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Dr. Laura Jana Talks Child Car Seat Safety

Pediatrician Dr. Laura Jana is a media spokesperson for the American Academy of Pediatrics and a member of the American Academy of Pediatrics’ Section on Injury, Violence and Poison Prevention.  Dr. Jana is a certified child passenger safety (CPS) technician, as well as a CPS instructor. Maura Keating recently interviewed Dr. Jana to help parents learn to use child safety seats consistently and properly.

dr-laura-janaKidoinfo: What should parents look for when they go car seat shopping?

Dr. Laura Jana: First and foremost, a car seat must properly fit both the child and the car. Beyond that, parents should look for additional features that afford their child maximum safety. This means choosing a car seat with higher weight and height limits – both for rear-facing and also for forward-facing 5-point-harness use, both of which we know offer children greater protection. Luckily, there are now seats available that allow rear-facing use well past 20 pounds, and 5-point harness systems in some forward-facing seats that allow harness use all the way up to 80 pounds.

I also recommend investing in a car seat that offers side impact protection. Twenty-five percent of all crashes are from the side, and these crashes result in a significantly higher fatality rate than front or rear crashes. Since side impact testing is not yet part of the federal car seat standard, parents should take it upon themselves to look for car seat features that can help their children ride more safely, such as deep side and head wings that are made out of energy-absorbent material and an adjustable head support to minimize lateral head movement in a crash.

Finally, features that make it easy for parents to use the car seat correctly each and every time are invaluable. This could mean something as simple as choosing a car seat that your child particularly likes – perhaps it has a vibrant fabric, a cup holder, or easily adjusted straps that don’t twist. After all, features that allow a child to sit comfortably and contently in his car seat ultimately help keep him safer on the road.

Kidoinfo: What is the best way to tell if a car seat will be compatible with your car?

Dr. Laura Jana: Since not all seats can be installed correctly in all cars, and not all kids fit the same in every car seat, I recommend that parents and caregivers test the seat in their car before purchasing it. They can also check with their vehicle manufacturer to see if a list of suggested car seat models is available for their specific car(s).

Kidoinfo: How can a parent tell if their installation is tight enough?

Dr. Laura Jana: Car seats, when installed correctly, should not move more than one inch side-to-side at the base of the seat. That said, it is estimated that at least 80 percent of all car seats are installed and used incorrectly. Because of this, all parents should take the necessary precautions to make sure they get it right. First, read your car seat and vehicle manuals. Take a look at the car seat manufacturer’s website for installation information and/or demos if you plan on installing your car seat yourself. And don’t forget to visit a certified CPS technician and have your child’s seat checked to make sure it’s correctly installed. NHTSA’s website (www.nhtsa.dot.gov) offers a list of child safety seat inspection stations and trained technicians by ZIP code.

Kidoinfo: My car has LATCH installed on only the two side seats in the rear. Is the LATCH system safer to use?

Dr. Laura Jana: The LATCH system was designed to make car seat installation easier and leave less room for errors in installation. Always be sure to follow the vehicle manufacturer’s instructions as to which seating position(s) in the vehicle are designed for use with the LATCH system. That said, when used correctly, both the vehicle’s seat belt and the LATCH system are equally safe, and the one that provides the best fit should be used.

Kidoinfo: How and why should I use a tether for forward facing car seats?

Dr. Laura Jana: The top tether is the strap that comes on the top of just about all new car seats in the United States. It serves the very valuable purpose of better securing the top of a forward-facing seat to a specific anchor point in the vehicle and significantly decreasing the amount of forward movement in the event of a frontal crash. This translates into decreased head excursion (how far forward the head comes out of the car seat in a crash) and decreased risk of injury to a child. In order to meet the newer and tougher federal safety standards that limit head excursion, most forward-facing car seats require the use of the tether.

Kidoinfo: Are padded cushions or blankets safe to use in car seats? What about toy bars?

Dr. Laura Jana: I don’t recommend that parents use any car seat accessories not created and tested by the seat’s manufacturer. Every element of a car seat is tested extensively to ensure that in the event of a crash it doesn’t affect performance. Using an add-on, or “after-market” product, not approved by the car seat manufacturer such as a toy bar risks altering how the seat performs.  Additionally, items such as a toy bar, if not properly secured, could become a projectile and cause injury to passengers in the event of a crash.

Kidoinfo: Is it safe for a child of any age to wear a coat in a car seat?

