Child Passenger Safety Basic Awareness Course

Child Passenger Safety Basic Awareness Course
OPERATION KIDS: NEXT GENERATION
Child Passenger Safety
Basic Awareness Course
PARTICIPANT MANUAL
May 2013
prepared under contract dtnh 22-08-00235
Table of Contents
Acknowledgements Chapter 1: Introduction and Course Objectives iii
1
Why Are We Here? 1
Operation Kids: Next Generation Mission 2
Goals and Objectives 2
Child Passenger Safety Is a “Moving Target” 3
Focus and Purpose of the Basic Awareness Course 4
Chapter 2: Child Passenger Safety — We’re All in This Together 6
Integrating Child Passenger Safety Enforcement and Education? 6
Our Roles in Engineering, Education, and Enforcement 7
Chapter 3: Who Makes the Rules? 14
National Highway Traffic Safety Administration (NHTSA) 14
State Occupant Restraint Laws 17
Chapter 4: How Restraints Protect Occupants in Crashes 21
What Happens in a Crash 21
How Restraints Protect Occupants 22
Types of Occupant Protection Systems 23
Occupant Protection Systems After a Crash 26
Everyone Buckle Up — Every Time, Every Trip 27
Unsurvivable Crashes 27
Chapter 5: Choosing and Using Child Restraints 29
What Is the Best Car Seat? 29
Are Used Child Restraints Okay? 30
Selecting the Right Restraint Based on the Age and Size of the Child 31
Chapter 6: Harnessing the Child in the Restraint Correctly 42
Rear-Facing Restraints
43
Forward-Facing Restraints 44
Booster Seats 45
Seat Belts 46
Adaptive or Specialized Restraints 46
Chapter 7: Installing Child Restraints in Vehicles Direction: Be Sure the Child and CR Face the Right Way in the Vehicle 48
48
Location: Install the CR in the Right Spot in the Vehicle 49
Installation: Secure CR to the Vehicle in the Right Way 53
General Steps for Child Restraint Installation 55
Child Restraints and LATCH 56
Chapter 8: Child Restraint and Seat Belt Misuses Reasons for Misuse 59
Misuse of Child Restraints 59
Misuse of Booster Seats 61
Misuse of Seat Belts 61
Chapter 9: Child Passenger Safety in Other Vehicles 63
Pickup Trucks 63
15-Passenger Vans 64
School Buses 64
Airplanes 65
Ambulances 66
Police Vehicles 66
Chapter 10: Where Do We Go from Here? 68
Intervention — Making a Difference in Child Passenger Safety 68
“What Can I See? Why Is This Important?” 68
Additional Questions Related to Vehicle Collisions Involving Children 70
“What Should I Do?” 72
The Very Last Question: What Should We All Do? 75
Appendices ii
59
78
CPS Resources 80
Recommendations for Replacement of Crash-Involved Seat Belts & Child Restraints 84
LATCH Handout 86
Car Seats and Booster Basics
88
Child Occupant Protection Glossary 90
English to Spanish Glossary 96
Spanish to English Glossary 108
Operation Kids: Next Generation — CPS Basic Awareness Course
Acknowledgements
The Operation Kids: Next Generation — Child Passenger Safety Basic Awareness
Course was produced to help create awareness of the importance of child passenger
safety (CPS) education and enforcement in preventing child passenger deaths and
injuries and to provide basic knowledge on this issue to groups and individuals
who can benefit from this information. It would not exist without the cooperation
and collaboration of many individuals and organizations. This course has evolved
from the initial “Operation Kids — Law Enforcement Child Passenger Safety
Program” (“OP Kids LE) training curriculum developed by Robert T. Wall, Master
Police Officer (Retired), Fairfax County, VA, Police Department and the late Joel
Bolton, Lieutenant, Lake Charles, LA, Police Department for the International
Association of Chiefs of Police.
Special thanks to the nurses who worked so hard to revise the original “OP Kids
LE” curriculum to make it pertinent to nurses and other health care professionals
as the “OP Kids RN” curriculum. They are: Anne Phelan Bowen, RN, MS,
Massachusetts; Mary Russell, EdD, RPT, RN, CEN, CCRN, Florida; Connie
Smith, RN, Washington; Susan Smuda, RN, New Mexico.
Special thanks also go to the individuals and organizations who worked to revise
the original “OP Kids” curriculums to make them more pertinent to child care
professionals. “Moving Kids Safely In Child Care” was developed in conjunction
with the Healthy Child Care America Campaign, supported by the U.S.
Department of Health and Human Services Child Care Bureau and Maternal and
Child Health Bureau, and coordinated by the American Academy of Pediatrics.
For the development and distribution of this program, thanks go to the University
of North Carolina and members and participating agencies of the National Child
Passenger Safety Board.
Appreciation is also extended to the two pilot sites and instructors for their
willingness to conduct pilot classes and to the organizations that participated by
sending students to the pilot classes:
DURHAM, NORTH CAROLINA
Instructors
• Theresa Cromling
Duke University Medical Center
• Kathy Mellown
Durham County EMS
• Stan McHenry
Durham Police Department
Participating Agencies
• Duke University Medical Center
• Durham County Health
Department
• Durham County Department of
Social Services
ASHEVILLE, NORTH CAROLINA
Participating Agencies
Instructors
• Vickie Whitlatch
Mission Hospitals
• Beverly Hopps
Mission Hospitals
• Asheville Police Department
• Buncombe County Department of Social Services
• Enka-Candler Fire department
• Henderson County Health Department
• Jena Johnson
Mission Hospitals
• North Carolina State Highway Patrol
• Reynolds Fire Department
Generous appreciation is extended to the organizations that provided illustrations
and videos for the manuals and accompanying PowerPoint slides:
• Britax USA
• Chicco USA
• Child Passenger Protection Research Program, University of Michigan
Medical School
• Children’s Hospital of Philadelphia
• Insurance Institute for Highway Safety
• Maryland Child Passenger Safety Advisory Board
• Montgomery County (Maryland) Fire and Rescue Service
• National Child Passenger Safety Certification Training Curriculum
• North Carolina Division of Public Health, Injury and Violence Prevention Branch
• Safe Kids Guilford County (North Carolina)
• Safe Kids North Carolina
• Safe Ride News Publications
• UNC Highway Safety Research Center
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Operation Kids: Next Generation — CPS Basic Awareness Course
Chapter 1:
Introduction and
Course Objectives
Why Are We Here?
Statistics tell us that approximately 55,000 children (under age 5) are injured in
crashes each year. An average of six children (0 – 14) in the United States are killed
and over 600 injured each day in motor vehicle crashes. Only diseases like cancer,
heart disease, and stroke kill more people than motor vehicles. Yearly, more than
41,000 Americans die in traffic crashes and another 2.5 million are injured. (All
current data is available from National Highway Traffic Safety Administration’s
Fatality Analysis Reporting System on the NHTSA website — nhtsa.gov.)
The Centers for Disease Control and Prevention tell us that injury is the leading
cause of death to children over the age of one. But death due to highway fatalities
is just the “tip of the iceberg.” Many more car-related injuries occur than deaths
every year. Some of those injuries have life-long effects and can be very costly. The
prevention of acute injuries and long-term disabilities is a priority in childhood
injury prevention. For every injury-related death, there are many more children
hospitalized and needing medical care in emergency rooms or doctor’s offices.
The discussion of child passenger
safety contained in Operation Kids:
Next Generation is designed to
increase your level of advocacy as
related to the transportation needs
and safety of children. In today’s
society, more parents are working and
placing their children in day care,
preschool, and after school sites than
in the past. There also are many more
community activities in which children
participate. The result is that children
are transported more often than ever
before with an increasing risk of being in a crash or injury event.
There are a number of issues that need your advocacy:
• Ensuring that children are always appropriately restrained by enforcing laws,
strengthening legislation and conducting educational programs.
• Making sure that children are placed in the back seat of vehicles because of air
bag technology and because it is the safest place for them to ride.
• Using the best restraint system for the child’s age and size and using the
restraint system correctly.
• Encouraging parents and caregivers to also buckle up correctly on every ride
regardless of their seating position.
Operation Kids: Next Generation Mission
The mission of this basic awareness course is to reduce the unnecessary and
preventable motor vehicle injuries and fatalities to infants and children through
increased education, support for enforcement, promotion of positive engineering
advancements, and the promotion of the correct usage of child restraint systems.
Goals and Objectives
The goal of the Operation Kids: Next Generation — Child Passenger Safety Basic
Awareness Course is to create an awareness of the importance of CPS education and
enforcement in preventing child passenger deaths and injuries and to provide basic
knowledge on this issue to groups who can benefit from the following information.
Operation Kids will NOT make you a child passenger safety expert, but at the
conclusion of this class individuals will be able to:
• Understand and explain their state’s occupant restraint laws vs. “best practice”
recommendations.
• Detect major and potentially harmful CPS and seat belt law violations.
• Identify local, state, and national CPS resources.
• Be able to say, “I don’t know,” when necessary.
•Provide basic information to parents on correct child restraint use.
• Understand and support the enforcement of existing child passenger safety
statutes.
• Develop effective strategies for assisting parents and other caregivers in the
correct use of CPS devices.
• Develop and participate in effective public safety partnerships to increase the
effectiveness of CPS programs.
• Assist at a child passenger safety checkup event.
This is NOT a certification course and should not be confused with the National
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Operation Kids: Next Generation — CPS Basic Awareness Course
CPS Certification Training Program. Participants will NOT be qualified to:
• Serve as a checker (a Certified CPS Technician qualified to check a car seat) at
a child passenger safety event.
• Set up and coordinate a child passenger safety event or inspection station
without guidance of a Nationally Certified Technician.
• Serve as a child passenger safety/seat belt technical expert for the media.
• Operate child restraint loaner/distribution programs.
KEY CONCEPT…
The participant who successfully completes this class will have developed
a basic awareness of child passenger safety issues and practice.
Participants wishing to provide these community services are encouraged to pursue
CPS Technician certification. The child passenger safety certification course is
designed to teach individuals the technical and instructional skills needed to
serve as child passenger safety resources for their organization, community, or
state. In general, it is recommended to take the National Child Passenger Safety
Certification Training Program after working with Certified Technicians in
established local programs for a period of time. Remember that increasing the
correct use of child restraints involves a variety of groups and individuals. The
load is not resting entirely on your shoulders. This is an awareness course — not a
technical training course.
Child Passenger Safety Is a “Moving Target”
The information contained in this manual was current at the time of printing,
but child passenger safety is a dynamic and ever-changing field. There are several
reasons for this. One reason is that the target audience that needs accurate and
current child safety seat information is continually changing. The parents who need
information about infant seats and how to use them correctly today is not the same
group we were talking to last year. The parents we talked to last year about infant
seats are now struggling to properly restrain a toddler.
Secondly, there are environmental issues that are in constant change, such as new
technology and product recalls. New technology covers a variety of improved child
restraint (CR) designs that are introduced into the marketplace on a regular basis.
Child restraint systems (CRS) are constantly being improved to provide additional
safety benefits for their occupants in a crash and easier for parents to install and use
correctly. It is important to stay updated with many technological factors associated
with vehicle design and safety improvements. An example of this was the addition
of frontal passenger side air bags in vehicles. A rear-facing infant seat must never be
placed in front of an active air bag. Another example is that the variety of seat belt
Chapter 1: Introduction and Course Objectives
3
systems in vehicles today are confusing, and, again, ever-changing. This has a direct
effect on the proper and safe installation of a CRS.
Federal safety standards also have changed in recent years. One such change mandates
technology upgrades in both the vehicle and child restraint in order to provide a more
universal child restraint installation system that makes it easier for parents.
Product recalls can be undertaken by the manufacturer or the National Highway
Traffic Safety Administration (NHTSA) to correct problems that may not have
been discovered during initial design or NHTSA testing. If a parent has not
registered their seat with the manufacturer, they will not be notified of a problem
with the seat. We can all work in a variety of ways to inform the public about recalls
and help to correct defects.
Focus and Purpose of the Basic Awareness Course
While the focus is primarily on child restraints (sometimes also referred to as “child
safety seats” or “car seats”) that are used for younger children, there also will be
discussion about seat belt use for older children and adults and passenger safety in
other types of vehicles. These topics go hand in hand because many children small
enough to benefit from child restraints are mistakenly placed in seat belts designed
for older children and adults. Parents and caregivers need accurate information
about the transition from child restraints to seat belts. Restraint use in other
vehicles is another topic that falls under the CPS umbrella.
Furthermore, injury prevention is a family issue. Proper use of seat belts by all
passengers helps assure the safety of all occupants. Some injuries are inflicted by
one passenger being thrown into another. Besides acting as a positive role model,
it is important to ensure the safety of adults riding in the vehicle. No one wants
parents killed or seriously injured leaving a child survivor in a car seat, yet some
adults seem to take risks themselves in spite of buckling up their children.
The basic knowledge that participants will develop during this awareness course is
essential in order to provide correct information and assistance. Participants will not
know everything about child passenger safety and child restraints by the end of this
training program.
They will, however, know enough to help convince people to correctly use child
restraints and seat belts for their children. Participants will know enough to
recognize the limits of their knowledge and know when to say, “I don’t know, but
I’ll find out.” Participants will learn where to find the information that is needed.
They will also discover that many issues may not have clear, concrete solutions.
This program is about more than the technical aspects of child restraints and seat
belts — it’s about children. Children who are passengers in motor vehicles. Children
who are riding with adults who may not be aware of the dangers of a crash.
Children who need and deserve protection from the devastating effects of motor
vehicle crashes.
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Operation Kids: Next Generation — CPS Basic Awareness Course
Chapter X:
1: Introduction
Title
and Course Objectives
5
Chapter 2:
Child Passenger Safety — We’re All in This Together
This segment of the course is designed to give law enforcement officers, health care
providers, child care providers, and fire and rescue professionals the tools needed to
actively promote child passenger safety laws and education that will ensure a safe ride
every time for all children. There are other environmental factors that affect CPS
programs. One of the largest problems for many of these professionals is to maintain a
balance between the myriad of everyday issues that compete for attention. Traffic safety
sometimes takes a back seat to these issues. Even in places where the importance of
maintaining traffic safety is stressed, child passenger safety can be overlooked.
Integrating Child Passenger Safety Enforcement
and Education? What Does That Mean?
What this means is that increasing CPS enforcement and education can be
accomplished without detracting from any other duties or services that you as
professionals may be called upon to perform. There is no need for specialized squads
or overtime to save children’s lives. It can be done by being aware of the magnitude
of the problem, by knowing how effective a professional’s actions can be, and by
integrating child passenger safety education and enforcement into daily routines.
It can be done through a casual glance at the child safety seat during any opportunity.
A glance that can tell if the harness is securing the child, if the car’s seat belt is
holding the child safety seat in the vehicle at all, if the seat is facing the right
direction for that age and size of child, and if the child is in front of an air bag.
LOOSE KIDS — WHAT DOES THAT MEAN?
