A Safety Boost for Kids

A Safety Boost for Kids

When it comes to the health and safety of your child, would you settle merely for what the law requires? Would you take a chance with your child's life?
This year, the New York State Legislature passed a law requiring that all children from birth through age 6 less than 4 feet 9 inches tall ride in an appropriate child safety seat. For most kids at the upper end of that age range, "appropriate" means a belt-positioning booster seat. With passage of the law, New York joins 28 other states in mandating proper protection for kids at the awkward "in-between" stage--too big for a forward-facing child safety seat, and not big enough for a lap-and-shoulder belt alone.
No one doubts the need for the new law. Traffic crashes remain the No. 1 killer of kids between ages 4 and 7, and experts agree that the right restraint dramatically reduces the risk of injury and death in a collision. Nevertheless, too many parents and caregivers allow kids to graduate to lap-and-shoulder belts too early. Some surveys indicate that more than half of children in that in-between age use neither a booster seat nor a safety seat.
But safety experts also agree that truly conscientious parents don't stop at the letter of the law. In fact, pediatricians will tell you to forget the "age 7" rule. Age and even weight aren't the most important criteria in judging whether a kid is ready to get out of a booster seat. "Ultimately, you have to ask yourself, what's best for the child?" says Dr. Gary Smith, director of the Center for Injury Research and Policy at Children's Hospital in Columbus, Ohio, and chair of the American Academy of Pediatrics' Committee on Injury, Violence and Poison Prevention. "I know my kids will probably stay in their booster seats until they're 10 or so."
How can you make sure that your child rides safely, not just legally? The answers are a little more complicated than the law implies--but far simpler than you may think.
Out of the Saddle
Booster seats come in two types: high-backed ones (for cars without built-in head restraints in the back seat) or the backless variety (only for vehicles with built-in backseat head restraints). Essentially, they allow the children to sit higher, putting them in position to use the vehicle's lap-and-shoulder belt properly.
When does a child grow out of a booster seat? According to the American Academy of Pediatrics, whether a child can ride adult-style, using only a lap-and-shoulder belt, depends on how well the child "fits" the vehicle's back seat. With the child sitting up straight (his or her bottom meeting the crack where the seat cushion meets the seatback, and the child's spine resting flush against the seatback), the kid's knees should bend at a comfortable, 90-degree angle at the edge of the seat cushion. The shoulder belt should pass across the chest--not the neck or throat. And the lap belt should fit across the hips--not the stomach or abdomen.
Under those guidelines, children can generally graduate out of a booster seat when they grow to 4 feet 9 inches, but a good fit really depends on the kid and the car. For instance, some vehicles have lower or scooped-out back seats, which affect seating height. The biggest problems occur when a kid is too short, the seat too low or the seat cushion too long.
"The child slouches down and the belt rides up," says Smith. "By doing that, the lap belt slides up over the abdomen and the shoulder belt slides up over the neck and throat. In that position, the crash forces would be distributed over places where they can cause internal injuries."
Just as worrisome, a high-riding belt becomes uncomfortable. Children will usually duck under the shoulder belt and tuck it behind their back--leaving their upper body unrestrained. Experts also warn that sitting the child on towels, a pillow, telephone book or other jerry-rigged boosters can't substitute for a true, approved booster seat.
Most 7- and 8-year-olds, however, don't measure up to the 4-foot 9-inch guideline. "When you look at the median height for age, most children don't reach 4 feet 9 until they're closer to 10 or 11 years old," notes Smith. That means those kids need booster seats far longer than the laws in New York and many other states require. Several states, including neighboring Pennsylvania, New Jersey and Vermont, require booster seats at least until age 8--older than New York's new requirement, but still too young for most kids, according to American Academy of Pediatrics recommendations.
Forward-Facing Seats
At the other end of the spectrum, toddlers over 1 year old should ride in harness-type, forward-facing safety seats. They're not ready for booster seats until they meet any one of three criteria: their ears reach the top of the safety seat's back, their shoulders go above the slots for the harness straps or they exceed the weight recommended by the seat's manufacturer (usually 40 pounds). Here again, size is the primary consideration. For instance, the requirement that the child's ears not reach the top of the seatback echoes advice for adults on properly fitting head restraints. "If the ears are above the back of the safety seat, the child is at risk for extension of the neck around the back of the seat in a crash," notes Dr. Dennis Durbin, associate professor of pediatrics and epidemiology at Children's Hospital of Philadelphia.
However, some age-related issues may affect the decision on when to move into a booster seat, especially for relatively tall toddlers. "I had this very discussion with a colleague of mine," says Durbin. "Her 5-year-old is getting close to outgrowing the harness-type safety seat and meeting the requirement to move into a booster. But the question becomes, is the child developmentally and behaviorally ready to sit comfortably for long in a booster seat?" Kids at that age tend to squirm a lot or tuck the shoulder strap behind them and leave it there while they reach for things. "You don't want to restrict their movement entirely, but you do want to keep them in the proper seating position," continues Durbin. "So the decision really depends on the maturity of the individual child as well as size.
Convincing Kids
Every parent knows that kids grow up too fast--but not nearly as fast as they want to. Naturally, impatient kids want to leave their boosters behind and ride "like a grown-up" as soon as possible. Don't give in. To get kids to settle into booster seats until they're ready to graduate, experts suggest emphasizing the advantages of a booster seat--a better view out the window, for instance.
Besides, the law now demands that children ride in an appropriate seat through age 6. For most kids, however, good sense and good safety demand that they ride in booster seats even longer.
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