Car Seat Rule #5: Booster Seats and Seat Belts

This is the fifth in my Car Seat Rules series, in which I focus on one aspect of car seat use in a small, digestible article.

See other Car Seat Rules articles here:Rule #1, on the Chest ClipRule #2, on Rear-FacingRule #3, on NewbornsRule #4, on Front-Facing

*The advice given in the Car Seat Rules articles is not a substitute for having your seats checked by a car seat professional (CPST) or for reading the manual that came with your car seat.--------------------------

A five-point harness is safer than a seat belt as long as it fits properly. Once your child outgrows his front-facing car seat by height OR weight, it may be time to switch to a booster seat. Please check your state laws with regard to the minimum age and weight requirements for use of a booster seat, but the recommendation is typically at least four years old and at least 40 pounds.

A booster seat works differently from a car seat. A car seat is attached to the car using LATCH or seat belt, and then the straps of the car seat hold your child in place. A booster seat is not secured to the car (typically, although some models allow you to use the LATCH connectors to hold the booster in place) but merely helps to position your child so that the seat belt will fit him properly. The seat belt is then the primary restraint, just as it is for the adult occupants of the car.

Your child has outgrown his forward-facing seat when ONE of the following is true:

• He has reached the maximum weight limit of the harness,
• His ears are above the top of the car seat, OR
• His shoulders are above the top harness slot.

Your child is ready for a booster when ALL of the following are true:

• He has reached the minimum weight and age limits designated by your state's laws,
• When sitting in the booster, the shoulder belt falls across his collarbone, not his neck,
• When sitting in the booster, the lap belt sits flat against the tops of his thighs, not across his abdomen,
• He can sit upright in the seat through the entire trip and not lean over, slouch, or fall forward (otherwise the seat belt will not function properly), AND
• You trust that he won't unbuckle the seat belt while the car is in motion.

There are two basic types of booster seats, the HIGH-BACK BOOSTER and the BACKLESS booster. Their function is the same, and one has not been proven to be "safer" than the other. The basic difference is that a high-back booster helps to better position the shoulder belt, may provide some additional side impact protection, and helps to protect the head and neck if your car's seats don't have headrests. A backless booster positions only the lap belt, so you need to make sure your child is tall enough that the shoulder belt falls over his shoulder correctly.

Some boosters come with additional features which may interest you, such as a reading light, cup holder, or LATCH connectors. The LATCH connectors do not serve as restraints. Rather, they ensure that the booster seat does not become a projectile in the car if no one is sitting in the seat. (If your booster does not have LATCH connectors, you should buckle it in even when no one is using it.)

It is important to use a booster seat until your child is tall enough for the seat belt to fit properly without it. An ill-fitting seat belt can do more harm than good in a crash by causing internal injuries. Some states have implemented a minimum age or height before a child is no longer legally required to use a booster. In California and a few other states, a child must be eight years old OR 4'9" before using a seat belt without a booster.

Car Seat Rule #4: When and How to Forward-Face

This is the fourth in my Car Seat Rules series, in which I focus on one aspect of car seat use in a small, digestible article.

See other Car Seat Rules articles here:
Rule #1, on the Chest Clip
Rule #2, on Rear-Facing
Rule #3, on Newborns

*The advice given in the Car Seat Rules articles is not a substitute for having your seats checked by a car seat professional (CPST) or for reading the manual that came with your car seat.
--------------------------

I spend a lot of time trying to convince you to keep your baby rear-facing as long as possible, but at some point, your child will outgrow the rear-facing specifications of his convertible car seat, or you'll reach a point where you just have to turn him around for some other reason. Many, many car seats on the market now allow children to remain rear-facing up to 40 or 45 pounds. Many children don't reach that weight until four or five years old! Your child has outgrown his rear-facing car seat when: Your child has reached the weight limit for rear-facing (outgrown by weight) OR the top of your child's head is within 1" (one inch) of the top of the car seat (outgrown by height). (Note that "feet touching the back of the vehicle seat" is not one of the criteria.)