What this means is that many violations of the law and violations of basic safety
principles are easy to spot. We’re talking about the 3-year-old that stood on the
back seat last week and waved as his child safety seat sat next to him unused.
We’re talking about the newborn baby that was being held in his mother’s arms.
We’re talking about the 2-year-old that was playing happily in the front seat with
no child safety seat in sight.
AREN’T THERE OTHERS OUT THERE DOING THIS
ALREADY?
Yes, there are any number of groups and individuals involved in promoting child
passenger safety as well as other injury prevention programs. But does that mean
that law enforcement officers, health care providers, child care providers, and fire and
rescue professionals do nothing? The simple answer is an emphatic “no.” Traffic safety
and the advocacy for traffic law enforcement is up to all of us. It is the responsibility of
all of us to ensure safety on the roadways for drivers and their passengers.
Our Roles in Engineering, Education, and
Enforcement:
The “Three E’s of Traffic Safety” are engineering, education, and enforcement.
HOW CAN WE BE INVOLVED IN ENGINEERING?
The first “E,” engineering, as it applies to child passenger safety, refers to the
design of child restraints. We’ll discuss how child restraints absorb and spread crash
forces later and we’ll also look at some of the issues of compatibility between child
restraints and vehicles later in this manual.
QUESTION #1: TRUE OR FALSE
Law enforcement officers, health care providers, child care providers, and
fire and rescue professionals have no role to play in the engineering of
child restraints?
The answer to this question is “FALSE.” Law enforcement officers, health care
providers, child care providers, and fire and rescue professionals have a very
significant role to play in the engineering of child restraints. Another important
lesson to learn is that it does not take a Certified Technician to play a role in the
engineering of child restraints.
Child restraints are designed, tested, and certified by the manufacturers to meet
the requirements of FMVSS 213 (a government safety standard). This standard
specifies certain performance criteria the seats must meet. Seats are routinely
and randomly tested by engineers at the National Highway Traffic Safety
Administration (NHTSA) to verify that they do indeed meet these standards.
These tests use instrumented “anthropomorphic” (human-like) dummies; however,
the real test of the performance of a child safety seat takes place in the field with
a real child involved in a real crash. That’s where law enforcement, fire and rescue,
health care and child care professionals come in.
Chapter X:
2: Child
Title Passenger Safety — We’re All in This Together
7
Law enforcement officers and fire and rescue personnel are the ones who respond
to the scene. Health care providers also see the results of the real crash and can
provide information to the child restraint manufacturers to help them determine
whether or not the child restraint performed as designed. Your role is to note
any failures and successes that may have been observed and report them so that
appropriate measures can be taken. The best method to do this is to call the
NHTSA Auto Safety Hotline at 1-888 DASH 2 DOT (888-327-4236).
In addition, a number of federal, state, and private agencies study motor vehicle
crashes and crash data to document the effects of use, correct use, non-use, and
misuse of occupant protection systems, including child restraints. Information
recorded in crash reports, EMS run reports, and hospital records can be invaluable
in studies such as these. It is important that persons completing these reports and
records do so as completely and accurately as possible.
Child care personnel and other child passenger safety advocates and educators
can help parents understand the vital importance of having their CRs registered
with their car seat’s manufacturer. Recalls on CRs are not common, but should a
manufacturer issue a recall on a particular model, parents will not be notified unless
they have registered their car seat. They may either contact their manufacturer
directly or call the NHTSA Auto Safety Hotline (see above) in order to obtain a
registration form and/or check for a recall on their child’s car seat.
HOW CAN WE BE INVOLVED IN EDUCATION?
The second “E,” education, involves a very large and diverse group of people and
organizations. They are representatives of police agencies, health care providers,
child care providers, fire and rescue professionals, health and safety coalitions,
health departments, military personnel, transportation departments, media outlets,
and commercial entities. As child passenger safety advocates, they are critically
important to increasing the correct use of vehicle restraint systems by providing
correct and current information and materials to parents and other caregivers.
Remember that military personnel represent many of the same audiences as their
civilian counterparts. They frequently have special circumstances, such as transience
and the stress that it causes to families, and they tend to have young children as well
as a lack of personal support systems. These things make them equally important
contacts in the field of CPS advocacy and should be included in educational
programs and activities as much as possible. (Military personnel and their families
can be reached by contacting the base safety offices and/or the family support group
offices in order to set up contacts for a variety of audiences on any military base.)
Also, remember the need to be aware of the different ethnic groups in any given
community and to take cultural and racial differences, as well as differences in
learning and communication styles, into consideration when planning educational
programs and activities. Examples of some cultural differences to be considered
include:
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Operation Kids: Next Generation — CPS Basic Awareness Course
• In some Hispanic and Latino communities, the car seat is blessed before it can
be used.
• Some African Americans, Native Americans, and Hispanics feel more
comfortable holding a child on their lap in vehicles.
• Some minorities will not seek advice from a public authority such as a
police officer.
• Some Arab American communities do not allow the mother to be spoken to if
the father is present.
Before beginning your educational efforts, think about the diversity within your
own community and identify your strategies for reaching the different cultures
within your community.
HOW CAN WE BE INVOLVED IN ENFORCEMENT?
QUESTION #2: TRUE OR FALSE
Police educate people with a pen and ticket book; “press hard, five copies.”
The answer to this question is “TRUE.” Enforcement is a form of education that
alters behavior and may be the only form of education that alters the behavior of
some people.
Law enforcement agencies across the country have been active for years in CPS
education. Police involvement has taken many forms including training for officers,
seminars for new parents and other caregivers, informational displays at fairs
and festivals, media interviews on the topic, and public service announcements
reminding motorists to restrain their children.
To increase correct use of child restraints, the active support of public safety
professionals is critical. Police officers have the respect of both adults and children.
They will listen to what an officer has to say in order to keep their children safe.
It is important, however, for an officer to give the correct information or to refer
the individual to the appropriate resources in their community for additional
information and assistance.
Accurate crash investigations by law enforcement officers matter! This information
can be used to pinpoint roadway problems such as hazardous intersections or sections
of roadway and to determine whether a child restraint did what it was supposed to do,
or whether the crash exceeded the protective capabilities of the child restraint. This
information can also play a major role in affecting the attitude of the public through
media stories about the effectiveness of occupant protection systems. This information
can only be generated if investigating officers report factual information about
restraint use in a crash and child restraint use in particular.
Chapter X:
2: Child
Title Passenger Safety — We’re All in This Together
9
QUESTION #3: TRUE OR FALSE
Health care providers have many opportunities to educate through the
“teachable moment.”
The answer to this question is “TRUE.” Health care providers across the country
have been active for years in education on a wide range of health and safety topics.
This involvement has taken many forms including training for nurses, seminars for
new parents and other caregivers, informational displays at fairs and festivals, media
interviews on the topic, and public service announcements reminding parents to
properly restrain their kids.
To increase correct use of CRs, the active support of health care providers is critical.
Parents and caregivers view nurses as credible health care professionals who can guide
them with language and terminology that is understandable as a way to keep their
children safe. Health care providers of all sorts (technicians, aides, physicians, PAs,
etc.) have valuable roles to play in increasing the way parents receive injury prevention
messages. If you have accurate, current information to give them, parents and
caregivers will listen to what you have to say to help keep their children safe.
QUESTION #4: TRUE OR FALSE
Child care providers have no role in the education of parents and
caregivers about child restraint systems.
The answer to this question is “FALSE.” Child care providers across the country
have been active for years in many forms of education for the parents and caregivers
who entrust their children into their care. Both during carpool pickup and dropoff
times as well as during “classroom” time, the child care provider has unique and
important times to advocate for truly effective child passenger safety education.
Child care providers have many opportunities to educate through “teachable
moments.” They can affect positive CPS messages during travel experiences related
to: field trips, before and after carpool times, pickup and delivery, emergency-related
transportation, and errands.
QUESTION #5: TRUE OR FALSE
Fire and rescue personnel have a limited role in the education of their
community when it comes to child passenger safety.
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Operation Kids: Next Generation — CPS Basic Awareness Course
The answer to this question is “FALSE.” As first responders to vehicle crash scenes,
fire and rescue personnel have a unique view of the devastation that occurs when
passengers are either incorrectly secured or not restrained at all. While it may be too
late to initiate education at the crash site, positive reinforcement for those parents
who did use child restraints correctly will certainly go a long way toward correct use
again (as well as passing that information on to other families).
Fire stations are excellent sites for setting up CR checkup events or permanent
inspection stations. Working with certified CPS Technicians to assist in organizing
and running regular events or inspection stations can go a long way toward
educating families one-on-one about the consistent and correct use of CRs.
Fire and rescue personnel’s involvement in CPS education can take many forms
including training for personnel, seminars for new parents and other caregivers,
informational displays at fairs and festivals, media interviews on the topic, and
public service announcements reminding motorists to restrain their kids.
QUESTION #6: TRUE OR FALSE
Only Certified CPS Technicians can play a role in providing education in
their communities when it comes to child passenger safety.
The answer to this question is “FALSE.” It does not take a Certified Technician to
play a role in educating parents and caregivers about the need for child restraints
and the need to choose and use them correctly. It is a basic recommendation that
persons providing “hands-on” assistance with the use and installation of child
restraints or who provide detailed education and advice to parents/caregivers on the
proper use of occupant restraints be current Certified Technicians.
However, the basic knowledge that participants will develop during this awareness
course is enough to help convince parents and caregivers to correctly use child
restraints and seat belts for their children, to know when to say, “I don’t know, but
I’ll find out,” and to learn where to find the additional information that is needed.
WHY SHOULD WE BE INVOLVED IN ENFORCEMENT?
The third “E” is enforcement. Of course, enforcement is carried out by law
enforcement officers, but community support for their enforcement efforts plays a
key role in the level and effectiveness of the enforcement efforts.
QUESTION #7: TRUE OR FALSE
As a law enforcement officer, nothing you can do has as much potential
to save lives and prevent injury for children as actively and aggressively
enforcing child passenger safety laws.
Chapter X:
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Title Passenger Safety — We’re All in This Together
11
The answer to this question is “TRUE.” Studies have shown repeatedly that public
information and education campaigns are only as effective as the enforcement that law
enforcement agencies provide. Active enforcement sends a very real message to the
public that the use of child restraints and seat belts are important and effective in the
view of public safety professionals who know and see the devastation of crashes.
Some officers may be reluctant to enforce their state’s CPS laws because they do
not know a lot about their state’s laws or car seats. An officer does not have to be an
expert or certified as a CPS Technician to be able to enforce the most blatant and
dangerous violations of a CPS law, such as children not being buckled in at all or
adults holding infants in their arms.
QUESTION #8: TRUE OR FALSE
Professionals such as health care providers, child care providers,
fire and rescue personnel, and other CPS advocates outside of law
enforcement have no role in effectively enforcing child passenger
safety and seat belt laws.
The answer to this question is “FALSE.” We must all recognize that enforcement
is carried out by the police, but the most effective enforcement is done with
community support. Usage surveys have confirmed that most parents respond
to our educational efforts to buckle their kids correctly. But a segment of the
population will only respond to active and aggressive enforcement. Some of these
caregivers have not been reached by educational efforts. Still others are simply
forgetful or do not consider the chances of being involved in a serious crash worthy
of the effort.
Enforcement is an important component, but state and local enforcement agencies
are more likely to effectively and actively enforce child passenger safety and seat belt
laws if the public demands and supports it. Expressions of support from the medical
community, fire and rescue personnel, child care providers, and parents help to
assure that enforcement agencies actively enforce these laws by integrating it into
their daily routines.
KEY CONCEPT…
Law enforcement, heath care providers, child care providers, and fire and
rescue personnel all play integral parts in the roles of CPS engineering,
education, and enforcement.
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Operation Kids: Next Generation — CPS Basic Awareness Course
Chapter X:
2: Child
Title Passenger Safety — We’re All in This Together
13
Chapter 3:
Who Makes the Rules?
There are a number of federal agencies that develop and set regulatory standards
related to child passenger safety. For the most part, the “rules” for federal standards
are set by the National Highway Traffic Safety Administration, and it is the
individual states that pass laws regarding who is required to be restrained, in what
manner, and under which circumstances.
National Highway Traffic Safety Administration
(NHTSA)
NHTSA is the agency within the U.S. Department
of Transportation focused on occupant safety and is
responsible for setting and enforcing safety standards
for motor vehicles and motor vehicle equipment
such as child restraints. NHTSA’s mission is to save
lives, prevent injuries, and reduce traffic crash costs
through education, research, safety standards, and
enforcement activities.
BASIC FUNCTIONS OF NHTSA
The following are some of the basic functions of NHTSA and how they relate to
child passenger safety.
Education
NHTSA provides a variety of traffic safety training programs and produces
brochures, posters, statistics, and fact sheets that you can get from nhtsa.gov or
trafficsafetymarketing.gov. NHTSA has 10 regional offices that work closely with
state and local agencies to carry out safety programs.
Enforcement
There are two types of enforcement: NHTSA provides funding to promote
occupant protection by working with the law enforcement community and media
campaigns such as Click It or Ticket. It also enforces its standards by selecting
certain products on the market to see if they meet federal standards.
Research
NHTSA conducts and/or funds research to demonstrate and evaluate programs
related to traffic safety.
Compliance Testing
NHTSA does not certify CRs before they go to market. Vehicle and CR
manufacturers self-certify their products as meeting NHTSA performance
standards. This means that products are sold on the basis of manufacturer testing
and assurances. NHTSA requires all manufacturers to label their products in
accordance with these regulations and randomly tests these products.
Defect Investigation and Recalls
NHTSA tests products that have been reported by the public or manufacturer to
have a potential problem. If a real problem is identified, a recall of the product may
follow. Manufacturers can issue a recall before involving the government if a problem
is known to them. This information is made available as a “recall list” by NHTSA
and other organizations. Knowing the model number and date of manufacture for a
particular CR is needed to determine if it has been recalled. A child restraint that is
missing its label may be dangerous to use, as recalls cannot be determined.
Each new CR comes with a product registration form that parents/caregivers should
complete and mail back to the manufacturer. Manufacturers can then let product
owners know if there is a recall or other problem. If a parent/caregiver has not sent
in a car seat registration form, he or she can submit the NHTSA CR Registration
Form (available on the NHTSA website — safercar.gov) or submit a registration
form online through the manufacturer’s website. Registration cards for older or
second hand restraints can be obtained from the NHTSA Auto Safety Hotline
(888-327-4236), through the NHTSA website, or through the child restraint
manufacturer’s toll-free customer service number. Some child restraints also can be
registered through their manufacturer’s website.
It is very important for CPS advocates and users to pay attention to recall notices
and for parents to check to be sure that their restraints are safe to use. Recalls
can be issued for any failure to meet Federal Motor Vehicle Safety Standard
(FMVSS) 213 established and enforced by the National Highway Traffic Safety
Administration. Problems may be discovered with child restraints during
government FMVSS 213 compliance testing, through manufacturer testing, and
through complaints of users.
