Car safety is a critical issue for everyone, especially parents and caregivers of children. Each year, motor vehicles claim the lives of more children in the United States than any other cause, according to the Centers for Disease Control and Prevention (CDC).

Children should always be secured by some type of safety restraint, no matter how short the drive. All children age 12 and younger should sit in the backseat when traveling in a vehicle. Children age 8 and younger should be secured in either a car safety seat or a belt-positioning booster seat, depending on their age and size.

Car seats also are available to meet the requirements of children with special needs. These can be used beyond the age when a child normally outgrows car seats and have extra pads and devices that allow them to secure children up to 105 pounds (48 kilograms).

Older children can use safety belts (both the lap belt and shoulder harness) to secure themselves. Before using safety belts, children should be able to sit with their backs against a seat back, their knees bent over the edge of the seat and their feet on the floor without slouching.

Air bags can protect adults and older children from injury during an accident. However, these safety devices can injure or kill infants and younger children when they deploy. Young children may suffer serious head and neck injuries because pre-crash braking causes their upper bodies to be thrown forward into the force of the deploying air bag. In some cases, air bags have killed young children.

By virtue of their age and lack of experience, adolescents may be more likely to underestimate potentially hazardous or dangerous driving situations (e.g., driving with an intoxicated driver, running a red light). Parents should serve as role models for their teen drivers while ensuring that their teenager gets adequate supervised on-the-road training.

Additionally, parents should choose a safe vehicle for their young teenager and control access to that vehicle. Adolescents also should be made aware of the dangers of speeding, not wearing seat belts and driving while intoxicated. Risky teen driving behaviors, traffic violations and automobile accidents are less common when parents impose limitations.

Children also need to exercise caution when using other modes of transportation. For example, children waiting for the school bus should stand at least 6 feet (2 meters) away from the street. They should wait until the bus driver opens the door and tells them it is safe to board. As with automobile travel, children should remain seated quietly during the bus ride to prevent distracting the driver and increasing the risk of an accident.

Car safety is an important issue for parents and other caregivers. Many children ride in automobiles on a daily basis, and inattention to basic safety measures can be fatal. Accidents involving motor vehicles are the leading cause of death among children in the United States, according to the Centers for Disease Control and Prevention (CDC).

According to the CDC, 1,638 children age 14 and younger died in automobile crashes in 2004, and 214,000 children in this age bracket were injured. Half of the fatalities occurred in children who were unrestrained. It is estimated that use of appropriate restraint systems could cut the number of serious and fatal injuries to children by more than half.

Parents are urged to teach their children the rules of safe automobile travel. Children should always be secured by some type of safety restraint, no matter how short the drive. Children age 12 and younger should always sit in the backseat, preferably in the middle. This provides a buffer zone from the exterior of the car and from side air bags. Also, children should be told that making excessive noise while traveling in the car can distract the driver, increasing the chances of an accident.

Children should understand that these rules are to be followed when they are in any car, not just when they are traveling with parents. If asked to sit in the front seat of someone’s car, a child should decline and ask to sit in the backseat.   

Parents also play an active role in keeping their children safe during automobile travel. Parents should never hold children on their laps during vehicle travel. The child could be crushed or thrown from the vehicle during an accident. Children also should never be placed in the cargo area of any vehicle. Drivers should never transport more passengers than there are safety belts available in a vehicle.

Children should never be left unattended in a vehicle. On a warm day, the car can heat up to the point of danger within minutes. Children can also be strangled by power windows, sunroofs or other accessories. Kidnappers and car thieves can also endanger the child. In some cases, children may put the vehicle into gear, sending it into motion, although this is more difficult to do with newer vehicle models.

Car safety guidelines are also crucial for adolescents since this age group may be more likely to underestimate potentially hazardous or dangerous driving situations (e.g., driving with an intoxicated driver, running a red light). Two out of five deaths among U.S. teens are the result of a motor vehicle crash, according to the CDC. The risk of motor vehicle crashes is higher among 16- to 19-year-olds than among any other age group. Per mile driven, the CDC estimates that teen drivers ages 16 to 19 are four times more likely than older drivers to crash.

It is important that parents and other caring adults serve as role models for their teenage drivers while ensuring that their teen gets adequate supervised on-the-road training. Additionally, parents should choose a safe vehicle for their young teenager and control access to that vehicle. Adolescents also should be made aware of the dangers of speeding, not wearing seat belts and driving while intoxicated.

Every state requires that parents strap infants and young children into a car safety seat before driving. These seats are installed with either the car’s safety belt or the lower anchors and tethers for children (LATCH) system to offer the best possible protection in accidents. However, car seats must be chosen and used correctly if children are to get the maximum benefit from them. Not all car seats can be used with all types of vehicles.

Younger children should use a car safety seat, whereas older children should use a belt-positioning booster seat. There is no single car seat that is better than the rest. Rather, a child’s weight, size and age help determine which seat is best for a particular child. Vehicle type also plays a role when selecting the optimal car seat.