Dr. Laura Jana: While heavily padded coats are admittedly warm, they translate into added slack when they come between a child and his harness straps or seat belt. I advise parents to simply wait until after their children are safely secured in their car seats, and then either cover them with their coats, or even put the coats on backwards over the top of the appropriately snug harness straps.

Kidoinfo: My car seat straps always get twisted. How can I prevent them from twisting so much?

Dr. Laura Jana: This is a tough one, as some straps seem to twist more easily than others. As a parent of three young children, I quickly came to value the added feature provided by some car seat manufacturers that allowed the harness straps to be velcroed out of the way, and found it well worth the extra investment in a higher quality seat–not only for the added safety features, but also for the fact that their straps don’t twist nearly as easily as many of the base models/brands.

Kidoinfo: What is the best way to protect kids when traveling? How do you suggest using car seats in airplanes, busses, or taxis?

Dr. Laura Jana: The best way to protect kids when traveling is never make exceptions when it comes to safety. Sure, it may not be particularly convenient to fly or hop in a cab with a car seat (much less three!), but the extra effort and precaution are well worth it.

Kidoinfo: When you have more than two car seats in the car, where are the ideal locations for baby versus toddler? In other words, is it better to have the infant car seat installed behind the driver seat or behind the passenger seat?

Dr. Laura Jana: While the back seat is known to offer the most protection for a child, statistically there are differences between the safety of the passenger and driver side of the back seat. Because seating position safety varies from car to car and seat to seat, and the age, and size of each child makes a difference, I strongly recommend visiting a CPS technician to help determine which is safest for your family, car, and seat combination.

Kidoinfo: Are there any books written for young kids on car seat safety that you can recommend?

Dr. Laura Jana: While I’m not familiar with books for parents that deal exclusively with car seat safety for young children, you can find information on child passenger safety in the “Car Safety” chapter in my book, Heading Home with Your Newborn; From Birth to Reality, which I co-authored with Dr. Jennifer Shu. You can also find valuable information on the websites of  the National Safe Kids Coalition, the American Academy of Pediatrics, and NHTSA.

Dr. Laura Jana attended medical school at Case Western Reserve University School of Medicine, completed her pediatrics internship at the University of California-San Francisco, and finished her residency training in pediatrics at Rainbow Babies and Children’s Hospital in Cleveland.  In 1996 she became a consultant for Dr. Benjamin Spock and was a co-founder of his national parenting media company, The Dr. Spock Company, in 1999.  In 2005, Dr. Jana published her first book, Heading Home with Your Newborn; From Birth to Reality, which she co-authored with Dr. Jennifer Shu.

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  • the injury prevention center in the jewelry district also installs/checks car seats. pedro was very thorough and patient teaching me how to install and use our seat. they also send back the car seat registration card, to ensure you’re contacted in the case of a recall. you can make an appointment by calling 401-444-2685.

  • I’ve heard Britax seats are tested at higher speeds than the other brands. And I’ve also heard that one kids are in a booster seat, they might as well be sitting (buckled) on an old phone book.

  • So the coat material is more compressible than the flesh of chubbiness, allowing the child to be ejected by the force of the crash. This makes me shudder.

  • Oh, also wanted to add that the fire stations in Providence (I know personally, those on the eastside) love helping to make sure carseats are installed correctly. If you call first they have many certified installers on their crews.

  • As a survivor of a roll over accident which thankfully my two children also survived, I can’t praise this article enough! My children were injured, but certainly would have been much more seriously injured or have died if not in their seats/booster seats. My three year old was in a Britax which actually broke in the accident against the force of the seatbelt holding it in, but still kept her safe (Britax will replace any carseat that has been in an accident). My 6 year old was in a booster seat sitting behind the driver and did the best of all of us.
    Please emphasize the importance of booster seats and the fact that RI and MA law require booster seats until age 8!!!

  • Katy,
    A nice way to visualize this is to think about where the straps are tightened if your child did not have the coat on, and then how much extra room you have to give them when they have their coat on. In the event of an accident, the material of the coat would compress allowing the child to be too loose in the restraint.

    Thicker coats when compressed can lead to the child being ejected from the seat. As a local CPS technician here in RI, our car seat checks have shown us that nearly 90% of all seats were improperly installed upon arrival.

    I hope it helped!

  • Why does wearing coat add slack to the seat belt? If the child has the coat on the whole time…isn’t it just as if a slightly chubbier version of your child were securely buckled in? I could see the danger if the child got hot and wiggled out of the coat, but that seems to be another issue.