It is important to note that many recalls or safety notifications do not affect the
crashworthiness of the restraint. Many recalls are for reasons related to labeling
requirements, flammability of the upholstery or padding, or for parts that pose a
choking hazard. All recalls should be corrected to ensure safety. In most cases, it is
better to use a recalled restraint than to not use one at all.
Chapter X:
3: Who
Title Makes the Rules?
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KEY CONCEPT…
Some recalls do not affect the crashworthiness of the restraint, but all
recalls must be corrected to ensure safety.
In cases where the manufacturer has gone out of business or discontinued
replacement programs, the restraint should be destroyed completely and replaced.
Do not throw unsafe restraints in the trash where they can be picked up and
reused by others. The restraint should be destroyed by stripping the upholstery and
removing the straps or by crushing the restraint.
FEDERAL MOTOR VEHICLE SAFETY STANDARDS
As noted earlier, NHTSA is responsible for setting and enforcing safety standards
for motor vehicles and motor vehicle equipment such as child restraints.
FMVSS 213 requires that a child restraint’s performance be measured through
“crash” tests that simulate 30 mph frontal crashes into a solid barrier. This is
considered to be a very severe crash. Manufacturers are required to test their
child restraints using the FMVSS 213 requirements and to place labels on
them with the model number and date of manufacture. Caregivers should not
use a restraint if it is missing the label, or if the label has no model number or
date of manufacture.
KEY CONCEPT…
NHTSA sets performance standards for child restraints and the
manufacturers “self-certify” that their models meet these standards.
NHTSA EASE OF USE RATINGS
The best seat is the one that fits the child
appropriately, is the one parents/caregivers are most
likely to use correctly every time, and fits the vehicle
correctly. All child restraints meet federal safety
standards and strict crash performance standards and
are safe when used correctly. While all CRs are safe, they do differ in their ease of use,
so NHTSA provides parents with a five-star ratings system that allows them to evaluate
how easy certain car seat features are to use before buying a seat. The primary purpose of
ratings is to educate parents/caregivers about child restraint features and assist them in
finding the appropriate seat for their needs. Manufacturers often take these ratings into
consideration when designing and updating their products.
Ease of Use Ratings are found on NHTSA’s website — nhtsa.gov. Ratings are
announced yearly.
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NON-REGULATED PRODUCTS
Products that are not regulated (sometimes called aftermarket products) and are
designed to improve the comfort, fit, or installation of CRs and/or seat belts. Some
examples are infant head-positioning pads and shoulder belt positioning devices.
However, there are no federal standards for these products. For example, a seat
belt adjuster label may say the product “meets all applicable federal standards” but
there is no federal standard for that type of product. Because of this, caregivers
should read all manuals and instructions carefully, including vehicle and CR
manufacturer’s instructions and recommendations. Many warn against using
“extras” with their products. Manufacturer-tested and approved accessories, such as
toys for their own CRs or shoulder belt adjustable clips, are fine.
Some devices can injure occupants in the vehicle if not properly secured during a crash.
Suction window shades and mirrors are two examples of objects that can harm vehicle
occupants during a crash. Window shades that stick to the windows are better to use.
State Occupant Restraint Laws
NHTSA is responsible for setting and enforcing safety standards for motor vehicles
and motor vehicle equipment such as child restraints; however, it is the individual
states that legislate which types of restraints must be used by which occupants.
All 50 states and the District of Columbia have laws that require some children to be
buckled up in child restraints. There are mandatory seat belt laws in 49 states and the
District of Columbia (New Hampshire is the exception). Child restraint laws require
children up to a certain age or weight or height to travel in child restraints. In most
states, the seat belt laws cover drivers and front-seat occupants only; however, the seat
belt laws in a number of states cover all rear seat occupants too.
Ideally, all occupants in all vehicles should be covered by seat belt laws, child restraint
laws, or both. But laws vary widely from state to state and differences in the laws can
leave many occupants, especially children, not covered by either law. Some states require
child restraints to be used (no seat belt substitute) by children up to age 5, while another
may allow substitution of seat belts for children after they reach their second birthday.
They may require that young people up to age 16 be properly restrained in any seating
position, or they may have that same requirement only for kids under age 3. They may
allow seat belts to be substituted for child restraints for kids of certain ages or sizes, or in
certain seating positions such as the rear seats. Booster seat laws also have been enacted
and some states now mandate seating locations for children under a specific age. The
fines imposed may be too little or too much, and can frequently be waived if the violator
proves to the court that they have acquired a child safety seat.
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Title Makes the Rules?
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Take a moment to examine the law(s) in your state and answer these questions:
• What ages and/or sizes of children are required to be in child restraints (CR)?
• Does the law require correct use of the CR?
• Does the law require that the CR meet federal motor vehicle safety standards?
• Does the law require certain ages and/or sizes of children to be in a rear seat
of the vehicle?
• Are children older than 4 and heavier than 40 pounds required to be in a CR
(booster law)?
• Is there a requirement for proper seat belt use by older children in all
seating positions?
• Does it permit substitution of seat belts?
º In certain seating positions?
º At certain ages?
• Is there a requirement for proper seat belt use by drivers and adults in all
seating positions?
• Who is responsible for violations?
• What are the penalties for violations?
º How much are the fines?
º Are court costs or other charges added to the fines?
º Are driver license points assessed?
º Are insurance points assessed?
• What exemptions are there?
º Non-parent vehicles?
º Out-of-state drivers?
º Emergency vehicles?
º Non-custodial drivers?
º While “tending to the child’s needs”?
º Number of occupants exceeding the number of restraints?
º Pickup trucks?
º Other (e.g. taxis, public transportation)?
º Is double buckling (two children in one seat belt) allowed?
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LEGAL VS. BEST PRACTICE RECOMMENDATIONS
Laws are minimum standards. When we talk of what is “legal” vs. what is
“recommended,” we are talking about the bare minimum necessary to comply with the
law versus what is the very best to ensure a child is as safe as possible in the car. In many
states, what is allowed under their occupant restraint law(s) is not necessarily what is
recommended to provide the best protection for a child or adult. For instance, switching
a child to a seat belt at 65 or 80 pounds may be legal in a particular state, but seat belts
still do not fit many children even at 80 pounds. Belt-positioning booster seats are
recommended for children until seat belts fit well on a child, as will be discussed later.
As educators, one of our goals is to get parents to realize that what is legal may not be
the safest way to transport a child — or an adult for that matter!
Chapter X:
3: Who
Title Makes the Rules?
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Chapter 4:
How Restraints Protect
Occupants in Crashes
What Happens in a Crash
It is important for child passenger safety advocates to understand a few basic
principles of crash dynamics. What happens in a crash? What forces do occupants
and restraint systems undergo during a crash? How do seat belts and child
restraints work to protect occupants? Advocates need to understand these concepts
before they can help parents understand how important it is to safely transport all
members of their families.
A basic law of physics states that an object in motion will remain in motion until
acted on by an outside force. This means that when a car stops suddenly, all objects
inside the vehicle, including people, continue moving at the original speed of the
vehicle toward the point of impact until stopped by another object. The outside
force that stops an occupant could be something dangerous such as the steering
wheel, dashboard, a tree, etc., or something designed to protect the occupant such
as a seat belt or child restraint system.
KEY CONCEPT…
In a crash we WILL hit something; however, we do have a choice as to what
we hit … either something dangerous or something protective.
The weight of the occupant multiplied by the speed the vehicle is traveling is an
approximation of the force of impact an occupant will sustain in a crash. As an
example, a 20 pound baby in a 40 mph crash will be thrown forward with a force of
800 pounds (20 x 40 = 800).
There are four main types of crashes — frontal, lateral (or side-impact), rear-end,
and rollover crashes. Child restraints and seat belts help to protect occupants in all
kinds of crashes, but the frontal crash is the most frequent type of crash and is the
type of crash for which seat belts and child restraints are primarily designed for.
In any type of crash, the occupants continue to move toward the point of impact.
In frontal crashes, the occupants continue to move toward the front of the vehicle.
The restrained occupant is protected by the seat belt or child restraint while any
unbelted occupant can collide with another occupant, the vehicle interior, or be
ejected from the vehicle. Unrestrained occupants pose a threat to those who are
properly restrained since the restrained occupants can be injured when unrestrained
occupants collide with them.
OTHER DANGEROUS CRASH EVENTS
Rotations (or spins) and ejections are two dangerous crash events that can occur
in almost any crash or chain of crash events. In a spin, unrestrained occupants are
more likely to be injured as they impact with the vehicle’s interior repeatedly and are
much more likely to be ejected from the vehicle than restrained occupants.
Ejected occupants are four times more likely to be killed as those who remain
inside. They also are more likely to receive cervical spine injuries. People who
are ejected, either totally or partially, may be thrown out a window or door, skid
along the pavement, or be pinned or crushed under a vehicle. Landing gently on a
soft and forgiving surface is highly unlikely. Even if the occupant does land on a
forgiving surface, the vehicle itself may follow the same path as the ejected person
and land on him or her.
OCCUPANTS IN NON-COLLISIONS
People can get hurt when their vehicle swerves, skids, or stops suddenly, especially
if the person is unbelted. Even in routine driving maneuvers, occupants can feel the
forces of changed speed or direction but can generally brace themselves and stay in
position on the vehicle seat.
In emergency swerves, unrestrained drivers are more likely to lose control of their
vehicle because they are not held firmly behind the wheel. Unrestrained passengers
may strike one another or parts of the vehicle causing injury. While going around a
corner, an unlatched door can come open, permitting an unrestrained occupant to
fall out.
KEY CONCEPT…
Occupant restraint laws differ from state to state, but the laws of physics
are the same in ALL states!
How Restraints Protect Occupants
Occupant restraint systems are designed to reduce injury to occupants and help to
do so five different ways:
1. Prevent ejection from seating position and vehicle. Drivers cannot
maintain control of the vehicle if they are thrown out from behind the
steering wheel when the vehicle swerves suddenly. People thrown from a
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vehicle are four times more likely to be killed than those who remain inside.
Ejected occupants are also much more likely to sustain cervical spine injury
than those who remain within the vehicle.
2. Load crash forces on the strongest parts of the body. For an older child or
adult, these parts are the hips and shoulders. For an infant and young child,
there is really no part strong enough, so the rear-facing restraint supports the
entire body to avoid stress on any one part.
3. Spread crash forces over a wide area of the body. This puts less stress on any
one part of the body. Lap and shoulder combination seat belts and child restraint
harnesses spread the crash forces across a large area of the body. A rear-facing
infant restraint spreads the force along the entire back, neck and head.
4. Allow the body to slow down gradually. Vehicles are engineered to crush in
a controlled manner. Occupants can take advantage of the vehicle ride down
only if they become a “part” of the vehicle using a snug seat belt or CR.
5. Protect the head, neck, and spinal column. A shoulder belt or CRS harness
helps to keep the head and upper body away from the hard interior surfaces of
the vehicle. A rear-facing child restraint supports the head and neck to avoid
stress on the neck and trauma to the head and spinal cord.
Types of Occupant Protection Systems
There is a wide range of equipment and systems that are designed to protect motor
vehicle occupants in crashes.
AIR BAGS
Air bags are designed to provide supplemental
head and chest protection in severe frontal
crashes. When sensors in the vehicle detect
a frontal crash severe enough for the air bags
to be needed, the air bags inflate. When
fully deployed the air bag offers additional
protection to the front seat occupants. As the
occupant moves into the bag, it immediately
deflates to further absorb energy and reduce
the risk of injuries. This process is completed
in approximately 1/4 of one second. Air
bags supplement seat belts, they do not replace them. Seat belts are needed for
protection in all types of crashes of all levels of severity.
Any occupant who rides in the front seat must be correctly restrained by the
vehicle’s lap-and-shoulder belt and the vehicle seat must be moved back far enough
so there is at least 10 – 12 inches of distance between the occupants chest and where
the air bag comes out of the dashboard.
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KEY CONCEPT…
Air bags are supplemental protection. Seat belts must be worn for
protection in all types of crashes and at all speeds.
Side impact air bags (SABs) improve the protection of adults in side impact crashes.
Like frontal air bags, side impact air bags do not take the place of seat belts but are
supplemental restraints.
There are concerns that children who are leaning against a side air bag at the time
of deployment can be seriously injured, but, to date, NHTSA crash investigators
have found no serious injuries to children as a result of SAB deployments. NHTSA
has not seen any indication that current SABs pose a risk to children. For more
information on this topic, go to safercar.gov.
Side air bags vary greatly from vehicle to
vehicle. Because of these variations, the best
source of information is the vehicle and/or CR
manufacturer. Refer to your vehicle owner’s
manual for recommendations that apply to your
vehicle, and contact the manufacturer’s customer
service department with additional questions.
Also, remember that that the best protection
for all occupants is provided by being properly
restrained and not leaning against the door.
SEAT BELT SYSTEMS
Seat belt systems vary widely. A seat belt system consists of anchor points, a latch
plate, a buckle, and webbing material. Many systems also include one or more
retractors. The vehicle’s owner’s manual has specific information about the seat belt
system and other occupant protection devices in that model.
There are two basic types of seat belt systems — the lap belt and the lap-andshoulder combination seat belt.
Lap Belt
The lap belt is a “2-point” belt that has two anchorage points and fits over the lap
(upper thighs/hips). Its primary benefits are to prevent ejection and to keep the
occupant from being thrown around inside the vehicle striking other occupants or
unforgiving surfaces. The lap belt does not restrain the upper body.
A lap belt should be as snug as possible and at least touching the upper thighs. In
this position the crash forces will be loaded on the hips. If the lap belt is too loose,
the occupant can “submarine” under the lap belt.
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In a crash, seat belt syndrome occurs if a lap
belt is worn over or rides up on the abdomen
rather than the hipbones, causing injuries to
the lower spine and organs, such as spleen,
liver, and intestines.
Lap-and-Shoulder Combination Belt
The lap-and-shoulder combination belt is
a “3-point” belt that has three anchorage
points. The shoulder belt provides restraint
for the upper chest and shoulders. When
positioned correctly, the shoulder belt reduces
head excursion, helping to reduce brain and
spinal cord injury. The shoulder belt must
lie across the collarbone as close to the neck
as possible without being uncomfortable.
Placing the shoulder belt under the arm or
behind the back is very dangerous. Doing
so increases the risk of belt-induced internal
injuries, in addition to not providing any
upper body restraint.
KEY CONCEPT…
• Lap belts must be worn as snugly as possible and at least touching the
upper thighs.
• Shoulder belts must come across the collarbone and middle of the chest.
• Placing the shoulder belt under the arm or behind the back is very dangerous.
The lap belt portion of a lap-and-shoulder combination must be positioned as
mentioned above. The importance of a snugly and correctly fitted lap belt should not
be neglected.
THE NEED FOR CHILD RESTRAINTS
Seat belts are designed for adults, and since children are not miniature adults, they
cannot adequately protect children in crashes. Children need their own special
restraints because of their developmental characteristics.