Parents are urged to buy a new car seat with an affixed label ensuring that the seat meets or exceeds “Federal Motor Vehicle Safety Standard 213.” In addition, parents are urged to read the manufacturer’s instructions for how to use car seats. After buying a car seat, parents are urged to send the registration card back to the manufacturer. This way, parents will be notified if there is any product safety recall associated with the seat.

Used seats may not be a good choice, especially if they are more than 10 years old or were previously involved in an accident. When considering a used seat, parents are urged to find out whether the seat was involved in a prior accident. Seats that do not have the manufacture date and model number make it difficult to tell whether the seat has been involved in any recalls, which are common in the car-seat industry. There are several types of car seats. They include:

• Car beds. Premature infants born earlier than 37 weeks may need to use a car bed, particularly if the child has breathing problems or other medical conditions that are worsened when sitting in a partially reclined position. These beds should always be secured to the backseat of the car. Special car seats are also available for babies or toddlers in casts.
  
  
• Infant-only seats. Made for babies who weigh up to 22 pounds (10 kilograms). The seats are installed in the backseat, facing the rear of the car, which allows the back of the car seat to protect an infant’s soft spinal column from damage. Babies younger than a year should remain in rear-facing seats, even if this means that their weight requires the purchase of a new seat approved for use at higher weights and heights. Babies have necks that remain too weak to support their heads during crashes.
  
  Infant-only seats often double as carriers, chairs and rockers. The seats often detach from the base, making it easy to move the seat in and out of the car.
  
  
• Convertible seats. Made for children from birth to 40 pounds (19 kilograms), they can be placed in the backseat in a rear-facing position until the child is 1, and then rotated to face forward. Many seats allow a child to sit in the rear-facing position until the child is 20 to 35 pounds (10 to 16 kilograms), at which time children can face forward. It is important to note that it is always safest to have children sit in the rear-facing position until they reach the top weight and height allowed by the seat for use in the front-facing position.
  
  Convertible seats have two different belt paths, one for use when the seat faces the rear and another for use when the seat faces forward. These seats tend to be heavy and cannot be easily moved in and out of the car. Some seats come equipped with tray shields, which should not be used with infants (who can injure their faces on the tray during a crash). Seats should not be used if they are obviously too large for a smaller child.
  
  
• Booster seats. Made for children between 40 and 80 pounds (19 and 37 kilograms), they should be used after a child reaches the maximum weight allowed by a car seat, or when the child’s ears have reached the top of the car seat. Typically, a child will begin using a booster seat sometime after turning 4. These seats are designed to serve as a bridge from when a child is too big for a car safety seat, but not yet big enough to wear a safety belt. Many states have passed laws that require booster seats for children up to 8 years old and 80 pounds (37 kilograms), or 4 feet 9 inches (150 centimeters) tall.
  
  Several styles of booster seat are available, including those with high backs (for use in cars with low seat backs) or those that are backless (for use when a vehicle’s back seat or head restraint offer support up to the top of a child’s ears). Shield boosters should not be used. These have a shield tray in front of the child but no back and are designed for cars with lap belts only. Most experts believe they do not provide proper protection. Parents who have cars with lap belts only are urged to have shoulder harnesses installed by a car dealer.

Parents are responsible for making sure that car seats are both properly installed and correctly used. Parents should either attach these seats with the car’s seat belt or the lower anchors and tethers for children (LATCH) system that uses a tether strap to attach the safety seat to points on the vehicle’s seat or floor. The LATCH system has been required in all vehicles manufactured since September 2002. Parents should not use both the car’s safety belt and the LATCH system to secure a seat.

Once secured, the seat should not move from side to side, or toward the front of the car. Studies have shown that most car seats are installed incorrectly. Seats are far too loose (even though they may appear tight) and often are installed at an incorrect angle.  

There are federally funded car-seat stations throughout the country that can either install car seats correctly or inspect a previously installed seat. Other organizations, such as local health departments, fire and police departments, new car dealers and hospitals also sometimes offer this type of help. 

Many car seats can be reused even after a minor accident. The seat should be inspected – including underneath the padding – to make sure there is no warping or cracking in the seat. Accidents are considered to be minor if the vehicle can be driven away from the crash site, the door nearest the safety seat remains undamaged, there are no injuries and the air bags do not deploy.

In addition, parents should never leave babies sleeping unattended in car seats, even when they are brought indoors. Recent findings indicate that although car beds and car seats are indispensable in protecting young infants during automobile accidents, these devices may impair breathing.

Safety belts are designed for adults, and young children usually do not have the required strength in their hipbones or the required length in their legs and body to use safety belts. Children can move from booster seats to using safety belts after they can sit with their backs against a seat back, their knees bent over the edge of the seat and their feet on the floor without slouching.

