UNC Health Care
Orange Car Seat Inside Small Family Van.

Child Safety Seats: Are They Used Correctly?

Robin Deal, BSN, RN, CCE is the Perinatal Services Manager for Rex Healthcare. She has been a Child Passenger Safety Technician for over 15 years.

September 13-19 is National Child Passenger Safety Week. Safe Kids coalitions and other organizations are holding child safety seat inspections to emphasize the importance of proper car seat installation and use.

Do most parents and caregivers use child safety seats correctly?

Baby boy in child-safety seat.
Be sure you are using your Child-Safety seat correctly: your infants life may depend upon it.

According to researchers at the Oregon Health and Science University Hospital led by Dr. Benjamin Hoffman, the answer is no!  In an ongoing study, new mothers who were asked to install a child safety seat in their vehicle and position their newborn in the seat under the supervision of a certified child passenger safety technician (CPST) did not do it correctly. 93% made at least one critical error in positioning their child in the car seat or installing the seat in their vehicle.*

Additionally, the study showed 68% made a harness error, 33% positioned the retainer clip too low, 28% used the incorrect harness slot, and 14% did not know how to adjust the harness.  The most common installation errors were a seat that was too loose (43%), incorrect angle (36%), and an unlocked safety belt (23%), There was an average of 2.3 positioning errors per family and an average of 1.9 installation errors per family.

The National Highway Safety Administration (NHTSA) reports that child safety seats reduce the risk of death in passenger cars by 71% for infants and by 54% for toddlers ages 1 to 4 years.  Proper usage of a child safety seat requires a combination of reading and following the car seat manufacturer’s instructions along with the vehicle owner’s manual that includes a section child seat safety.

Here are a few tips to help you install and use your child safety seat correctly.

  • Mother with daughter in child-safety seat
    Read the manual for your child-safety seat AND your car, to be sure you do everything correctly.

    Read all directions carefully in both manuals – vehicle owner’s and car seat

  • Know and understand the locking system of your seat belt.
  • Install the seat with less than one inch of movement – it does not have to be immoveable!
  • For a rear-facing seat, use the correct angle as noted by the indicator on the seat.
  • Position the harness retainer clip at armpit level.
  • Choose the harness slots that are at or below the child’s shoulders for a rear-facing seat.
  • Snug the harness so you are not able to ‘pinch up’ the material.
  • Know how the LATCH system works if you have it in your vehicle (hint: owner’s manual!).
  • Avoid the use of products that did not come with your child safety seat.

There is no substitution for reading all instructions thoroughly before installing and using your seat.  Additional assurance that you are correctly using your child seat can be provided by having your seat inspected by a certified Child Passenger Safety Technician (CPST).

Premature infant in a child-safety seat
Be sure to get the correct seat if you have a preemee: lower weight limit of 4 pounds and low harness slots.

If your baby is premature, make sure you choose a seat appropriate for the weight and length of your baby.  Select a seat that has a lower weight limit of 4 pounds and low harness slots.  Most premature babies are tested in their seat before discharge from the NICU to make sure they can ride safely in their seat.

Rex is proud to offer car seat inspections and classes for caregivers.  A certified CPST is available from 8:30 AM- 12:30 PM Monday, Wednesday, Thursday and Friday to inspect your car seat installation for free.  Please note:  We ask that you have read your instructions and installed your seat prior to coming to the inspection area in front of the Rex Women’s Center.  You may contact our technician, Chris Morris, at 919-784-1802 or Robin Deal at 919-784-3340.

*Hoffman B. Abstract #25919.  Presented at the 2014 AAP National Conference and Exhibition, ‘Majority of Parents with Newborns Misused Car Safety Seats.’