Proportionately, an infant’s head is larger and heavier, and his or her legs are shorter.
A newborn infant’s shoulders are narrow and flexible, so they can fit through the birth
Chapter 4: How Restraints Protect Occupants in Crashes
25
canal. The bones and ligaments in the
neck are not well developed until after
the age of one. A child’s pelvis is small
and rounded and its shape is not fully
developed until puberty.
Child restraints work with vehicle seat
belts to prevent ejection and distribute
and load crash forces to the strongest
parts of the body. The child restraint
must be firmly attached to the vehicle
and the child must be snugly secured
in the child restraint in order for it to
work as designed.
DO CHILD RESTRAINTS WORK?
NHTSA conducted an evaluation of the effectiveness of child restraints in crashes
and found that, depending on correct use and restraint type, they are up to:
• 71% effective in preventing fatalities
• 67% effective in reducing the need for hospitalization
• 50% effective in preventing even minor injuries
KEY CONCEPT…
Infants and children need special restraints to protect them in a crash.
Seat belts are designed to restrain the adult body.
Occupant Protection Systems After a Crash
In general, seat belts, child restraints, and air bags should all be considered “one
time use” products and vehicle and child restraint manufacturers recommend
replacement of their restraints after a crash. NHTSA recommends that child
restraints be replaced following a moderate or severe crash in order to ensure a
continued high level of crash protection for child passengers.
Parents who have been involved in a minor crash with their children in child
restraints should call the child restraint manufacturer for advice on replacing it
and continue to use the restraint in the meantime if no immediate replacement is
available. More information on what is classified as a minor crash can be found on
NHTSA’s website — nhtsa.gov.
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Everyone Buckle Up — Every Time, Every Trip
Everyone in the vehicle should be buckled up — every time and on every trip.
Adults are role models for children’s safety behavior, so it is important that the
driver and all adults in the vehicle buckle up correctly. While lap belts are not ideal,
they are better than no protection at all since one of the main purposes of seat belts
is to keep occupants from being thrown out of or around the inside of the vehicle.
Pregnant women should correctly use a lap-shoulder seat belt to provide protection
to the unborn child as well as themselves. The lap belt must fit snugly across
the hips and route underneath the bulge of the belly; the shoulder belt must be
positioned across the center of the chest, between the breasts, and above and to
the side of the belly. Reassure pregnant women that studies have shown that it is
much safer for the baby if they wear seat belts. Pregnant women should remove or
unfasten coats to make sure the clothing doesn’t interfere with good belt routing.
Help educate obstetric and family practice physicians and nurse practitioners about
the importance of providing seat belt education to pregnant patients. Remind
pregnant women to seek medical care if they are involved in a crash, even if there is
no apparent injury.
With carpools, all drivers must always make certain that CRs and seat belts are
used correctly every time children ride in a vehicle. There should be a seat belt for
each passenger and the proper restraint device should be used for each child.
Unsurvivable Crashes
CPS advocates and educators must be very careful not to promise complete crash
protection through the use of child restraints and seat belts. Properly used child
restraints are about 70% effective in reducing fatalities and serious injuries in the
smallest children. Lap and shoulder belts and frontal air bags are about 50 – 60%
effective in reducing fatalities to adults.
Unfortunately, some crashes are unsurvivable despite correct restraint use. Factors
that contribute to unsurvivable crashes are high speeds, small vehicle vs. large vehicle,
intrusion into the vehicle, and the health and physical condition of the occupant.
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Chapter 5:
Choosing and Using
Child Restraints
There are any number of things that must be taken into consideration in order to
provide the maximum protection for children in passenger vehicles. These include:
Selection — Choose the right restraint based on the age and size of the child.
Harnessing — Harness the child in the restraint correctly.
Direction — Be sure the child and CR face the right way in the vehicle.
Location — Install the CR in the right spot in the vehicle.
Installation — Secure CR to the vehicle in the right way.
Selection of the right restraint based on the age and size of the child and
positioning and harnessing children in their restraints correctly will be discussed
in more detail in this chapter. Installation of child restraints in vehicles, including
being sure the child is facing the right direction and choosing the right spot in the
vehicle, will be discussed later in the section titled “Installing Child Restraints in
Vehicles.”
What Is the Best Car Seat?
A common question parents ask is, “What is the best car seat for my child?” or
“Which seat do you recommend?” You can’t really answer this, as no child restraint
system is “safest” or “best.”
All child restraints for children under 65 pounds must meet the certification
requirements established by the National Highway Traffic Safety Administration
(NHTSA).
Since all child restraints are certified to meet federal standards and must
perform to a certain level, the “best” or “safest” restraint is the one that fits the
child, fits the vehicle, and will be used correctly every ride. All other things
being equal, the least expensive model will protect the child as well as the most
expensive model.
KEY CONCEPT…
There is no “best” child restraint. The best or safest restraint is the one that:
• Fits the child.
• Fits the vehicle.
• Will be used correctly every ride.
Are Used Child Restraints Okay?
Parents must decide if the lower cost of a used child restraint is really worth
it. Many of the newer child restraints are more convenient and easier to use
correctly than older models. An inexpensive but hard-to-use seat may not be a
bargain over time.
In some cases, used seats can be a bargain as well as safe and easy to use. If the
requirements listed below cannot be met, the best advice is to not use the restraint
being considered. To tell if a used seat is safe to use, check to make sure that the
following criteria are met:
• It has a label that can be read and that clearly indicates the manufacturer,
model number, date of manufacture, and that it met all applicable federal
motor vehicle safety standards in effect at the time of manufacture. If there is
no label at all or if the label cannot be read, do not use the seat.
• It is no more than 10 years old. Some advocates and manufacturers suggest not
using seats older than 5 or 6 years old. Check if there is an expiration date.
• It has the instruction booklet, not just labels on the seat (replacement
instructions can be ordered from the manufacturer).
• All the parts are included (check in the instruction booklet) or can be obtained
from the manufacturer.
• It has never been involved in a moderate or severe crash.
• It is not under recall or corrections have been made if it was recalled.
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Selecting the Right Restraint Based on the Age and
Size of the Child
There are many makes and models of child restraints for parents and caregivers to
choose. It is no wonder that they are confused about which type or model to use
for their children; however, much of the confusion can be reduced by following
NHTSA’s guidelines for restraint selection based on the age and size of your child.
Birth – 12 months: Your child under age 1 should always ride in a rear-facing
car seat. There are different types of rear-facing car seats. Infant-only seats can
only be used rear-facing. Convertible and 3-in-1 car seats typically have higher
height and weight limits for the rear-facing position, allowing you to keep
your child rear-facing for a longer period of time.
1 – 3 years: Keep your child rear-facing as long as possible. It’s the best way to
keep him or her safe. Your child should remain in a rear-facing car seat until
he or she reaches the top height or weight limit allowed by your car seat’s
manufacturer. Once your child outgrows the rear-facing car seat, your child is
ready to travel in a forward-facing car seat with a harness.
4 – 7 years: Keep your child in a forward-facing car seat with a harness until
he or she reaches the top height or weight limit allowed by your car seat’s
manufacturer. Once your child outgrows the forward-facing car seat with a
harness, it’s time to travel in a booster seat but still in the back seat.
8 – 12 years: Keep your child in a booster seat until he or she is big enough to fit
in a seat belt properly. For a seat belt to fit properly, the lap belt must lie snugly
across the upper thighs, not the stomach. The shoulder belt should lie snug
across the shoulder and chest and not cross the neck or face. Remember, your
child should still ride in the back seat because it’s safer there.
REAR-FACING SEATS
A rear-facing car seat is the best seat for your young child to use. It has a harness, and in
a crash, cradles and moves with your child to reduce the stress to the child’s fragile neck and
spinal cord. Keep your child rear-facing as long as possible, according to manufacturer’s
insturctions.
A child’s body changes as the child grows. The infant’s head is larger and heavier
in proportion to its body than that of an older child. The shoulders of an infant are
narrow and flexible. This is important to know for proper placement and snugness
of the CR harness straps.
A rear-facing CR supports the child’s entire head, neck, and back in a headon collision. In a head-on crash, the restraint cradles and moves with the child,
reducing stress to the neck and spinal cord. It is the shell of the CR itself that
absorbs the forces in a head-on crash. In a rear-end crash, the forces are absorbed
by the harness system. Rear-end crashes are much less frequent and usually involve
lower crash forces. The harness needs to be snug and to hold the infant down in the
seat so he/she does not slide up in a crash and suffer ejection from the car.
Chapter 5: Choosing and Using Child Restraints
31
The increased protection afforded by the rear-facing position is the reason the
American Academy of Pediatrics (AAP) is now encouraging parents to keep
children rear-facing until they are at least 2 years old. According to the AAP, new
research indicates that children are more than five times safer riding rear-facing in a
child restraint up to their second birthday. The following are some safety tips for car
seat use based on AAP guidelines:
• All children should ride rear-facing in either a rear-facing-only car seat or
convertible seat.
• If a rear-facing-only car seat is used, the child should be switched to a rearfacing convertible car seat once the maximum height (when the infant’s head
is within 1 inch of the top of the seat) or weight (usually 22 – 32 pounds)
have been reached for that rear-facing-only seat, as suggested by the car seat
manufacturer.
• Children should remain rear-facing in a convertible car seat until they have
reached the maximum height or weight recommended for the model, or at
least the age of 2.
There are two main types of rear-facing CRs to choose from — rear-facing-only
seats and rear-facing convertible seats.
Rear-Facing-Only
Rear-facing-only seats have weight limits that
can range from birth up to 30 pounds or more.
These seats can only be used facing to the rear of
the vehicle and are generally the best fit for small
babies. The rear-facing position supports the entire
head, neck, and back. Refer to the manufacturer’s
instruction book for more details.
Rear-facing-only seats can have either a 3-point
harness (mostly older seats) or a 5-point
harness. Most of the newer models have
detachable bases that are installed in the vehicle
and which the restraint/carrier itself snaps into. The carrier can be easily removed
to carry the infant in or out of the house. Most models with detachable bases can
be used with or without a base, but a few can be used only with the base. Read the
manufacturer’s instructions to be sure.
Babies may outgrow this restraint in length before they reach the weight limit. The
restraint should only be used until the child’s head comes within an inch of the top
of the shell.
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Rear-Facing Convertible
Convertible restraints can be used either facing
the rear of the vehicle or facing toward the front
of the vehicle and will have weight and height
limits for each position.
It is recommended that the child not be
turned forward-facing until the child
reaches the rear-facing size limit of the child
restraint — as long as the child’s head is not
within an inch of the top of the shell.
Convertible child restraints will have a 5-point
harness. A 5-point harness is usually most
recommended for small infants.
Small infants, under 10 – 12 pounds, do not
fit well into convertible restraints with a tray
shield.
Rear-Facing Reminders
Manufacturers of many rear-facing CRs recommend that infants under 5 pounds
not be placed in their products. Always check the CR label and/or instructions for
the lowest weight allowed for any particular model. Only a few CRs are labeled
for use by infants from “birth” or “4 pounds.” As for outgrowing a rear-facing CR,
do not use the rear-facing seat above the weight or height limits designated by the
manufacturer. In addition, the top of the child’s head should not be less than 1 inch
from top of the shell of a rear-facing CR unless the manufacturer’s instructions state
otherwise — even if the child has not outgrown it by weight. Moving a child to a
rear-facing convertible seat with a higher weight rating is generally recommended
once a child outgrows a rear-facing-only seat.
Many parents/caregivers may be tempted to place the rear-facing seat forwardfacing to allow them to view their child more easily. This is a serious error and
places the child at a significant risk of injury/death in the event of a crash. CPS
educators and advocates routinely provide parents with suggestions to ease their
desire to see the baby during driving. For example, babies sleep through the night
without being under the parents’ watchful eye. If the CR is appropriate for the size
of the child and is installed correctly, the baby should be fine.
Chapter 5: Choosing and Using Child Restraints
33
Parents may wonder if children’s legs are at risk for injury in the rear-facing CRs.
Children commonly sit with their legs crossed or resting on the back of the vehicle
seat. The risk of injury to a child’s legs in a crash is low, and injuries to the lower
extremities are usually less severe with fewer long-term complications than injuries
to the head, neck, or spine, which occur more commonly when a child is seated in
the forward-facing position.
Because the rear-facing position is safest, children should ride facing the rear of the
vehicle as long as possible (but never exceed the manufacturer’s weight and height
limits). Older children with poor head control who are within the height and weight
requirements of a particular CR will benefit from staying rear-facing longer.
KEY CONCEPT…
Keep your child rear-facing as long as possible. Once your child
outgrows the rear-facing car seat, your child is ready to travel in a
forward-facing car seat with a harness.
FORWARD-FACING SEATS
When children outgrow their rear-facing seats, they should ride in forward-facing child
safety seats, in the back seat, until they reach the upper weight or height limit of the
particular seat. A forward-facing car seat has a harness and tether that limits your child’s
forward movement during a crash.
There are a variety of restraints that can be used facing the front of the vehicle.
Many of these products can only be used facing the front of the vehicle. Frontfacing CRs are recommended for children who have reached the highest rear-facing
weight allowed by the CR or have grown too tall for the rear-facing position.
Children should remain in a forward-facing CR with a full harness until they reach
the top weight or height allowed.
The use of “higher weight harness” restraints is especially important for young
children who may be too behaviorally immature to safely use a booster seat.
Forward-Facing Convertible
As previously noted, convertible restraints
can be used either facing the rear of the
vehicle or facing toward the front of the
vehicle and will have weight and height
limits for each position. Furthermore,
NHTSA and the AAP recommend that
the child be kept in the rear-facing position
until the child reaches the rear-facing
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weight limit of the child restraint — as long as the child’s head is not within an
inch of the top of the shell.
Convertible CRs usually have a 5-point harness, which is recommended for infants
as well as toddlers.
Forward-Facing-Only With Harness
Some restraints are only to be used forward-facing with a harness. Some may go
as high as 80 pounds or more with the harness.
Combination Child Restraints
Combination restraints have an internal
harness that can be used for a forwardfacing child up to a certain weight and
then modified for use as a belt positioning
booster seat for larger child. As with other
forward-facing with harness models, some
combination CR harnesses may be used for
children who weigh as much as 80 pounds or
more. Regardless of what the upper weight
limit is for the harness, the combination seat
must only be used as a booster seat with a lap
and shoulder seat belt once the child reaches
that upper limit.
When used with the harness, a combination seat can be installed in a lap beltonly seating position since it is installed and used as a forward-facing with harness
restraint. When used as a booster seat, the combination seat must only be used
with a lap/shoulder belt. Combination seats tend to position children lower in
vehicles and in a more upright position than do convertible seats. Parents may find
that smaller children are more comfortable and content in a convertible than in a
combination seat. The booster mode of a combination seat may or may not produce
a good fit of the seat belts on a particular child in a particular vehicle and another
booster may be needed to make the seat belts fit well on the child.