When it's finally time to turn your car seat around, you'll need to know how to properly install the seat and secure your child in the forward-facing position. Once you've turned your child forward-facing, it is best to continue using a five-point harness until he outgrows the front-facing specifications for his convertible car seat. Many, many car seats on the market allow a child to remain in a five-point harness until 65 pounds. To get an idea of how big that is, my six-year-old isn't 65 pounds yet, and he's quite big for his age. Some go as high as 85 pounds.

Your child has outgrown the forward facing limits of his car seat when: Your child has reached the upper weight limit of his five-point harness (outgrown by weight) OR his shoulders are above the highest shoulder strap slot (outgrown by shoulder height) OR his ears are above the top of the car seat (outgrown by height).

Most of the same rules apply otherwise for front-facing that I've gone over for rear-facing. The main difference is that when adjusting the harness straps, you need to use a slot that is AT or ABOVE your child's shoulders (not below). If you use a slot below your child's shoulders, he will not be properly restrained and even may be able to wiggle out of the straps.

Buckling your child in a five-point harness, front-facing:

1. Place your child (or have him climb) into the seat. Make sure his bottom is all the way to the back of the seat and that he's sitting up straight.
2. Pull the harness straps over his shoulders and pull the crotch strap up between his legs.
3. Fasten the buckles.
4. Fasten the chest clip.
5. Tighten the harness. Tug on the shoulder straps to pull out any slack around the hips and then tighten the straps more if needed. Do the "pinch test" to make sure the straps are tight enough: Try to pinch the harness webbing between your thumb and forefinger at the child's collarbone. If you can't maintain a fold in the strap, it is tight enough.
6. Align the chest clip with the child's nipples or armpits.

Check out this video of my middle son being buckled into his five-point harness.

  Installing your convertible car seat front-facing:

1. Before placing the seat in the car, check your manual for whether the car seat can be reclined while forward facing. Put the car seat in an upright or allowable recline position before installing.
2. Have your child sit in the car seat before installing it in your car. Identify the shoulder strap slot that is closest to, but still above your child's shoulders. Re-thread (if necessary) the harness straps. (See your manual for instructions.) Remember that as your child grows, you will need to periodically readjust the harness height. (Some car seats have harnesses that are adjustable "on the fly," meaning you don't have to take the seat out of your car to adjust them. If you have one like this, you can skip this step.)
3. Locate the belt path that should be used for a front-facing installation. It should be clearly marked on the seat itself. (Usually, there are arrows pointing to the slots with the words "forward-facing belt path" or similar language.) If you're installing using LATCH, feed the latch straps through this path. Make sure they're not twisted. If you're installing with the seat belt of the car, stow the LATCH straps appropriately. (Note that you can install a car seat equally safely using either LATCH or the vehicle seat belt, but NOT BOTH together.)
4. Place the seat in the car so that the child will be facing the FRONT of the car.
5. Locate and extend the top tether strap from the back of the seat. Loosen it as much as necessary until you can hook it into the top tether connector on your vehicle seat. This may be located just behind the head rest of the vehicle seat, somewhere on the back of the seat in an SUV or minivan, or sometimes in the ceiling of the car. There should be a tether hook for each rear seat in the vehicle where it is permissible to install a car seat; use the hook associated with the vehicle seat you are using. If there is no top tether hook for the seat you were planning to use, you must install the car seat in a different location. (Note that your front-facing car seat is not properly installed if you do not connect the top tether!)
6. If using LATCH, snap the LATCH connectors into the LATCH hooks in your vehicle. OR If using the vehicle seat belt, feed the belt through the front-facing belt path. Make sure the belt is not twisted. Buckle the seat belt. Then, loosen the seat belt ALL THE WAY until it locks and then allow it to retract. On an older vehicle, the seat belt may not automatically lock when pulled out all the way. In this case, you'll need to use a seat belt locking clip.
7. Climb into the seat and lean in with your knee to squish down the vehicle seat. Tighten the LATCH straps as much as you can by hand. (Do not use any aftermarket mechanical tighteners.) OR tug on the seat belt so it will retract as far as possible. Tighten the top tether strap as much as you can.
8. Standing on the floor of the car or outside the car, grasp the car seat with your stronger hand right at the belt path and attempt to wiggle it. If it shifts more than 1" (one inch) side to side or front to back, the LATCH or seat belt is not tight enough. Lean into the seat again and try to tighten it further.

