Booster seat safety

How to choose and use a booster seat
by Melanie Haiken
Reviewed by the BabyCenter Medical Advisory Board

Highlights Why does my child need a booster seat?Which type of booster seat does my child need?How do I know if I've installed my child's booster seat correctly?

Why does my child need a booster seat?Although many of us have fond memories of rattling around in the back of the family station wagon, what we didn't know then is that riding that way was the number one cause of death for children. And now it's even more dangerous out on the road.While the number of motor vehicle injuries and deaths has been declining as more people use seat belts and car seats, the number of crashes continues to go up every year because there are more cars than ever on the road — and auto crashes are still the leading cause of death in children over age 3. Making matters worse, kids these days spend a lot more time in cars than they used to.Luckily, we have seat belts to keep us safe. The problem is, seat belts designed to fit adult bodies don't hold our children securely.That's where booster seats come in. A booster seat does exactly what the name suggests: It boosts your child up so that your vehicle's lap and shoulder belts restrain her safely. Without a booster seat, an adult seat belt can actually cause injury in the event of a crash rather than preventing it.If the lap belt rests on your child's tummy (which it's likely to do without a booster), for instance, she could suffer stomach, liver, or spleen damage in a crash. And if the shoulder belt rests against her neck rather than her chest, she may try to move it under her arm (where it could crack her ribs and damage internal organs) or behind her back (where it offers no protection at all against head, neck, and spinal injuries). These considerations are serious enough that the National Highway Traffic Safety Administration now recommends that all children who've outgrown their car seat continue to ride in a booster seat until they're at least 8 years old and 4 feet 9 inches tall.What's more, strapping your child into a booster seat may well be the law in your state. Arkansas, California, Oregon, Rhode Island, South Carolina, and Washington have all enacted laws that require children under age 6 (or those who weigh less than 60 pounds) to ride in appropriate car or booster seats; New Jersey enacted a law requiring proper restraints for kids under 8 who weigh less than 80 pounds. Safety experts hope that other states will soon follow suit. (To find out exactly what your state requires, go to the National Safe Kids Campaign Web site and click on the state-by-state guide on the right side of the page.)There's plenty of justification for the increasing calls for booster seats: In 2000, 248,000 kids were injured in car crashes and 1,668 children died. Most of them weren't properly restrained, which means that booster seats could have prevented many of those deaths. And while you may assume that most of these tragedies resulted from fiery highway collisions, the truth is that 75 percent of car accidents happen within 25 miles of home, and 60 percent of them happen on streets where the speed limit is 40 mph or less.Of course you want your child to travel safely. The trick is to avoid those "we're just going to the grocery store" lapses, says Stephanie Tombrello, executive director of the nonprofit child passenger safety organization SafetyBeltSafe U.S.A. "Ask yourself, 'If I were in a crash right now, how would I want my child to be riding?'" Then make sure your child rides this way every day.Since convenience is obviously a big issue for time-crunched parents, Tombrello recommends coming up with an approach that's simple and consistent, so that it becomes automatic. If your family has two cars, for example, you'll make things much easier on yourself if you pony up for two booster seats and leave one in each car, rather than trying to move one seat back and forth all the time — a step that's likely to fall by the wayside on especially frantic mornings.
Which type of booster seat does my child need?All booster seats on the market meet the U.S. government's stringent crash- and fire-safety standards, so any seat you buy new is technically safe. (The same isn't true for secondhand seats or seats purchased more than a couple of years ago, which may have been designed to meet outdated standards or been recalled for safety violations.) But even if a booster seat itself meets the government's standards, it can still present safety problems if it's installed or used incorrectly. The safest seat, therefore, is the one that best fits your child and your car and is easiest for you to use.If your child weighs less than 40 pounds, consider using a combination car seat and booster seat. These seats come with a removable five-point harness that's similar to those used in regular car seats. This is considered the safest type of harness because the straps restrain your child at both the shoulders and hips, distributing the force of a collision to the strongest parts of the body. For the best protection, you'll want to use the harness as long as possible, so choose a seat that has several harness-strap height settings, especially if your child is tall.Stay away from older combination or convertible seats that use plastic tray bars or T-shaped shields, since they distribute the force of a collision to the belly, one of your child's most vulnerable areas. In addition to being less safe than a seat with a five-point harness, these seats are also less comfortable for many kids. If your child is on the chubby side, for instance, the plastic tray or shield may press on her thighs or squeeze her tummy. And if she's tall, you may have trouble getting the tray or shield comfortably over her head.When your child grows too tall for a combination car seat and booster seat (when her shoulders are above the seat's top set of harness-strap slots), you can remove the harness and use the seat to boost her height while she's buckled in with your car's lap-and-shoulder belts. Or you can go straight to a simple booster seat.There are two main types of booster seats: high-back or chair-style seats that support your child's rear, torso, neck, and head; and backless seats that raise her rear so that she sits higher in your car's own seat. The type that's best for your child depends mainly on what kind of seats you have in your car.If your rear seat has a low back, you're better off with a high-back