A few models of child restraints, sometimes called 3-in-1 seats, can be used in three
modes — as a rear-facing CR, as a forward-facing with harness restraint, then as
a belt positioning booster seat. In some cases, a 3-in-1 seat may be suitable for a
child through all three stages, but parents should be cautioned that these CRs may
or may not work well for all three modes for any given child in their particular
vehicle(s). Also, not all 3-in-1 seats include rear-facing options.
Harness/Vest
Travel vests have rigid backs or specially designed loops of webbing for
installation with vehicle seat belts and use 5-point harnesses to distribute crash
Chapter 5: Choosing and Using Child Restraints
35
forces across children’s bodies. Although
they differ in appearance and function from
most child restraints, they meet FMVSS 213
performance standards.
There also are many different styles and sizes
of vests and harnesses that must be used with
the vehicle lap belt and a top tether. They are
available in a variety of sizes, some can fit
adults, and can be considered as a relatively
inexpensive way to provide additional upper
body restraint for children over 40 pounds in
lap belt-only seating positions.
KEY CONCEPT…
Children should remain in a forward-facing CR with a full harness until
they reach the top weight or height allowed.
BOOSTER SEATS
Once children outgrow their forward-facing seats with harnesses, they should ride in
booster seats, in the back seat, until the vehicle seat belts fit properly. Seat belts fit properly
when the lap belt lays across the upper thighs and the shoulder belt fits across the chest.
Once children outgrow their forward-facing seat, they should ride in booster
seats in the back seat until the vehicle seat belts fit properly (lap belt should
lie across the upper thighs, and the shoulder belt across the chest). The
child’s pelvis is small, rounded, and not fully developed until puberty. This
is important to know because the lap belt does not always stay below the
hipbones in pre-school or elementary school-age children. Booster seats serve
as an important middle step between a restraint with harness and a vehicle’s
lap-and-shoulder belt without booster seat (for youth and adults).
Many booster seats have a weight range starting at 30 – 40 pounds, with a
maximum weight of 80 – 100+ pounds. Both NHTSA and the AAP recommend
the use of a booster seat until the vehicle seat belt fits properly. According to some
studies, belt positioning booster seats are more than twice as effective in reducing
risk of injury to children when compared to seat belts alone.
Another benefit of booster seats is that they help children see out the window
better (since they are “boosted up”) and may be more content in the car. This
may help when parents talk to children about why they might like riding in a
booster seat.
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When correctly positioned in a booster seat, vehicle seat belts fit over the
shoulders and hips much like an adult in a seat belt. In addition to meeting
the minimum weight range for a booster seat, it is important that a child is not
switched to a booster seat until he is behaviorally mature enough to sit in the
booster seat with both the lap-and-shoulder belts properly positioned for the
entire ride. The use of “higher weight harness” restraints is especially important
for young children who may be too behaviorally immature to safely use a
booster seat.
Most boosters have some type of shoulder belt adjustment. Some models have a
high back, while others have no back.
High-Back Booster Seats
High-back boosters must be used when
vehicle seat backs are low or do not have head
restraints. This type of seat provides head, neck,
and back support for the child.
Backless Booster Seats
Backless boosters should only be used with
a lap-and-shoulder belt in a seating position
with head restraints. With a backless booster,
the child uses the vehicle’s seat back or builtin head restraint for head, neck, and back
support. In general, the child’s ears should not
be above the back of the vehicle seat or the top
of the head restraint.
KEY CONCEPT…
Belt positioning booster seats are more effective in reducing risk of injury
to children when compared to seat belts alone.
Chapter 5: Choosing and Using Child Restraints
37
SEAT BELTS
When children outgrow their booster seats, they can use the adult seat belt in the back seat,
if it fits properly (lap belt lays across the upper thighs and the shoulder belt fits across the
chest).
When children outgrow their booster seats, they can use the adult seat belt if it
fits properly. A seat belt fits when the lap belt lies across the upper thighs, and the
shoulder belt fits across the chest.
There are two types of seat belt systems found in vehicles: the lap belt-only and the
lap-and-shoulder belt.
Lap Belt
A lap belt offers two-point protection because it connects with the body in two
places — at each hip. The lap belt should rest snug and low across the hips/upper
thigh area, not across the stomach. Lap belts do not provide upper body protection.
As a result, head, spine, and/or neck injuries can occur. With no restraint above the
waist, the upper body moves forward until it is stopped by something. Many times,
it is the head that contacts the dashboard, front seats, consoles, doorframes, floor, or
even the individual’s knees. A lap belt is better than no restraint at all and should be
used when no other restraint is available, but a lap-and-shoulder belt provides the
best protection.
Lap-and-Shoulder Belts
A seat belt with both a lap and a shoulder portion offers three-point protection because
it connects with the body in three places — at both hips and at the shoulder. The lap belt
should fit snugly, placed low over the hips/upper thighs. If it rides up on the stomach,
it could cause serious injuries in a crash. The shoulder belt should rest securely across
the chest and shoulder, not the neck or face. It should never be placed under the arm
or behind the back, as this can cause serious injury. Lap-and-shoulder belts are a better
choice than just a lap belt because they provide upper body protection.
Add-on shoulder belt adjusters are not
recommended since they are not covered by
any federal standards and may, in fact, do
more harm than good by pulling the lap belt
up onto the abdomen in a crash. Shoulder
belt positioners supplied with some rear-seat
lap-and-shoulder belts in a number of vehicles
may be used since they are supplied by and
tested by the vehicle manufacturer. Note,
however, that a shoulder belt positioner cannot
correct the fit of an ill-fitting lap belt. A beltpositioning booster seat is the only way to
make a lap belt fit better.
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To be able to fit a lap-and-shoulder seat belt, a child must:
• Sit with their back and hips against the vehicle seat back and sit without slouching.
• Bend their knees easily over the front edge of the seat with feet flat on the floor.
• Safely wear the seat belt with:
º Lap belt low and snug across the hips.
º Shoulder belt across mid-chest and shoulder.
• Use properly adjusted vehicle head restraint.
• Stay in position for the entire ride.
Never put the shoulder belt under the child’s arm or behind the child’s back. This
can cause severe injuries in a crash. If the seat belt does not fit properly, the child
should use a belt-positioning booster seat.
Adaptive or Specialized Restraints
As a general rule, conventional restraints
discussed above can be used for most children
with behavioral, medical, or positioning
needs; however, some medical or behavioral
conditions may require that some type of
adaptive or specialized restraint be used. Basic
types of adaptive or specialized restraints
include*:
• Car beds: Premature or low birth weight babies may have breathing problems
that require them to lie flat. Car beds are restraints that allow infants to travel
lying down.
• Specialized restraints for children in casts:
º A hip spica cast spreads the legs out at a wide angle, making it difficult for
children to fit into most child restraints. The Snug Seat Hippo is a convertible
safety seat designed specifically for children in hip casts. The modified E-ZON Vest may be an option for those children who do not fit in the Hippo.
º The Modified E-Z-ON Vest allows some children in full body casts
to lie flat.
Chapter 5: Choosing and Using Child Restraints
39
• Positioning/Postural restraints: These restraints are used for children with
poor head or trunk control and require special positioning. There are models
that have been designed and tested for crash worthiness for weights as high as
150 pounds.
• Upright vests: Typically, vests are intended to be used by children who are
over two years of age and have behavioral problems that prevent them from
being safely transported in a conventional child restraint.
A special needs CR is usually physician prescribed and may need to be ordered from
a medical supply company. Often, all or part of the cost is paid for by the child’s
health insurance.
*Adapted from: Children with Special Health Care Needs, preventinjury.org
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Chapter X:
5: Choosing
Title
and Using Child Restraints
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Chapter 6:
Harnessing the Child in
the Restraint Correctly
Harnesses are important because the harness keeps the child inside the vehicle,
reduces contact with the vehicle interior and other occupants, distributes crash forces
over the widest area of the body possible, and also loads the forces on the strongest
parts of the child’s body. Different harnesses have different weight limits and the only
way to be sure of these limits is to check the manufacturer’s instructions.
There are several types of harness found in child restraints. Some may be found
primarily in older models of CRs.
• 3-Point: A harness that comes over each shoulder with the shoulder straps
coming together at a buckle on a crotch strap or in the shell of the CR. These
harnesses are found only in older, rear-facing-only CRs since they are not
allowed to be used for a CR that faces the front of the vehicle.
• 5-Point: A harness that comes over each shoulder and across both hips and has one
strap between the legs. All five parts of the harness come together at a common
buckle. 5-Point harnesses are considered to be the most protective type of harness.
• T-shield: A triangular or “T”-shaped pad that is attached to the two shoulder
harnesses (but not to the shell of the CR), fits over the child’s abdomen and
hips, and buckles between the legs. There have been no CRs made with
T-shields for many years.
All harnesses provide some type of mechanism to adjust the length and snugness of
the harness straps, but some harness adjustment mechanisms are much easier to use
than others. Some harnesses adjust with the pull of a single strap from the front,
by a twist of a knob, or even adjust to the child automatically. Other adjustment
mechanisms are less convenient and more prone to misuse.
Child restraints may have from one to four sets of harness slots — slots in the plastic
shell and padding that the harness straps are routed through — that are used to adjust
the straps in relation to the height of the child. It is important that the child restraint
manufacturer’s instructions are referred to when determining which slots to use. Some
models may have harness height adjusters that slide up and down the back of the shell
and do not require moving the harness straps among different slots. Most CR harnesses
also use a harness retainer clip to help keep the harness in the proper position on the
child’s shoulders. Parents must be sure to read the manufacturer’s instructions to be
certain of the proper way to position and adjust the harnesses and retainer clips.
PROPER POSITIONING AND HARNESSING OF
CHILDREN IN REAR-FACING RESTRAINTS
Always check the manufacturer’s instructions for harnessing information. In general
the shoulder straps should be at or below the rear-facing infant’s shoulders (or in the
lowest slot).
Place the infant in the CR with the infant’s back and bottom flat against the CR
seat back, then place the harness straps over the child’s shoulders and buckle the
harness at the crotch. Check to ensure that the buckle is latched completely. The
harness holds the infant down low in the CR so he/she does not slide up and out of
the CR in a crash. The crotch strap keeps the infant from moving forward.
Tighten the harness straps snugly. You should
not be able to pinch excess webbing at the
shoulder once the harness is buckled. This
is called the “pinch” test. Then position the
harness retainer clip at armpit level to keep the
straps on the child’s shoulders.
If a small infant needs additional support,
place blankets around the baby after harness
is snug and secure. If needed, place a rolled
diaper or small blanket in front of the crotch
strap between the child’s legs to prevent slumping. Be careful that no additional
padding gets under the child since thick padding placed behind or under the child
or under the harnesses can compress in a crash and create slack in the harness.
The semi-reclined rear-facing position provides the primary crash protection. The
harness serves to correctly position the child and to prevent ejection. The recline angle
of the rear-facing restraint itself, ranging from 30 – 45 degrees, needs to be upright
enough to provide crash protection but not so upright that the child’s head falls forward
toward the chest. Older children are better able to tolerate a more upright position.
Chapter X:
6: Harnessing
Title
the Child in the Restraint Correctly
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PROPER POSITIONING AND HARNESSING OF
CHILDREN IN FORWARD-FACING CHILD RESTRAINTS
To harness a child in a forward-facing child restraint, have the child sit with his
back and bottom flat against CR seat back, move the crotch strap, if adjustable,
to properly align the harness over the hips, and then check to see that the harness
straps are threaded through the correct set of harness slots. Then snug the harness
and check to see that the harness retainer clip is positioned at armpit level. A
snug harness lies flat and passes the pinch test. Loose straps allow excess forward
movement of the child and make it easier for the child to wiggle out of the harness.
Different models of CRs have different methods for harness adjustment. Be sure to
read the manufacturer’s instructions to be certain of the proper way to position and
adjust the harnesses.
Bulky clothing can interfere with proper harness fit. Avoid bulky clothing or padding
behind child’s head or back or under buttocks. Bulky jackets can be put on backwards
(over the child’s arms and torso) after the harness is secured. If needed for additional
warmth, place blankets over and around child after the harness is snug.
The following are additional issues related to proper positioning and harnessing of
children in different types of forward-facing child restraints:
Forward-Facing Convertible Seat
To secure a child in the harness of a forward-facing child restraint, the child
restraint should be in an upright position and the harness straps threaded as
specified by the manufacturer. For many models of convertible seats, the harness
straps must be in the upper slots since the lower slots may not be strong enough to
withstand forward-facing crash forces. The reinforcement of harness slots may not
be visible and structures that look like reinforcement may not be. The only way to
know for sure which set of slots to use is to read the manufacturer instructions.
Combination CR
The combination CR is used with a harness until a certain weight specified by
the manufacturer is reached. Always check the manufacturer’s instructions for
the highest weight allowed by the harness. After the weight specified by the
manufacturer is reached, the harness must be removed. Then the seat can be used as
a belt-positioning booster.
Since the combination CR is only allowed to be used facing the front of the vehicle,
the harness slots on the back of all combination seats are reinforced so that any
harness slot can be used as long as it is at or above the child’s shoulders. When
determining the correct fit, make sure that the mid-point of the back of the head is
not above the top of the shell.
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Vests and Harnesses
There are a variety of vests available for use as CRs. They meet the same crash
test requirements as conventional CRs. Vests or harnesses may help children
with behavioral issues, weak muscles, excess weight, or other situations when a
conventional restraint cannot be used. They may also provide a good restraint when
the vehicle has lap belts only. As with all other child restraints, always follow the
manufacturer’s instructions for proper positioning and harnessing of children in
them. Some products are made just for school bus use.
PROPER POSITIONING AND SECUREMENT OF
CHILDREN IN BOOSTER SEATS
To secure a child in a booster seat, make sure the booster seat fits flat on the vehicle
seat and that the child’s knees bend comfortably so the child does not slouch. Then
place the lap belt low across hips and shoulder belt across chest and buckle the seat
belt. Use the shoulder belt positioners that are provided with the belt-positioning
booster — and only those supplied with the booster — to keep the shoulder belt
in position across the mid-point of the child’s shoulder. Refer to the booster
manufacturer’s instructions.
Belt positioning boosters should not be used with a lap belt-only seat belt and
children must not be allowed to place the shoulder belt behind their backs or under
their arms. Serious head or internal injuries can result from excessive head excursion
and jackknifing over the lap belt if the shoulder belt is not properly positioned in
front of the child.
PROPER POSITIONING AND SECUREMENT OF
CHILDREN IN SEAT BELTS
As a reminder, children should remain in their booster seats until they can use the
adult seat belt properly in the back seat. To be able to fit a lap-and-shoulder seat
belt, a child must:
• Sit with their back and hips against the vehicle seat back and sit without slouching.
• Bend their knees easily over the front edge of the seat and feet stay flat on the
floor.
• Safely wear the seat belt with:
º Lap belt low and snug across the hips.
º Shoulder belt across mid-chest and shoulder.
• Use properly adjusted vehicle head restraint.
• Stay in position for the entire ride.