Other tips:

• Older children may want to buckle themselves. If they're physically capable, I encourage you to allow them to do so, but always check to make sure the harness is tight enough and that the chest clip is properly positioned.
• Some children play with the chest clip, try to wiggle out of the straps, etc. This is a discipline issue, and it needs to be handled in the same way you would handle other undesirable behaviors. You can try positive reinforcement (every time you complete a car ride without them messing with the clip or the harness, they get a prize or something), consequences (if you have to stop to fix the straps, they lose a privilege), or some combination. I have also found it very helpful to talk to my kids about the importance of being in the car seat, how it helps keep them safe, and they take pride in knowing how to be properly buckled in. They will even fix their own chest clip if they are buckled incorrectly.
• Do not dress your child in heavy winter clothing or extra layers when they are in their car seats. Puffy coats will interfere with properly positioning and tightening the harness. It is recommended to remove bulky clothing just prior to buckling the seat, then put the coat or blanket over the child after he is harnessed.
• Some kids will not be happy about still being in a car seat when some of their friends have "graduated" to a booster. As above, you can talk about the importance of being safe in the car. I'd say that this falls under the "if all your friends jumped off a cliff..." category of parenting. Just because their friends' parents let them sit in a booster doesn't mean you have to allow your child to be less safe in the car.
• Nothing should go between the car seat and the vehicle seat. Unless your car seat manual specifically states that you may place a towel, blanket, or car seat mat under your car seat, then you should not do so. Anything between the car seat and the vehicle seat may prevent you from properly tightening the LATCH straps or seat belt. If you're not sure, you can contact the manufacturer and ask.
• If it didn't come in the box with the car seat, you shouldn't use it with the car seat. This includes shoulder strap padding (most car seats come with these anyway, but if yours didn't, don't buy them from somewhere else), head or neck support pillows, toys, etc. Nothing should go between the child and the car seat except the clothing the child is wearing, and nothing should be attached to or interfere with the harness straps.

Your child is ready for a booster seat when...

1. He has reached the minimum weight AND height limits by state law (minimum is usually 4 years AND 40 pounds) AND
2. The seat belt fits him properly across his shoulder (not neck), breastbone, and upper thighs (not stomach) AND
3. He can remain seated upright through the whole car trip and does not lean or slouch (if he is not seated properly, the seat belt will not restrain him properly) AND
4. You trust that he will not unbuckle his seat belt in the middle of a car ride.

Please remember that an ill-fitting seat belt can do more harm than good. If your child is too small to be using a seat belt (even with a booster seat), in a crash the seat belt can cause internal injuries that would be avoided by using a five-point harness instead.

Car Seat Rule #3: Newborns

This is the third in my sometime Car Seat Rules series (Rule #1, on chest clips; Rule #2, on rear-facing).

I want to talk specifically about newborns in car seats. Often demonstrations are given using older babies or toddlers, but most of us first use car seats with newborns, and it's helpful to know some specific rules pertaining to newborns that may not apply to older babies.

A newborn may sit in an infant "bucket-style" car seat or in a rear-facing convertible car seat. The same rules apply in either type of seat. These rules really apply to any rear-facing baby or toddler, with some additional detail given for the specific case of a newborn. (For "newborn," I mean a baby from birth to approximately three months of age.)

1. What's Wrong with This Picture?

A brand new NJ in a Graco infant car seat. 

See if you can spot any problems with how he's buckled! (Answers below.)

2. What's Wrong with This Picture?

Here is newborn SB in his Chicco KeyFit30 infant seat, with two-year-old NJ looking on. Can you spot any problems with how he's buckled? (Answers below.)

So what are the rules for newborns in car seats?

1. The shoulder harness straps must be adjusted AT or BELOW the baby's shoulders.

This means that if the straps are above your baby's shoulders on their lowest setting, then the seat is too big for your newborn. Many seats come with additional newborn support padding. If your seat comes with this additional padding, you may need to use it both for your baby's comfort and to bring him up to the level of the lowest shoulder harness slots. DO NOT USE ANY AFTERMARKET PADDING with your car seat. The general rule is, if it didn't come in the box with your car seat, you shouldn't put it on your car seat. (This also applies to head supports and shoulder strap padding!)