Most newer vehicles have safety belts with both a lap belt and a shoulder harness. Lap belts should fit snugly across the top of a child’s thighs and the shoulder harness should fit across the center of the shoulder and across the chest. This typically occurs when a child is 4 feet 9 inches (150 centimeters) tall.

Safety belts are to be used by one child at a time – strapping two children under one belt could result in a head-against-head collision during an accident. Drivers should never carry more passengers than can be accommodated by the vehicle’s safety belts.

Air bags can protect adults and older children from injury during an accident. They are supplemental restraint devices, designed to operate best when used in conjunction with safety belts. However, air bags can injure or kill infants and younger children when they deploy. This is because they are designed to open at a speed of 200 miles per hour (322 kilometers per hour) and to protect someone who weighs 165 pounds (75 kilograms).

Young children may suffer serious head and neck injuries during an accident because braking causes their upper body to be thrown forward into the force of the deploying air bag. In some cases, air bags have killed young children. For this reason, parents are urged to require all children 12 and younger to sit in the backseat of a car when possible, preferably in the middle of the seat. A car seat or booster seat should be used or a safety belt should be worn.

Car seats should never be installed in front seats, especially if the vehicle has a passenger side air bag. In vehicles with no rear seat that require a child be seated in the front, the passenger seat should be pushed back as far as possible to maximize the distance from the air bag. Since 1995, some cars have been manufactured with a manual cut-off switch that allows for disabling of the passenger-side air bag.

Parents should be aware of their children’s safety in other forms of transportation. Most commonly, children ride on school buses. Children should wait for the bus at least 6 feet (2 meters) from the street. They should wait until the bus driver opens the door and tells them it is safe to board. They should be careful while boarding not to snag a book or backpack and should wear safety belts if available. As with automobile travel, children should remain seated quietly during the bus ride to prevent distracting the driver and increasing the risk of an accident.

When exiting the bus, children should use the handrail and step down carefully and slowly. They should always walk about 10 feet (3 meters) ahead on the sidewalk, look to the bus driver for acknowledgment, then cross the street in front of the bus. Children should never walk behind a bus. They should be told never to bend down in front of the bus, even if they drop something. This can obscure the bus driver’s view of the child. Instead, a child who drops something should alert the driver before picking up the item that they dropped.

On airplane flights, the Federation Aviation Administration (FAA) and the American Academy of Pediatrics (AAP) recommend that all children younger than age 4 use car safety seats. These seats should be secured with airplane seat belts to protect children during takeoffs and landings or during air turbulence. The rules for which direction these seats should face are the same as they are for use in cars. Car safety seats typically must be set up in window seats, and are prohibited from being set up in emergency exit rows. 

Most car seats manufactured today are certified to be used on airplanes, although booster seats and child vests are not. Child safety seats wider than 16 inches (41 centimeters) will not fit on airplane seats. Parents are urged to check the label on their child’s car safety seat and to contact the airline ahead of time to make sure the seat meets federal regulations. Children should not sit on a parent’s lap during a flight.

Parents who take their children boating should be aware of all boat safety regulations. Children should wear a life jacket at all times while on a boat.

Parents should be especially vigilant with children who ride trains, including subways and light rail trains commonly seen at airports. Children should be monitored to avoid the edges of train platforms and to be careful of closing train doors. Moving between train cars while the train is in motion is also dangerous.

Car seats also are available to meet the requirements of children with special needs. These can be used beyond the age when a child normally outgrows car seats and have extra pads and devices that allow them to secure children up to 105 pounds (48 kilograms). They may be used by children with cerebral palsy, skeletal disorders, nerve or muscle disorders, or decreased head, neck and trunk control. These types of seats may need to be secured with both a safety belt and a tether.

Children who do not require as much support may be able to use a device called an upright vest. An occupational therapist or physical therapist can help parents choose the right restraint for their child with special needs. These seats are often expensive, but health insurance programs may cover the cost in some cases.

Preparing questions in advance can help parents have more meaningful discussions with experts regarding their child’s safety. Parents may wish to ask their child’s doctor or another safety expert the following questions related to car safety:

1. Where can I learn more about the best car safety seat for my child?
   
   
2. What are the advantages and disadvantages of purchasing a convertible seat?
   
   
3. How can I be sure that a used seat is safe for my child?
   
   
4. I bought a car seat for my first child five years ago. Is it safe to use now for my second child?
   
   
5. Who can help me install my car seat and inspect the installation?
   
   
6. I only have a two-seater car. How can I make sure my child is protected while traveling?
   
   
7. I have a child with special needs. What options exist for my child?
   
   
8. How will I know when my child is ready for a booster seat?
   
   
9. How will I know when my child is ready to begin using safety belts?
   
   
10. Who can I call to make sure my car safety seat will fit on our family’s next flight?
    
    
11. How can I ensure that my teen engages in safe driving behaviors?