Chapter X:
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Title
the Child in the Restraint Correctly
45
PROPER POSITIONING AND SECUREMENT OF
CHILDREN IN ADAPTIVE OR SPECIALIZED RESTRAINTS
A number of conditions may require specialized adaptive child restraints, but
many children with special needs can use a conventional CR (a CR that is readily
available to the public — usually from a retailer) and do not need a special CR.
The correct CR selection should be made by the child’s medical team (therapists,
doctors, parent/caregivers, and CPS Technicians with “Special Transportation
Needs” training). It is best if the members of the medical team have received
transportation-specific special needs training. If a specialized restraint must be
used, it is important that decisions on the positioning of children in the restraints
be done in accordance with the manufacturer’s instruction manual. The instructions
need to be read and followed carefully.
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Chapter X:
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Title
the Child in the Restraint Correctly
47
Chapter 7:
Installing Child
Restraints in Vehicles
Child restraints are designed to be installed in vehicles with tight and locked seat belts
or LATCH (Lower Anchors and Tethers for Children) attachments. The correct
installation of a CR with a seat belt requires that something on the seat belt must
lock the CR into the vehicle and keep the seat belt tight at all times. All seat belts
are designed to lock in a crash, but not all seat belts have “pre-crash locking” features.
Unless the seat belt is locked before a crash occurs, the seat belt will likely be too loose
for the child restraint to provide maximum protection. A seat belt that will not stay
locked and tight can allow the child restraint to be knocked over or out of position
during braking or in other maneuvers such as turning a corner.
Once installed the right way, the seat belt will stay locked and tight, and the CR
will not move more than 1 inch side-to-side or front-to-back.
KEY CONCEPT…
Once installed the right way, a CR will not move more than 1 inch side-toside or front-to-back. Be sure to read both the child restraint instructions
and the section in the vehicle owner’s manual on installing child restraints.
Direction: Be Sure the Child and CR Face the Right
Way in the Vehicle
For the best possible protection keep infants in the back seat, in rear-facing child
safety seats, as long as possible up to the height or weight limit of the particular
seat. In addition, the American Academy of Pediatrics is encouraging parents to
keep children rear-facing until at least age 2 based on new research that indicates
children are more than five times safer riding rear-facing in a child restraint up to
their second birthday.
Rear-facing-only child restraints can only be used facing to the rear of the vehicle
and must never be placed in the vehicle so the child faces toward the front of the
vehicle. Forward-facing-only restraints must never be used facing to the rear of the
vehicle. Doing either of these is a serious error and places the child at a significant
risk of injury or death in the event of a crash. In addition, no child restraint
manufacturer allows any of their seats to be used in side-facing vehicle seats,
sometimes found in extended cab pickup trucks.
Location: Install the CR in the Right Spot in the Vehicle
Although there may be many seating positions in a vehicle, not all may be suitable
for installing a CR. In addition, the CR manufacturer’s instructions and/or the
vehicle owner’s manual may not allow certain vehicle seating positions to be used.
General considerations that come into play for determining the safest position in a
vehicle for installation of a child restraint include:
SHOULD THE CHILD RESTRAINT BE INSTALLED IN THE
FRONT OR BACK SEAT?
The back seat is generally considered safer than the front seat due to the rear seat
being further from the point of impact in frontal crashes. There are, however,
situations in which placing a child in the rear seat is not possible or may not be as
safe as some alternatives. Examples of situations where placing a child in the front
seat may be necessary include:
• Families with more children than rear seating positions.
• Rear seats with lap-only belts and older children who need lap-and-shoulder belts.
• Rear seats that are too narrow to accommodate a child restraint.
• No rear seat.
As long as the CR fits, the center-rear seating position is considered to be the safest
because it is farthest from impact and intrusion from any direction; however, the
center position is not always the optimal position for installation of a child restraint.
Instances when the center-rear might not be best include:
• There is no center seating position.
• The seat belt in that position for some reason does not work well to install the
child restraint.
• If a pull-down armrest or console is present, some child restraint instructions
will prohibit rear-facing installation in that position.
• If the vehicle manufacturer prohibits installation of child restraints in that position.
• Parents may need to transport more than one child.
If a side position has to be used, neither the left (driver) nor the right (passenger)
side is safer than the other in terms of crash protection. Installing the seat on the
right side (behind the front-passenger position) may be preferred since the right side
is curbside for parking on the street.
Chapter X:
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Title
Child Restraints in Vehicles
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KEY CONCEPT…
For all CRs, the back seat is generally considered safer than the front seat,
and if the CR fits, the center-rear seating position is considered to be safest.
ARE THERE ANY ACTIVE AIR BAGS IN THAT SEATING
POSITION?
Frontal Air Bags
NEVER place a rear-facing child restraint in
front of an active air bag. Research has clearly
shown that inflating air bags cause serious or
fatal injuries to rear-facing children and other
improperly restrained occupants. The basic
and simple message that parents and other
caregivers need to keep in mind is that children
under 13 years old should ride in the back seat.
If there is no back seat, the AIR BAG MUST
BE TURNED OFF! Some vehicles have
passive suppression or on-off switches that make
the front seat usable for children if the back seat
is unavailable. Drivers must always check the
vehicle owner’s manual to be sure air bags can be
deactivated before using the front seat option.
Single seat vehicles such as pickup trucks
may have an air bag on-off switch. OnOff switches allow the air bag to be turned
off when a child restraint or small child
is positioned in front of the air bag. It is
important for the driver to remember to turn
the air bag off with a child in the front seat
and to remember to turn it back on, if necessary, when the child restraint is not
used.
If children must regularly sit in the front because there are too many children for
all to ride in the back, the air bag should be turned off when possible. There is a
procedure through NHTSA where an air bag on-off switch can be installed. For
more information on which risk groups can choose to have an air bag on-off switch
installed in their vehicle, visit safercar.gov.
If children must sit in the front seat — not just because they want to — they must
be properly restrained with upper and lower body protection. This means using a
lap-and-shoulder belt, a lap-and-shoulder belt with a belt positioning booster, or a
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forward-facing child restraint with an internal harness. The vehicle seat should be
moved back far enough to give at least 10 – 12 inches between the child’s head or
chest and the air bag compartment.
Behavioral, as well as physical, maturity must also be considered since anyone
sitting in front of an active air bag needs to remain seated with proper posture and
positioning rather than leaning up or otherwise moving out of position.
Side Air Bags
There are concerns that children who are leaning against a side air bag at the time
of deployment can be seriously injured. Side air bags vary greatly from model to
model. Because of these variations, the best source of information is the vehicle
and/or child restraint manufacturer.
Refer to the vehicle owner’s manual for recommendations that apply to a particular
vehicle, and contact the manufacturer’s customer service department with additional
questions if necessary. At least one child restraint manufacturer states that their
restraint devices must not be used in seating positions with side air bags.
The risk of injury from side air bags can be minimized by properly restraining all
occupants regardless of the type of air bag present. If parents have reason to be
concerned about a particular situation, side air bags may be disabled since they are
not required safety equipment. Refer to the vehicle manufacturer for information
about disabling side air bags in their vehicles.
ARE THERE ANY FEATURES PRESENT THAT WILL MAKE CR
INSTALLATION MORE DIFFICULT?
There are a number of features that can be present in any given seating position that
can make the installation of a child restraint easier or more difficult.
• Belt-positioning booster seats should only be used in a seating position with
lap-and-shoulder belts. Belt-positioning booster seats should not be used with
just a lap belt. Unless there is a shoulder belt in use to restrain the upper body,
serious head or internal injuries can result from excessive head excursion and
jackknifing over the lap belt. Many vehicles do not have lap-and-shoulder
belts in the center-rear seating positions. In these vehicles, boosters must be
used in the outboard positions.
• For forward-facing child restraints, the location of tether anchors should be
considered when selecting a location to install it.
• Child restraints cannot be used with side-facing jump seats, as found in some
extended cab pickup trucks.
• The contours of the vehicle seat, such as deep “buckets” or large humps, may
make it difficult to find a child restraint that will fit.
º The bases of many child restraints do not fit in deeply contoured seats.
These seats often have belt buckles mounted so high that they do not
Chapter X:
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Title
Child Restraints in Vehicles
51
fasten tightly around many restraints. These high-mounted belts also
tend to ride up on the child’s abdomen if the child is using the belt alone.
º The contours of the vehicle seat may not permit the CR to stay level and
may cause a rear-facing infant to ride too upright or lean to the side.
• Different seat belt anchor types and locations can cause problems when trying
to use them to install child restraints.
º Rigid stems, designed to keep the belt buckle within easy reach, can
place the buckle so high that the belt cannot fasten tightly around many
restraints. They also can make the lap belt ride up on the child’s abdomen.
º Lap belt anchors forward of the vehicle seat back may fit adults better but
do not work well to install child restraints.
º Some belts are “asymmetrical” — one side of the belt anchored forward
of the other. Asymmetrical seat belts do not work well to install child
restraints either.
• Limited Interior Space
º Small passenger compartments may restrict the use of some CRs,
especially rear-facing models and shield convertibles.
º Unless specified otherwise by the CR manufacturer, at least 80% of the
CR base (footprint) must fit on the vehicle seat, meaning no more than
20% of the CR can hang over the front edge of the vehicle seat. Some
CR manufacturers may not allow any overhang at all.
ºThe width of the child restraint belt path should be no greater than the
width between the seat belt anchor points.
HOW DO THE NEEDS OF EACH CHILD RELATE TO THE
NEEDS OF OTHER CHILDREN OR ADULT OCCUPANTS?
All attempts should be made to choose a seating position that will give all
occupants the best protection possible. An example of this would be to install
a forward-facing convertible seat in a center lap belt-only position to leave the
outboard lap-and-shoulder belt positions available for a child’s older, larger siblings
or an adult. Sometimes “real world” conditions lead to choices that are less than
ideal or do not follow the strict “best practice” guidelines.
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Installation: Secure CR to the Vehicle in the Right Way
INSTALLATION — REAR-FACING BASICS
The child restraint manufacturer’s specified
recline angle, generally ranging from 30 – 45
degrees from vertical, provides the appropriate
compromise between the amount of recline
needed to maintain an open airway for the
infant while being upright enough to provide
maximum crash protection. Always consult the
manufacturer’s instructions to determine the
appropriate recline angle range for any given
model.
Many models of rear-facing child restraints have some type of correct recline
indicator. As long as they are in good working condition, recline indicators should
be used to help install the restraint at the correct angle.
Sometimes it is difficult to install a rear-facing child restraint with the appropriate
recline angle on a steeply sloped vehicle seat. For help in these situations, contact the
child restraint and/or vechicle manufacturer or the nearest CPS inspection station.
KEY CONCEPT…
The rear-facing child restraint should be reclined far enough so that the infant’s
head touches the back of the restraint and does not flop forward; however, the
recline angle cannot be more or less than what is allowed by the manufacturer.
Some models of rear-facing-only child restraints with detachable bases have levers
or some type of adjustable “foot” intended to help with the installation.
To tightly secure the child restraint in the vehicle, it must be installed according
to the manufacturers instructions with a seat belt or with lower anchor and tether
attachments.
To test the installation, grip the CR at or near the belt path and pull on the CR.
There should be no more than 1 inch of side-to-side or forward movement at the
belt path. Many parents who mistakenly grab their rear-facing CR near the baby’s
head (instead of near the belt path) think the CR is not installed properly because it
moves more when tested at this point.
The use of tethers on rear-facing CRs is not common in the United States.
A rear-facing CR should never be tethered unless recommended by the CR
manufacturer. Several products have optional tethers in the rear-facing position.
The practice of tethering rear-facing restraints is unusual and child restraint
instruction manuals must be reviewed carefully for this information.
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Title
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INSTALLATION — FORWARD-FACING BASICS
The manufacturer’s instructions for many convertible CRs recommend that they
be in the fully upright position when used forward facing. Some models of child
restraints have front-facing recline positions as well as their fully upright positions.
Child restraints must pass the required crash tests in all manufacturer-designated
positions. Consider this recline position if child has special health care needs or if
the seat belts used to install the CR cannot be made tight when the CR is upright.
Forward-facing-only CRs can be used in any position designated for use in the
vehicle. Always follow the manufacturer’s instructions.
To tightly secure the forward-facing
child restraint in the vehicle, it must be
installed according to the manufacturer’s
instructions with a seat belt or with lower
attachments — again, usually not both.
Tethering a forward-facing CR will reduce
forward and side-to-side motion in a crash and
helps to stabilize a CR with an otherwise loose
installation. Correctly using the recommended
tether strap can improve how any CR performs,
and thus a basic recommendation is to tether
any forward-facing CR that comes with a tether
even when installed with a seat belt.
To test the installation of a forward-facing CR,
grip the CR at or near the belt path and pull on
the CR. There should be no more than 1 inch
of side-to-side or forward movement at the belt
path. Many parents who mistakenly grab their
front-facing CR at the top of the shell (instead
of down low near the belt path) may think the
CR is not installed properly because it moves
more when tested at this point.
INSTALLATION — BOOSTER SEAT BASICS
Booster seats are not tightly installed in the vehicle as other child restraints are.
Booster seats are held in place by the child’s weight and vehicle’s lap-and-shoulder
belts. These seats boost children up to ensure correct seat belt fit.
To properly “install” a booster seat:
• Have the child sit with their hips back against the booster seat (or against the
vehicle seat for a backless booster) with knees bending comfortably at the front
edge of seat.
• Keep the lap belt low and snug on the hips.
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• Place the shoulder belt across the shoulder and middle of the chest and adjust
the shoulder belt positioner if necessary.
• Adjust the head restraint properly.
Even if the child is not present, booster seats should be secured in the vehicle at all
times. When not buckled, the booster seat can be tossed around the vehicle causing
injury to vehicle occupants during a crash or sudden stop.
Some booster seats may come with LATCH attachments, or if a combination seat
is being used as a booster, connect the CR to the vehicle using LATCH when used
as a belt-positioning booster. This does not make for a better installation but does
help to keep the booster in place when the child is not in it. Check the instructions
for the booster to see if this is allowed.
General Steps for Child Restraint Installation
Even though there are many different types of child restraints and many different
types of seat belt systems used to install them, there are common steps that need to
be followed to insure a correct installation:
1. Place the CR on the vehicle seat in the proper forward- or rear-facing
orientation and at the correct recline angle.
2. Place the seat belt through the correct belt path and then buckle.
IMPORTANT NOTE: Child restraints installed with lower anchors do not
use the seat belt.
3. Push the CR down into the vehicle seat cushion. The weight from an adult
hand should allow the seat to be tightened enough.
4. Tighten and lock the belt as directed by the vehicle and/or CR manufacturer.
5. For forward-facing restraints, hook the CR’s tether hook to a designated
tether anchor and tighten the tether strap to make it snug.
6. Test for a tight installation of the CR and check CR installation for tightness
before each use.