If you do use the support padding that comes with your car seat, check your user's manual for the upper weight limit for this padding, and remove it when your baby reaches that weight limit. A heavier baby will compress the padding in the event of an accident, which may mean that the harness is not tight enough, potentially causing your baby injury or even causing him to be ejected from his seat.

2.  The chest clip must be fastened and lined up with his armpits or nipples.

I've talked about the chest clip before. At length. If your car seat has a chest clip, use it properly.

3.  Did I mention? Don't use any aftermarket products on your seat.

Don't use any padding, supports, add-ons, or accessories that didn't come in the box with your car seat. This includes the ever-popular Bundle-Me, head supports, shoulder strap padding, and body support pillows. These (a) interfere with the harness, meaning you may not be able to adjust, buckle, or tighten it properly; and (b) are not crash-tested with your seat, meaning you don't know how safely your car seat will perform in a crash if you are using one of these products.

4.  Make sure your car seat is installed at a 45 degree angle.

Newborns don't have enough head control to sit at a more vertical angle. If the seat is not reclined properly, his heavy head can fall forward onto his chest, obstructing his airway.

5.  It's okay for the head to fall to one side or the other, but not forward.

If your baby looks uncomfortable because his head is tilted far to one side or the other, especially if he falls asleep in the car seat, you may put a rolled up receiving blanket on either side of his head to offer additional support. You should put the blankets in after he is buckled in properly. They should not be attached to the car seat in any way, and they should not go between the baby and the car seat.

6.  Don't be afraid to tighten the harness!

The harness should be tight enough to pass the "pinch test." The pinch test is when you attempt to gather the strap between your thumb and forefinger at the baby's shoulder. If your fingers slide off the strap, then it is tight enough. If you can pinch and hold the strap material between your thumb and forefinger, the harness is too loose.

One tip: After you buckle the harness, tug on the straps around the baby's tummy to pull the slack out of the hip area, then tighten.

7.  If your baby is cold, put blankets on over the harness.

You should not put too many layers of clothing on your baby when he is in his car seat. Bulky clothing will prevent the harness from being properly tightened. If your baby is cold, buckle him into his seat in one or two layers of clothing and then put blankets or a jacket over the baby. You can tuck a blanket around the baby tightly to help keep him calm if he usually likes to be swaddled, but you should not put a blanket between the baby and the harness or behind the baby.

My friend was generous enough to allow me to film her newborn, at about seven weeks old, being buckled into his car seat. Please watch and share this video, and subscribe to the Jessica on Babies YouTube channel!



Note: Unless it states otherwise in your car seat manual, the handle of the car seat may be in any position when the seat is in the car, as long as it is locked in that position.
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Answers to "What's Wrong with This Picture?"
1. Harness is not tight enough - you can see how loose it is around his right shoulder. Too much slack in the hip area. Chest clip is too low - if the slack were pulled out of the straps and the harness properly tightened, you could see that the clip is not at his armpits. It's hard to see anything else from the angle of the photo. The head support came with the car seat, but it is probably both unnecessary and useless.

2. Harness is not tight enough - you can see the slack at his chest area. Chest clip is too low. All of the additional padding - shoulder pads, head support, and body support - came with the car seat and are acceptable to use. Because the car seat was not in the car in this picture, I can only assume I made the corrections before we went anywhere. :)

And, finally, in this picture, baby SB is buckled nice and securely, harness properly tightened, chest clip properly positioned. He is in one layer of clothing and is kept warm by placing a blanket over the harness.

Car Seat Rule #2: The Whys and Hows of Rear-Facing

For the second in my sometime series on Car Seat Rules, let's talk a little bit about rear-facing. (Rule #1 is here.)

What is "rear-facing"?

We hear this term a lot. "Extended rear-facing." The AAP recommends "rear-facing" for at least two years. Use a "rear-facing" infant or convertible car seat.

It's simple, really. Rear-facing means that the child will ride facing the back of the car.

What is "extended rear-facing"?

"Extended" just implies that you keep your child rear-facing longer than the law requires. In most states, the law requires that your baby be rear-facing until at least 20 pounds AND one year old. Most convertible car seats also state that you should not turn the car seat to face forward until your child is 20 pounds AND one year of age. "Extended rear-facing" means that you keep your child rear-facing well beyond the 20-pound/one-year minimum. Most organizations interested in child safety, such as the NHTSA and the AAP, recommend you keep your child rear-facing until at least two years old, or as long as he or she fits within the height and weight limits of the rear-facing car seat.