model, which will provide your child with head and neck support in a rear collision. If your rear seats are high enough to support her head and neck but are deeply contoured, a backless model will sit more snugly on the seat and be less likely to tip over than a high-back model. Some auto safety experts also give the edge to backless seats because they allow your child to sit farther back in the seat. (One caveat: Stay away from backless boosters that have a shield-style closure; these are not considered safe for children over 40 pounds.)Whichever type of seat you choose, check to see if it has a positioning guide for your vehicle's shoulder belt, which positions the belt across your child's chest in the right place. If it has a guide, make sure it's one that allows the belt to retract easily.Most high-back boosters come with clips on the sides; the best ones have clips at several heights to accommodate your child as she grows. A backless booster should come with a separate belt-positioning clip (even better if it's attached to a strap so it doesn't get lost) and handles or guides near your child's hips, under (or sometime over) which you route the lap belt and the lower end of the shoulder belt.Some high-back boosters have padded "wings" that function as headrests, which are useful if your child still tends to fall asleep in the car. (If you have a car sleeper who rides in a backless booster, you can buy a special pillow that fits around her neck during naps or wedge a rolled blanket between your napping child and the side of the car.) Some car- and booster-seat combos have a recline feature, but they're not recommended because they put too much pressure on a reclining child's groin in a crash.Your child's size is another consideration. If she's on the stocky side, look for a booster with a wide or adjustable base. And if she's tall or big for her age, look for one that has higher shoulder strap slots or a roomier base.
How do I know if I've installed my child's booster seat correctly?Test before you buy. Since boosters are designed to work with your car's lap-and-shoulder belts, they're easy to install; just place them on top of your car's seat. Still, it's important to make sure that your child's booster sits flat against the seat and doesn't tip over easily. If possible, test out the booster in your vehicle and with your child in it before buying.Make sure she's really ready for a booster. One mistake many parents make is putting their child in a booster seat too soon, before she's truly big enough to use it safely. While the instructions on most car- and booster-seat combos say they can be used without the harness starting at 30 pounds, this is really true only for a very tall, thin child who's grown too tall for the harness but doesn't yet weigh 40 pounds. Most kids can and should continue using the harness until they reach 40 pounds. This is particularly true if your child tends to be active in the car, because she may struggle out of a seat belt or push the shoulder belt behind her or under her arm (a much more difficult endeavor when she's strapped into a five-point harness).To see whether your child's ready to move into a booster, have her sit in it and check that she's sitting all the way back against the seat back with her knees bending at the edge of the seat cushion. If she's too small for the booster, her legs will stick straight out and she may slouch or slide forward in the seat, both of which can be dangerous. While she's in the booster, also check the position of your car's lap belt (it should cross her hips — not her belly — and touch the top of her thighs) and the shoulder belt (it should land on her shoulder — not her neck or upper arm — and cross the center of her chest).Make sure the booster is in the right place. The safest place for most booster seats is in the center of the rear seat, where your child is best protected from a side-impact crash. The problem is that many vehicles have only a lap belt in the center back (rather than a lap-and-shoulder belt), which should never be used on its own to anchor a booster seat. If this is true of your vehicle, position your child's booster on either the right or left side of your back seat. (Hint: It's easier to see your child if she's on the right side of the car rather than directly behind you; this also makes getting out of the car easier and safer for her when you're parked on a busy street.)If you have two kids in the car, positioning will depend on what kind of seat belts you have, as well as the contours of your back seat. If you can, you're best off putting one child in the center and one on the right side of your vehicle's rear seat. But if sitting close together is an invitation for your kids to poke, pinch, and grab each other (distracting you from safe driving while you play referee), you'll probably need a buffer zone in the center.In that case, put the younger child on the right side since you'll probably need to check on her more often. If your car is an older model that has only lap belts in the rear seat, you have a real dilemma. Your best bet is to have shoulder belts installed; you can do this by purchasing a retrofit kit from a dealer.And, of course, never let any child under age 13 (booster or no) ride in the front seat, especially if you have a passenger air bag. Air bags may be lifesaving for adults, but they can cause serious head and neck injuries to children when they inflate.Use the booster's belt-positioning clips. If your child's booster came with belt-positioning clips — either on the sides of a high-back booster or attached to a special strap on a backless model — use them if you need to. These clips ensure that the shoulder belt crosses your child's torso correctly. If your car's shoulder belt actually lands on your child's shoulder (rather than her neck or upper arm) and crosses the middle of her chest without the guides, however, you don't need them.If you can, use the anchoring system. Since September 2002, all new car seats and vehicles must be compatible with the LATCH system, short for Lower Anchors and Tethers for Children (combining the previously existing top tethers with lower anchors, built into the rear of the car; some cars built between 1999 and 2002 also have the system). Front-facing toddler/booster combo seats are required to have both the upper and lower attachments. LATCH is not required for booster seats.Get more information on booster seat safety from the National Highway Traffic Administration website.