SEAT BELT TIGHTENING DEVICES
CPS advocates cannot say that seat belt tightening devices used to install child restraints
are good or bad. What is known is that there are no federal regulations, requirements,
or recommended testing procedures for such devices. There also is some concern about
the potential for over-tightening the belt, which could put undue stress on parts of the
child restraint or seat belt. CPS advocates and educators cannot endorse the use of these
safety belt tightening devices unless both the vehicle and child restraint manufacturers
approve of using these devices with their belts and child restraints.
Chapter X:
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Title
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LATCH (Lower Anchors and Tethers for Children)
The National Highway Traffic Safety Administration created a more universal
method of installing the many different combinations of child restraints and
vehicles. This system is known as “LATCH” (Lower Anchors and Tethers for
KEY CONCEPT…
Belt-positioning booster seats must always be used with a properly worn lapand-shoulder belt.
Children). Almost all passenger motor vehicles and child restraints manufactured
since September 2002 are required to be equipped with LATCH.
LATCH ON THE CHILD RESTRAINTS
LATCH-equipped child restraints have lower anchor attachments that hook or
snap onto the lower anchor bars in the vehicle. The CRs can use either a flexible or
rigid lower attachment. The flexible attachment uses a hook attached to a length of
webbing. The webbing is tightened after being hooked to the vehicle anchor.
A tether strap is the restraining strap attached near the top and in the rear of most
models of forward-facing child restraints that is then hooked to a tether anchor
in the vehicle. A tether reduces the forward movement and rotation of the child
restraint. A tether strap also can provide a more secure child restraint installation in
some situations of incompatibility between child restraint and vehicle.
LATCH IN THE VEHICLE
The complete LATCH system consists of two lower anchors and one upper tether
anchor. Each lower anchor is a pair of rigid anchor points located in the vehicle seat
bight (where the cushion meets the seat back). The tether anchor is permanently
attached to the vehicle at the top or behind the rear seat. At least two rear seating
positions are required to be equipped with the complete LATCH system. In
addition, a third rear seating position is required to have an upper tether anchor. If
a lower anchor or tether anchor is hidden behind fabric or a cover in the vehicle, a
symbol will identify the LATCH anchor locations.
KEY CONCEPT…
Both seat belts and LATCH provide equal protection since child safety
seats must meet federal safety standards with either installation method.
The most important thing is to be sure that the child restraint is correctly
installed in the vehicle.
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Always follow both the vehicle manufacturer’s and the CR manufacturer’s
instructions for LATCH installation. It is important to remember that a
CR installation with a properly used seat belt, together with a tether strap
properly anchored if appropriate, should perform as well as an installation with
LATCH.
Tether anchors can be found in many different locations in vehicles. If a tether
anchor is hidden behind fabric or a cover in the vehicle, a symbol will identify the
anchor location.
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Title
Child Restraints in Vehicles
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Chapter 8:
Child Restraint and
Seat Belt Misuses
The National Highway Traffic Safety Administration has estimated that
correctly used child restraints reduce fatalities by as much as 70 percent and
hospitalizations by more than 60 percent. Partial misuse of child restraints
reduces their effectiveness, especially so in more severe crashes, and grossly
misused child restraints are of little or no value in preventing fatalities or serious
injuries.
Reasons for Misuse
National studies indicate that about four out of five child restraints are installed
or used incorrectly. There are many reasons child restraints are misused. Some are
related to “human factors” while others are related to equipment.
Reasons for misuse related to “human factors” include failure to read instructions,
inability to understand instructions, and choosing the “convenient way,” which
may not be the correct way. Reasons for misuse related to “equipment” include
the many combinations of seat belts, child restraints, and vehicles that can create
incompatibilities, child restraint instructions may conflict with instructions in the
vehicle owner’s manual, or a lack of instructions (used seats are often missing parts,
instructions, and labels).
Misuse of Child Restraints
Gross Misuse
Gross misuse occurs when the child restraint is rendered virtually useless and likely
to result in serious injury or death. These are the types of misuses that anyone with
the most basic knowledge of choosing and using child restraints should be able to
recognize. These also are the types of misuse that law enforcement officers should
consider issuing a citation for whenever encountered.
The most dangerous form of misuse is no restraint at all! Unrestrained occupants
are at great risk of being seriously injured, if not killed, should a crash occur.
Other examples of gross misuse are:
• The child restraint is not secured to vehicle at all.
• The child is not harnessed in child restraint at all.
• A rear-facing restraint is installed in front of an air bag.
• A rear-facing-only restraint is being used facing toward the front of the vehicle.
• A forward-facing only restraint is being used facing toward the rear of the
vehicle.
An infant facing the front of the vehicle before 20 pounds or before 1 year of age
is considered by many to be extremely dangerous, but in fact may be legal. This
would depend on the specifics of the particular state’s law. Even if it is not a “citable
violation,” educating the driver on the dangers of turning an infant to face toward
the front too soon would be called for in these situations.
Other Misuses
There are a number of ways that other misuses can reduce the effectiveness of child
restraints. Multiple misuses can compound problems and can become a serious
danger to the child. Examples of other types of misuse include:
Restraint Selection
• Inappropriate restraint selection (using the wrong type of CR for the age/size
of the child)
• Recalled seat that has not been repaired
• Seat than has been damaged or not working correctly
Harnessing Errors
• The harness straps are in the wrong slot.
• The harness is not placed on the child correctly.
• The harness is too loose.
• The harness adjustment mechanism is not locked.
• The harness retainer clip is not fastened or is incorrectly fastened.
• The harness retainer clip is too high or too low.
• The harness is frayed, twisted, pinned, knotted or otherwise damaged.
Installation Errors
• The seat belt is not locked.
• The seat belt is locked but too loose.
• The child restraint is installed in the wrong direction.
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• The seat belt is routed through the wrong belt path.
• The CR is installed at an incorrect recline angle.
• The locking clip (if needed) is not used or is used incorrectly.
• No tether is used when required.
• Incorrect use of the tether system.
KEY CONCEPT…
National studies indicate that about three out of four child restraints are
installed or used incorrectly.
Misuse of Booster Seats
Belt positioning boosters must never be used with just a lap belt. Jackknifing over
the lap belt is more exaggerated than occurs when just the lap belt is used without
a booster seat. There are no booster seats currently on the market that can be used
with just a lap belt.
Misuse of Seat Belts
Lap belts should be worn tight and low across the hips not over the abdomen.
Shoulder belts should be snug across the collarbone and middle of the chest. Seat belts
are designed to restrain and protect one occupant at a time. This is important because:
• A lap belt worn too high can result in internal injuries.
• A shoulder belt too loose increases upper body movement.
• A shoulder belt under the arm increases upper body movement and can result
in internal injuries.
• A shoulder belt behind the back provides no upper body protection.
• Restraining two or more occupants in one seat belt increases the risk of
occupant-to-occupant injury.
• Any misused seat belt is especially dangerous in front of an active air bag.
Chapter 8: Child Restraint and Seat Belt Misuses
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Chapter 9:
Child Passenger Safety
in Other Vehicles
The focus of this course is on the transportation of children in family passenger
vehicles, but there are a number of vehicles in which children are transported that
present special challenges. These vehicles include pickup trucks, 15-passenger vans,
school buses, airplanes, ambulances, and police vehicles.
Pickup Trucks
The occupant restraint standards for pickup
trucks are the same as for passenger cars, but
there are a number of differences between
pickups and passenger cars that must be
considered when transporting children.
Some regular-cab and extended-cab pickup
trucks with frontal passenger air bags have onoff switches for the frontal passenger air bag.
Some of these extended cabs are equipped with
side-facing jump seats that serve as the back seat.
CRs are only crash tested on forward-facing
vehicle seats and should not be secured on a
pickup truck’s side-facing jump seat, so the child restraint must be installed in the front
seat, preferably with the passenger air bag turned off. A child who needs a rear-facing
child restraint cannot be placed in the front seat if the air bag cannot be turned off.
Some of the rear seats face to the front of the vehicle but are much narrower than
the rear seats of passenger cars, and the limited rear bench seats may not allow
enough space between front and rear seating areas, especially to achieve the correct
recline angle for a rear-facing car seat. Refer to the vehicle owner’s manual for
additional CR requirements, tether, and airbag information.
Cargo areas of pickup trucks are not designed for passenger seating under any
circumstances. The cargo area of a pickup truck, with or without a canopy,
has proven to be a source of injury and death to children and adults. Ejection
from the cargo area during a collision is a major cause of injury and death
for pickup truck passengers. Many non-collision deaths to pickup truck
passengers are caused by falls due to swerving, braking, or rough roads. In
addition to the possibility of being ejected, passengers riding in covered cargo
beds are exposed to carbon monoxide from exhaust fumes.
KEY CONCEPT…
Child restraints cannot be secured on a pickup truck’s side-facing jump seat.
15-Passenger Vans
15-Passenger vans are required to have seat belts in all seating positions, but older
models of vans may have lap belt-only seat belts in all rear seats. Newer vans have at
least some rear seat positions equipped with lap and shoulder combination belts.
While federal regulations do not prohibit the use of vans by schools, they do require
that new vans with a capacity of more than 10 persons, purchased or leased with the
intent to transport children to or from school or school events, meet the same safety
standards applicable to school buses. In addition, NHTSA recommends that children
be transported in school buses rather than in vans, and some states prohibit child care
centers and schools from transporting children in 15-passenger vans.
Head Start regulations require that children weighing 65 pounds or less must be
restrained in height- and weight-appropriate child restraints in school buses or
vehicles that meet all the Federal Motor Vehicle Safety Standards applicable to school
buses except those related to flashing lights and stop arms. Vans that do not meet the
school bus standards are prohibited by Head Start transportation regulations.
School Buses
“We have seat belts in passenger cars, so why don’t we have them on school buses?” is
a very common question asked by many parents. The basic answer is that school buses
are different from passenger cars by design and use different kinds of safety systems
that work extremely well — so well, in fact, that school bus transportation is the
safest form of ground transportation. School buses are nearly eight times safer than
passenger vehicles, and getting to and from the bus is more dangerous than riding it.
There are a number of factors that make school buses so safe. School buses
provide a high level of safety through the Federal Motor Vehicle Safety
Standards that regulate how they are made. Buses are larger and heavier than
most other vehicles and participants sit high above the impact zone. The crash
forces are distributed throughout the vehicle differently and are experienced by
the occupants differently. In addition, school buses are equipped with special
equipment that is bus safety-specific, such as stop arms, warning lights, roof
hatches, crossing arms, and more.
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Federal Motor Vehicle Safety Standard (FMVSS) 222, “School Bus Passenger
Seating and Crash Protection,” requires the installation of seat belts on new
small school buses with gross vehicle weight ratings (GVWRs) of 10,000
pounds or less. The standard large school buses rely on strong, well-padded,
energy absorbing seats and higher seat backs to “compartmentalize” and protect
passengers during a crash and do not require that they be equipped with seat belts
except for the driver.
Whenever preschool-age children are transported in school buses, NHTSA
recommends that each child should be transported in a child restraint suitable for
the child’s weight and age with the restraint system being properly secured to the
school bus seat. Refer to the NHTSA website (nhtsa.gov) for additional information
on school buses.
Airplanes
Current Federal Aviation Administration (FAA) regulations do not require that
all children be restrained on aircraft. Instead, children younger than 2 years old
are permitted to be held on the lap of an adult even during takeoff, landing, and
conditions of turbulence (rough flying). All child passenger safety researchers,
advocates, and educators agree that using a child restraint system on board an
airplane is the safest way for an infant or small child to fly. Turbulence can happen
with little or no warning. The safest place for children during turbulence or in an
emergency is in an approved CR.
Most current rear-facing-only and convertible child restraints have passed testing
criteria that allow them to be certified for use on aircraft. Any CR used on an
airplane must have a label stating it is certified for aircraft use. FAA regulations
prohibit the use of most harness/vest restraints and all booster seats on board
airplanes. The FAA has recently established guidelines for the use of certain
restraint systems for use on planes only, not in motor vehicles.
The FAA strongly urges parents and guardians to secure children in an appropriate
restraint based on child weight and size as follows:
• Use a rear-facing CR for infants less than age 1 and 20 pounds.
• Use a forward-facing CR for children over age 1 and 20 pounds.
• Use the airplane seat belt for all children over age 2, if no CR is available.
• Do not use booster seats or vests, as there are no lap/shoulder belts for
airline passengers.
Airlines are not required to allow the use of child restraints certified for use on an
aircraft. Parents may have to purchase a ticket or travel on low-occupancy flights
to assure a seat for a child under 2 years old. Adults flying with young children
are urged to make arrangements in advance with the airline and get written
confirmation of the airline’s approval for use of the child restraint on the flight.
Chapter 9: Child Passenger Safety in Other Vehicles
65
Ambulances
Safe transportation of passengers in ambulances presents special challenges for
emergency medical service providers and patients being transported — especially
children. Effectively restraining children depends on what the restraint
system is attached to as well as the child restraint equipment being used. The
environment of the ambulance is much different than passenger cars, but
fundamental principles of occupant restraint can still be used to make ambulance
transportation as safe as possible.
The “typical” patient compartment of an ambulance is equipped with a captain’s
chair that faces the rear of the ambulance or swivels, bench seats along one side
of the ambulance, a cot or stretcher for the patient, and storage for equipment
and medical supplies. There are no forward-facing vehicle seats in the patient
compartment where CRs can be properly installed.
If possible, non-patient children should be transported in another vehicle and
CRs used in the ambulance should be secured with seat belts anchored only in
locations considered safe in a crash. There are no standards for crash-testing a CR
on a side-facing or rear-facing vehicle seat, and a CR should not be used in these
seating positions.
There are a number of restraint systems being developed for ambulances including
integrated child restraints built into the captain’s chair. Methods for securing
convertible CRs to crash-tested patient cots using two pairs of belts — one routed
through the forward-facing belt path and the other routed through the restraint belt
path used for “rear-facing” installation — are also being developed and tested.
Police Vehicles
Child restraints should not be installed in police vehicles if a prisoner screen is
present. This screen does not allow enough space for the forward movement of the
child’s head. In cases where police equipment is present and correct installation is
not possible, police officers will need to find another way to transport the child.
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Chapter X:
9: Child
Title Passenger Safety in Other Vehicles
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Chapter 10:
Where Do We Go From Here?
As was discussed at the beginning this course, the goal of Operation Kids: Next
Generation is to create an awareness of the importance of CPS education and
enforcement in preventing child passenger deaths and injuries. Another goal
has been to provide basic knowledge on this issue to individuals who can then
understand and explain their state’s occupant restraint laws, detect major and
potentially harmful CPS and seat belt law violations, support the enforcement of
existing child passenger safety statutes, provide basic information to parents on
correct child restraint use, and to develop and participate in effective public safety
partnerships to increase the effectiveness of CPS programs. The following are
suggestions for way to act upon the knowledge gained through this class.
Intervention — Making a Difference in Child
Passenger Safety
Whenever we look at children in cars and in child restraint systems, we should ask
ourselves three basic questions. These questions are related to many things we do,
but we can easily apply them to the important issues of increasing the correct use of
child seats. When we are in a situation where we see children in a car, we need to ask
ourselves some basic questions, understand why the questions are important, and decide
what corrective action, if needed, can or should be taken. These questions are:
• What can I see?