Why is rear-facing safer?

Facing backwards is safer than facing forwards because, in a crash, inertia will cause everyone in the car to continue moving forward. (The car stops, but the people inside will still be moving forward at whatever speed the car was going when the crash happened.) The occupants of the car will be held in place (hopefully) by their seatbelts or their car seat harnesses. This puts stress on the neck, shoulders, and spine of forward-facing passengers, because the shoulders and body are held back by the restraint, but the head and arms are free to continue their forward motion. In a child, this can cause severe neck and spine injuries, shoulder injuries, and even death, as the weight of a child's head traveling forward with the force of the crash can stretch the spine as much as two inches and may break the child's neck.

By contrast, if a child is facing backwards in a car seat, the whole body will be pressed back into the seat, distributing the crash force over the body and the car seat itself, which is built to withstand these forces. The child's body will be cradled by the seat and held in a normal position, instead of the head being flung forward, as it would be when facing front.

In other words, to put it harshly, rear-facing versus front-facing can be the difference between your child's escaping unscathed or being killed in a crash.

How do I install my car seat rear-facing?

1. You may use either LATCH or the car's seat belt (but NOT BOTH). 
2. Find the rear-facing belt path or LATCH path by consulting your car seat manual. It should also be clearly marked on the car seat itself. Make sure the LATCH strap is fed through the right path, is not twisted, and is under the car seat padding. Locate the LATCH connectors in your car in the crease where the seat and seat back meet. (There should be a little LATCH symbol on the seat where the hooks can be found. )
3. Make sure your seat is at the appropriate recline angle, as designated by the car seat manual. 
4. Connect the LATCH or feed and buckle the seat belt as shown in the manual. 
5. Tighten. If using LATCH, lean your knee or hand with as much weight as possible into the seat and pull tight the LATCH straps. If using a seat belt, pull the belt all the way out until it locks, then allow it to retract as far as you can. Put some weight into the car seat and pull that seat belt tight. 
6. With LATCH and with seat belt, make sure the straps are not twisted at any point. 
7. Your seat is installed when you cannot wiggle it more than one inch side-to-side or forward-and-back while grasping the seat at the belt path with your stronger hand. (In other words, the seat may still move a little bit, but it shouldn't move back and forth too much. One inch of movement in any direction is the maximum.)

Where should the straps of the harness go?

Unless you have a car seat that can be adjusted while installed (such as the Britax Boulevard or Pavilion), sometimes marketed as a "no re-thread harness", then adjust the straps before you install the car seat. Recline the seat and sit your baby or child in the seat. Find the strap slots that are closest to your child's shoulders but still BELOW them. Having the straps at or below the shoulders prevents the child from sliding up the back of the seat in a collision. Unhook the shoulder straps from the metal clip at the back of the car seat and pull them out of the slots, then thread them through the correct slots. Make sure the straps are not twisted or folded. Reconnect the straps to the metal hook. Then install the car seat. As your child grows, you will need to re-thread the straps occasionally to keep up with him, so learning this process will be helpful.

How do I buckle my child in?

1. Sit your baby or child in your correctly-installed and adjusted seat. 
2. Make sure his bottom is all the way back against the seat. 
3. Put his arms through the straps and pull the crotch strap up between his legs. 
4. Fasten the buckles of the harness and tighten the harness* until you cannot pinch and hold a fold of the strap at the child's collarbone. The straps should be tight, like a hug, but not uncomfortable. If the straps are too loose, your child could be ejected from the seat or not be restrained properly in a crash. 
5. Now buckle the chest clip (if your seat is equipped with one - nearly every seat on the market in the U.S. has one; European seats do not). Place the chest clip in line with your child's armpits. (See Car Seat Rule #1 for more information on using the chest clip.)

*For most modern car seats, you tighten the harness by pulling on the long strap that comes out of the front of the car seat. To loosen the harness, press the button or pull the lever near where this pull strap emerges from the seat and tug on the harness to loosen it. Consult your car seat's manual for instructions on tightening and loosening the harness. Most car seats are similar and straightforward when it comes to tightening and loosening the straps.


