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Ask the Doc: Car Seat Safety

When you get into the car, there is more to focus on than just making sure your child is buckled in. Deborah Sickmon, a pediatric wellness and safety expert at St Joseph’s Children’s Hospital spoke with us to share the most common mistakes parents make when it comes to car seats.

What are some of the most common mistakes that you see parents making when it comes to car seat safety?

For our rear-facing kids, one of the most common mistakes is that they do not keep the child rear-facing until the age of two. Another common mistake that we see with installation both with rear-facing and forward-facing is that many parents tend to use both the seatbelt and the LATCH system (LATCH stands for lowers anchors and tethers). They use both thinking that it will provide extra protection, when really it is too much restraint on the car seat– so it could actually damage the car seat in the event of an impact. So you should use one or the other, not both.

Another common mistake is that a car seat is not installed tight enough. It needs to move less than one inch side-to-side and front-to-back when tested using the seatbelt path.

In regards to harnessing the child in, the most common mistake is that the chest clip or retainer clip is too low. What will happen is that in the event of a crash, that retainer clip will naturally ride down the harness strap. So if it starts out too low it can open up a gap big enough that the child can actually be ejected out of the seat.

And how high should the clip sit? I am guessing that the belly-button is way too low, correct?

Exactly, plus that pulls on the soft abdominal organs of the child. So the chest clip needs to be up against the bony part– so all the way up to the armpit level.

If you look at the retainer clip [chest clip] there are instructions printed as well regarding how high you need to keep it. Normally it will say “Keep at armpit level”, but some of them don’t say it. No matter what though, it should always be at armpit level.

What other mistakes might there be?

Another mistake with harnessing the child in either rear-facing or forward-facing is that they don’t make the harness tight enough. Parents should use what is called the pinch test, and the pinch test is when they try to pinch the harness strap up by the shoulder, if they can gather any of the harness when trying to pinch it, it is too loose. Their fingers should naturally slide off the harness and not gather any of the harness material in the pinch. Again that should be kept up by the shoulders above the retainer clip.

Another common mistake with harnessing the child in is that for rear-facing, the harness straps should be at or below the child’s shoulder where it feeds into the seat. When the child is forward-facing, it should be at or above their shoulders. So what we are seeing with kids that are starting to grow out of their forward facing seat is that harness strap wrapping below their shoulders because they are getting too tall for that seat and not transitioning out of it.

Is there anything dangerous about keeping a child rear-facing who is older than two?

No, that is okay. They are safest when riding rear-facing as long as they still meet the height and weight restrictions that are printed on the label on the side of their rear-facing seat. So if a child is still under that maximum weight and height they can still ride rear-facing. Most children by then don’t want to ride rear-facing because they want to be able to engage and see out the front window and that kind of stuff, plus [rear-facing] seats are more tilted back so they are more laying than sitting up.

What is the age limit when a child should move to a booster seat?

There is a new study that was just released that shows that 9 out of 10 parents are moving their child out of the booster seat into the seat belt alone way before their child is big enough. It is not based on age, it is based on height. The child, to be sitting in an adult seatbelt needs to be a minimum of four foot nine inches, or 57 inches. So we have children that are 8 and 9 years-old that should still technically be in a booster, because all a booster does is position your body higher so that an adult seatbelt fits properly. Too many of them are out of those booster seats for social reasons– they’re carpooling or riding with a bunch of other kids, they don’t want to look like a little kid anymore and be in some type of seat. So we recommend for those older school-aged children that should still be in a booster seat but don’t want to look like they’re in a car seat, that they get a low-backed booster. They can use that low-back booster as long as the seat that they are in has a normal headrest.

Do you carry car seats in the St. Joseph’s Safety Store, and if a parent buys a car seat there can they get help with installation there as well?

We don’t offer ever brand of car seat, but we do have each of the different ages and stages of car seats available and we have technicians available who can help you install it.

Any parent, regardless of where they purchased their car seat, can get an on-demand appointment at our office which is just behind St. Joe’s hospital. Those appointments are $20. They can also sign up for free inspections and we have a partnership with AAA through Hillsborough County for appointments at AAA locations (they will have to call and register for those) but they can get free appointments to get the car seat inspected. Whether it is a newborn infant seat, a rear-facing or forward-facing we can help.

Does the brand of the car seat matter?

The most expensive car seat doesn’t mean it is the best fit for your particular child.  A lot of people buy the one with all of the bells and whistles and it does’t end up fitting your vehicle.

Safe Kids Worldwide has come up with the ultimate car seat guide to help you personalize and find the best car seat for your child’s age, weight and height. It will help you find the best seat for your child. That can be found at It is very user friendly– I went through it last week when it was released and it has videos that can show you the right way to do things with the car seat.

For more information on the Safety Store, click here.

To find out more about car seat safety, click here.

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