• Why is that important?
• What should I do?
“What can I see? Why is this important?”
Regardless of how much or how little CPS training you have, there are a number of
dangerous behaviors and situations that can be identified anytime you see children
in a car.
• Are all children sitting in the back seat?
• If there are more children than seating positions in the back seat, who is up
front and how is that child restrained?
• At a minimum, look for GROSS MISUSE OR NO USE.
º Non-use of restraints is the worst type of misuse.
º Gross misuse may include:
- No seat belt or LATCH attachments anchoring the CRS.
- No harness securing the child in the CR.
- A rear-facing infant in the front seat with an active air bag.
- An infant (less than 20 pounds or less than 1 year old) facing
forward.
Additional questions to ask each time you see children in a car — and why the
answers are important — include:
Is there a baby or small child in the car?
• Does the child restraint law cover that child? Legal requirements can be an
effective “educational” tool in some situations.
Is there a child restraint in the car?
• This is easy — either there is or there isn’t.
Is there a child in the child restraint?
• Another easy one, although if the seat is occupied, there are new questions to
ask.
Is the child in the right type of child restraint?
• Should the child be in a rear-facing seat, a forward-facing seat, or a
booster? The child needs to be in the best type of restraint for his size for
maximum protection.
Is the child restraint facing forward or rearward?
• This is determined by the size and age of the child. Infant seats face the rear.
That’s the way the seat is designed to work in order to absorb the crash forces
and keep the young baby safe.
Is there a front passenger air bag in the vehicle?
• Is there a child restraint in front of the active air bag?
• NEVER place a rear-facing CR in front of an active air bag.
Can I see a child restraint harness system?
• The harness is what holds the child to the child restraint. If it’s not used, then there
is no restraint. If it is too loose, there’s a danger the child could be ejected in a crash.
Chapter X:
10:Title
Where Do We Go From Here?
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Can I see the vehicle’s seat belt? Is it anchoring the child restraint?
• A child restraint that’s not anchored to the car is dangerous to the child and to
other passengers.
• Though it can be difficult to tell, the car’s seat belt should be routed correctly
and tightened down to reduce movement of the child restraint.
Is there a child using a seat belt who is too small to use it properly?
• Is the lap belt riding up on the child’s stomach?
• Is the shoulder belt crossing the child’s neck or face or placed under the arm or
behind the back?
• Is there a booster seat available for the child to use to make the seat belt fit?
Additional Questions Related to Vehicle Collisions
Involving Children
In an ideal world, we would be able to prevent motor vehicle crash-related injuries
by preventing the crashes from happening in the first place. Unfortunately, this is
not the case and motor vehicle crashes will occur and occupants in these crashes
will be injured. So it is clear that first responders, investigating officers, and health
care providers need to be aware of ways that restraint use, non-use, and misuse
can affect injuries and incorporate relevant questions about restraint use into their
routine procedures.
Additional Questions for Enforcement/Emergency Professionals to Ask
When Approaching a Vehicle Collision
After a crash has happened, and the trauma has produced injuries, investigating
officers and emergency services personnel need to look for crash scene clues on
restraint use and possible causes of injury:
• In which seating position in the vehicle was the child?
• Was the child in a child seat?
• Was the CR held in the vehicle by the seat belt or LATCH system?
• Was the child secured in the seat by a harness?
• Was there intrusion into the vehicle where the child was sitting?
• Was the child in an air bag position with the air bag deployed?
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Questions for Health Care Professionals to Ask of Police and EMS
About a Child Who Has Been in a Crash
Whenever health care professionals receive motor vehicle crash victims for
treatment, they need to ask first responders about crash scene clues on restraint
use and possible causes of injury to possibly aid in diagnosis and treatment. The
questions to ask of first responders are the same that the enforcement/emergency
professionals are looking for:
• In which seating position in the vehicle was the child?
• Was the child in a child seat?
• Was the CR held in the vehicle by the seat belt or LATCH system?
• Was the child secured in the seat by a harness?
• Was there intrusion into the vehicle where the child was sitting?
• Was the child in an air bag position with the air bag deployed?
Why Are These Questions So Important?
The answers to these questions may provide clues about potential injuries that may
not otherwise be easily observed. Specific forms of misuse may lead directly to
specific types of injuries. If the child was not restrained snugly, he or she may have
been partly ejected. If the CR was not secured tightly in the vehicle, the injury
could have occurred when the CR moved too much and allowed the child to strike
some part of the vehicle’s interior. If a seat belt was being used incorrectly on a
child, there may even be very serious hidden injuries in the abdomen or spinal cord
areas.
In addition, if a child is injured, first responders need to follow state or local
protocols for transporting the injured child. Usually, this means leaving the child in
the CR to administer care and often transporting the child in the CRS.
KEY CONCEPT…
Besides asking, “What do I see,” “What does that mean,” and “Why is
that important,” all professionals can ask and answer the question, “What
should I do?”
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“What should I do?”
The last question to ask is, “What should I do?” What the answer is will depend in
large part on your profession and the resources available to you at the time.
LAW ENFORCEMENT PROFESSIONALS — “WHAT
SHOULD I DO?”
Law enforcement professionals need to know what to look for, how to identify what
they see, and what needs to be done anytime they encounter children in a motor
vehicle. The International Association of Chiefs of Police (IACP) has a “Model
Enforcement Program for Occupant Protection” that helps provide guidance for the
enforcement of occupant protection laws in all states. The IACP guidelines endorse
the “integrated enforcement approach” in which:
• Each officer should ensure that, at every traffic enforcement contact, the use of
safety restraints is addressed.
• This may simply be positive reinforcement if proper use of safety restraints
is observed.
• All vehicle occupants should be checked for compliance.
When safety restraints are not being used correctly, officers should provide
the appropriate educational information to encourage their proper use. If the
illegal non-use or intentional misuse of safety restraints is noted, the appropriate
enforcement action should be taken. All enforcement actions should be
accomplished in a firm, fair, impartial and courteous manner and can include the
following actions:
• Verbal warning
• Written warning
•Citation
This integrated approach to highway safety costs nothing. But there is nothing you
can do as a law enforcement officer that has more effect on safety than enforcing the
restraint laws in your state.
WHAT ELSE CAN WE DO?
When you stop a vehicle for a child passenger safety violation, whether you issue
a hard copy citation, a written warning, or use the stop as a chance to educate the
parent, you will be making a difference, and you will be stressing the importance of
properly buckling up kids. At a minimum, if the officer sees a child in the vehicle,
he or she should look for the gross misuse or non-use of child restraints.
Police officers have the respect of both adults and children. Parents will seek
out officers for information about the laws for their states and how to keep
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their children safe. The children themselves will listen to what you have to say
and can be some of your most effective advocates for delivering your safety
messages to their parents and other adults. You will find that there are many
opportunities for participating in local child passenger safety educational
programs and activities in your communities and local program coordinators
will welcome your involvement.
NURSES AND OTHER HEALTH CARE
PROVIDERS — “WHAT SHOULD I DO?”
As with law enforcement professionals, nurses and other health care providers need
to know what to look for, how to identify what they see, and what needs to be done
anytime they encounter children in a motor vehicle. They also need to be aware that
the non-use or misuse of occupant restraint systems can have an effect on injuries
sustained in motor vehicle crashes and possible treatment options.
If a nurse or other health care provider sees a child in the vehicle during the course
of daily activities, he or she should look for the gross misuse or non-use of child
restraints. If the opportunity presents itself, then you should take appropriate action
to protect the child if misuse or non-use is observed. You can educate the driver
about proper use and warn the parent about the potential of serious injury or death
to the child and, if necessary, inform the parent about your state’s laws and the
possibility of a citation.
What Else Can We Do?
In addition to treating injuries, thorough pre- and post-natal child passenger
safety related information and education can and should be a part of clinic visits
and classes as well as hospital discharge planning and teaching. The information
provided to parents through these educational efforts should be routinely evaluated
to be sure that only the most current and correct information is provided.
Also, remember that the most effective enforcement of occupant restraint laws is
done with community support and that enforcement agencies are more likely to
effectively and actively enforce child passenger safety and seat belt laws if the public
demands and supports it. Expressions of support from the medical community to
local government and enforcement officials can go a long way toward helping to
assure that these laws are actively enforced.
FIRE AND RESCUE PROFESSIONALS — “WHAT SHOULD
I DO?”
Fire and rescue professionals need to know what to look for, how to identify
what they see, and what needs to be done anytime they encounter children in a
motor vehicle. They also need to be aware that the non-use or misuse of occupant
restraint systems can have an effect on injuries sustained in motor vehicle crashes
and possible treatment options in order to know what to look for at a crash scene to
possibly aid in treatment.
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If a fire and rescue professional sees a child in the vehicle during the course of daily
activities, he or she should look for the gross misuse or non-use of child restraints.
If the opportunity presents itself, then you should take appropriate action to protect
the child if misuse or non-use is observed. You can educate the driver about proper
use and warn the parent about the potential of serious injury or death to the child
and, if necessary, inform the parent about your state’s laws and the possibility of a
citation.
What Else Can We Do?
Interaction with neighborhoods and city/county districts always have been a part of
the fire and rescue professional community. Child passenger safety information fairs
and car seat checkup clinics are particularly well-suited events for fire stations. Fire
stations also are good locations for operating permanent CR inspection stations.
As first responders to crash scenes, fire and rescue personnel are uniquely qualified
to act as spokespersons to their community about the importance of CPS.
Also, remember that the most effective enforcement of occupant restraint laws is
done with community support and that enforcement agencies are more likely to
effectively and actively enforce child passenger safety and seat belt laws if the public
demands and supports it. Expressions of support from the fire and rescue and EMS
community to local government and enforcement officials can go a long way toward
helping to assure that these laws are actively enforced.
CHILD CARE PROVIDERS — “WHAT SHOULD I DO?”
Child care providers need to know what to look for and how to identify what they
see whether it is in the carpool dropoff or pickup line or during facility sponsored
transportation.
At a minimum, if the child care worker sees a child in the vehicle, he or she should
look for the gross misuse or non-use of child restraints. Then, at that point, you
should take appropriate action to protect the child if misuse or non-use is observed.
You can educate the driver about proper use and provide informational materials.
Also, you can warn the caregiver about possible serious injury or death and the
state’s law and the possibility of a citation.
What Else Can We Do?
Child care providers often play a role in the transporting of children and assume a
tremendous responsibility to protect the children’s health and safety when providing
transportation services, whether it is for routine transportation to and from the
center or for field trips. The child care facility should be able to develop a written
transportation policy (considering state laws), provide guidelines, and recommended
practices based on the availability of CRs and types of vehicles used. The facility
should be able to accurately and consistently, in accordance with their developed
policy, document the number of children transported by the child care provider in a
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given time. Reports should include children’s ages, types of restraints, vehicles used,
and the special needs of individual children.
Child care providers also may conduct educational training sessions for parents
and other caregivers to encourage knowledge and behavior changes in the parents’
and caregivers’ use of restraints. They also can conduct age appropriate educational
training sessions to encourage children to make correct buckling up a habit.
Also, remember that the most effective enforcement of occupant restraint laws is
done with community support and that enforcement agencies are more likely to
effectively and actively enforce child passenger safety and seat belt laws if the public
demands and supports it. Expressions of support from child care providers and
other educators to local government and enforcement officials can go a long way
toward helping to assure that these laws are actively enforced.
The Last Question: WHAT SHOULD WE ALL DO?
The Operation Kids: Next Generation — CPS Basic Awareness Course is just that. It has
been a basic introduction to the broad and in-depth field of child passenger safety.
The basic knowledge that you have gained during this class should be enough to
help convince parents and other caregivers to correctly use child restraints and seat
belts for their children and themselves and where to find additional information
that may be needed. The basic knowledge that you have gained during this class,
along with discussions with instructors and others in the class, may have convinced
you that you would like to learn more about child passenger safety and become
more involved in local programs and activities.
As noted at the beginning of this class, persons wishing to provide handson community child passenger safety services are encouraged to pursue CPS
Technician certification after working with Certified Technicians in established
local programs for a period of time. There are many opportunities for participating
in local programs and activities including checkup events, permanent inspection
stations, and CR distribution programs.
CHILD PASSENGER SAFETY CHECKUP EVENTS
Many organizations (fire, law enforcement, health agencies, Safe Kids coalitions, etc.)
sponsor child passenger safety checkup events periodically in their communities. This
is a scheduled checkup event that provides a public service to educate parents/caregivers
about the correct use of child restraints. Teams of checkers, headed by Certified
Technicians, teach caregivers the basics of correct selection, use, and installation of
child restraints. The event also provides an excellent opportunity for checkers to identify
unsafe child restraints and gain experience in diagnosing misuse. An event that has
child restraints available for the individuals that do not have the resources to purchase
their own will be most effective. In order to conduct a successful event, an event
coordinator will need to organize and promote the event well in advance.
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PERMANENT INSPECTION STATIONS
Many public health and safety agencies have established permanent inspection
stations or sites for parents/caregivers to get assistance with their child restraint.
Permanent inspection stations have a regular schedule of operation. Some
sites require appointments and others allow drive-ups. Nationally certified and
experienced CPS technicians must be available during hours of operation.
CHILD RESTRAINT DISTRIBUTION PROGRAMS
Some organizations and agencies participate in a child restraint distribution
program that provides child restraints to families identified as needy or who receive
public assistance. In some cases, the recipient may be asked to make a donation to
receive the CR. Education about the correct use of the child restraint should always
be a part of the distribution process.
WELCOME TO THE CHILD PASSENGER SAFETY TEAM
You are now part of a larger community of child passenger safety advocates that
can be found in many agencies and support systems within local, state, regional,
and national levels. Contacts with your State CPS Coordinator, state and/or local
Safe Kids coalitions, and other child passenger safety advocates and educators can
be a start for you to become a piece of an even larger CPS team. Persons wishing
to participate in these local programs can contact their state’s child passenger safety
training contact for information about programs and services in their communities.
Lists of CPS training contacts can be found on the NHTSA and National CPS
Board websites (nhtsa.gov and cpsboard.org).
These advocates and educators can assist you in seeking out additional training
programs, including standardized CPS Technician training, as well as providing
information about collaborating with existing programs as well as setting up your
own child passenger safety focused programs. Doing so can provide you with one of
the best feelings that an individual can experience — knowing that you have done
all you can to prevent a number of needless deaths and injuries to children rather
than just responding to them.
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ADDITIONAL ONLINE RESOURCES
• National Highway Traffic Safety Administration
http://www.nhtsa.gov
• National Child Passenger Safety Board
http://www.cpsboard.org
• Parents Central
http://www.safercar.gov
• Traffic Safety Marketing
http://www.trafficsafetymarketing.gov
• National Safety Council
http://www.nsc.org
• Safe Kids Worldwide
http://www.safekids.org
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