelvis and the shoulder. That’s where the booster seat comes in.
Parents should think of booster seats as belt-positioning devices, not restraints.
“The critical thing is that the booster adjusts the lap-belt fit. It also adjusts the shoulder-belt fit because you are raising the whole child up,” said Weber
Booster seats are of two types. One type of belt-positioning booster seat is called a high back, the other is called a low back or backless.
Then there is a shield booster.
“The American Academy of Pediatrics does not recommend shield boosters any more because of a risk of submarining and ejection,” said Winston.
And backless boosters can be as good as high-back designs, Weber said. Backless boosters do a good job of routing lap/shoulder belts correctly, they are cheaper than high-back designs and older children might like them better because they don’t look like child seats.
“The only reason you need a high-back booster is if you have a low back seat that doesn’t support the child’s head,” she said.
There is no easy answer as to why parents don’t use booster seats for their children. One might be that parents don’t know what boosters do, Winston said. Unlike a child safety seat that has to be cinched down tightly, a belt-positioning booster sits on the seat.
“So parents think of a booster seat like something that you use in a restaurant so the kid can reach the table. But they don’t understand that the whole purpose is to help make the seat belt fit right. There’s very little information out there on booster seats and how important they are.”
Also, children of booster-seat age are asserting their independence, and parents are picking their fights. Because they don’t understand the importance of booster seats, this isn’t a battle that they choose to fight.
“A lot of people don’t understand it, including my colleagues,” said Winston, “and besides that, no one else is using them.”
At this age, children are riding around in many vehicles other than those of their parents, and it’s a problem moving the booster from one vehicle to another or remembering to leave it at school if they are being driven home by a friend’s parent. This is something Winston, who has two boys ages 10 and 5, deals with all the time.
Then, if you expect other parents to use your booster seat when they aren’t using one for their children, “they will look at you like you’re crazy,” Winston said.
“Kids who are in booster seats love them because they are comfortable. Their knees bend at the right spot and they are higher so they can see out the window. They really like them. But once they get past liking it and see that their friends aren’t in a booster seats, they just stop using it. There is this mixed message.”
Safety experts say children age 4 to 8, weighing 40 to 80 pounds or shorter than 4 feet 9 inches should be in booster seats.
Age, height and weight guidelines are important, but children vary in sizes at different ages. There are additional ways to judge whether your child is ready to use lap/shoulder belts alone.
“People have to know what they are aiming for so they shouldn’t be hung up by rigid limits on either end,” said Weber.
With the child’s back against the seat back cushion, “if their knees don’t bend comfortably at the edge of the seat cusion, it is guaranteed they are going to need a booster.”
“Other than that you can look at where the lap belt ends up. It’s important to understand that the lap belt is a lap belt, not a waist belt. But just because the lap belt is in a good place when the child is sitting ramrod straight, it doesn’t meant that 10 minutes down the road they’ll still be sitting the same way.
“You have to give children something to sit on that will allow them to sit relatively upright under this lap/shoulder belt because that’s the way they are designed and that’s the way they need to be used.”
“Boosters, for whatever reason, have not taken off yet,” Weber said. “They are still a hard sell, as infant restraints were 25 years ago. These things come around gradually. But we have had this mindset for so many years now of `use a car seat until your child is 3 or 4 and then put her in the back with a belt around her.’ We just have to develop a new mindset.”
BOOSTER TIPS
Here are tips on properly restraining your child in a booster seat.
– The vehicle shoulder belt should be over the child’s shoulder, not his neck, face or arm.
– To keep the child’s head from striking the vehicle interior in a crash, do not let the belt be moved off the child’s shoulder.
– The shoulder belt must adjust but remain snug at all times.
– Put the lap belt low on the child’s lap to prevent possible abdominal injuries.
– Don’t use a booster seat with a lap belt only, with a door-mounted lap-and-shoulder belt or with a motorized shoulder belt.
– Accident statistics show that a child is safer when restrained in the back seat.
Source: Fisher-Price.