How long can my child rear-face?

A child can stay rear-facing until he reaches the height or weight limit of his car seat. Many, many convertible car seats these days have a rear-facing weight limit of 40 pounds or more. My 3.5-year-old, who is above the 50th percentile in height and weight, is only 33 pounds, to give you an idea of how long that could be. A seat is outgrown by height for rear-facing when the top of the child's head is within one inch of the top of the car seat shell when seated in it properly.

Don't worry about your child's legs being "scrunched" or "squished" up against the back of your vehicle seat. Legs bend. Children will adapt, by crossing their legs, resting their feet up high on the back of the seat, or draping their legs over the sides of their car seat, and be perfectly comfortable. And even if, G-d forbid, you are in a crash and your child's leg breaks, a broken leg is a much less severe injury than a broken neck. For the record, there are no documented cases of a child suffering leg injuries as a result of being rear-facing in a car accident.


This YouTube video clearly (and tragically) illustrates the dangers to a baby's neck and shoulders if front-facing in a car accident.

Car Seat Rule #1: How To Use That Chest Clip

In my car seat posts, I tend to lump all the car seat rules I can think of all in a big list, which I think maybe doesn't have much impact anymore. It becomes white noise. So what I thought I'd do is do an every-so-often series of posts about various individual aspects of proper car seat use and go into more detail about why that particular rule applies.

This first post addresses the infamous chest clip! What is that thing for, and how should it be used?

The chest clip is found on most rear- and forward-facing car seats with a five-point harness. You have the shoulder straps, which come over the shoulders, and the crotch strap, which comes up between the legs. The shoulder straps have tabs which fit into the buckle on the crotch strap. Then there's another plastic clip that connects the two shoulder straps. That is the chest clip, and of all the things I see people do wrong with car seats, misuse of the chest clip is just about at the top of the list. Even people who are very safety-conscious, keep their kids rear-facing longer, in a harness longer, in the best seats, often incorrectly place or use the chest clip.

The most egregious chest clip misuse I've personally heard of is parents who think using only the chest clip is sufficient. They have their preschoolers in a five-point harness, except that they don't. They secure the chest clip but leave the tabs out of the buckle. This does nothing to secure the child in an accident, and is actually less safe than putting the child in a booster and buckling the seat belt. Using the chest clip alone is basically as good as not buckling the child at all.

Here's why:
This thread from car-seat.org, answered by certified car seat technicians, explains that the chest clip is not meant to restrain the child in a crash. Indeed, it is often designed to break away in a crash. Thus, if you buckle your child with only the chest clip, and the chest clips breaks upon impact in a crash, your child will be ejected from his seat. Why bother having a car seat at all?

Chest clips are actually meant to be pre-crash positioners, ensuring that the shoulder straps are in the right place so they can do their job in a crash. If the chest clip is in the wrong place, it won't do its job of keeping the shoulder straps in place, and the straps could slip off the child's shoulders in a crash. Also, since it is designed to crack against the child's sternum, which is a very strong bone, if it is in the wrong place, it could cause damage to the child's soft tissue.

In Europe, chest clips are not used, but car seats are designed differently to accommodate this difference. If your car seat has a chest clip, you must use it, and you must use it properly.

So... how do I use the chest clip?

Well, it's simple. Buckle your child in, fasten the chest clip, tighten the harness if necessary, and then position the chest clip at the level of the child's armpits or nipples. From tiny babies to big seven-year-olds, rear-facing or front-facing, the chest clip always goes at the level of the armpits or nipples. Not higher (can damage the child's windpipe), and not lower (doesn't do its job).

What do I do if my child moves the chest clip?

Discipline and education, mostly. Use whatever works for your child. My kids respond well to safety lectures. "It's very dangerous if you move that chest clip. I put it where it was for a reason!" Other kids need reinforcement along the lines of punishment or rewards. Consistency is key, of course, as with any discipline issue.

Summary:

Again, the chest clip should be fastened and positioned in line with the child's armpits. This properly positions the shoulder straps and helps prevent the child from slipping his arms out of the straps. It is not meant to withstand crash forces and should not be used without the buckle!