Child Passenger Safety: Are You Using Safety Seats Correctly?

From the Show: Healthy Children
Summary: Learn some simple precautions to keep your child safe while driving.
Air Date: 3/18/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Joseph O’Neil, MD, MPH, FAAP
ONeil JosephDr. Joseph O’Neil is an Associate Professor of Clinical Pediatrics at Riley Hospital for Children at IU Health. He received his Bachelors and Master of Science in Civil Engineering, specializing in structural mechanics, from the University of Notre Dame. He worked as a professional engineer for five years before attending Indiana University School of Medicine. He completed his pediatric residency at Riley Hospital for Children. Dr. O’Neil later earned his Master’s in Public Health at Indiana University. Since 2001, Dr. O’Neil has been at Riley Hospital for Children in the Section of Developmental Pediatrics. He is boarded in Neurodevelopmental disabilities and General Pediatrics. His areas of interest are child passenger safety and injury prevention.

Dr. O’Neil’s current projects include transportation safety for children with special health care needs, teen driving, and injury prevention.
Child Passenger Safety: Are You Using Safety Seats Correctly?
Using a car seat correctly makes a big difference.

Even the right seat for your child’s size may not properly protect your child in a crash unless it is used properly.

It's not enough to just put your child in a car safety seat.

A child's weight, age and even knowing what safety features your car has are very important toward keeping your child as safe as possible while driving.

Dr. Joseph O’Neil discusses the best ways to keep your child safe while driving.

RadioMD Presents: Healthy Children | Original Air Date: March 18, 2015
Host: Melanie Cole, MS
Guest: Joseph O'Neil, MD Hear it from the doctor. With expert guests from the American Academy of Pediatrics. Now, our favorite mom, Melanie Cole, MS:

MELANIE: When you bring that baby home from the hospital, they don't even let you leave the hospital unless you have an approved car seat. So, you've got the little baby in a car seat, you lug that thing around. Maybe it fits into a stroller. Maybe it doesn't. Then, when do you rear face? When do you front face? When does the booster come in? What seats are appropriate? My guest today is Dr. Joseph O'Neill. He's Associate Professor of Clinical Pediatrics at Riley Hospital for Children at IU Health.

Welcome to the show, Dr. O'Neill.

So, tell us a little bit about passenger seats and baby seats, car seats. There are a million on the market. How do you know which ones to get?

O'NEILL: Oh, thanks for having me on, Melanie. This is a really important topic for all parents and it just isn't in the infants and small children, it goes all the way up to like with my own son who has just started driving. So, I think the best thing for a parent, because I direct the Automotive Safety Program here at Riley and I get asked a lot of times, what's the best seat to buy. Well, honestly, the best seat to buy is the one that fits your child, fits the car and you'll use it correctly every time.

MELANIE: Well, that's a good answer. Of course. So, how do you know which one? I mean, you have to have one before the baby's born. But then, as they grow, I know we went through three or four with my first child because he hated the car seat and he would scream and arch and we had to stop and find another one and then another one. So, how do you know which one? Do you bring your baby with and sit them in different seats?

O'NEILL: Absolutely. A lot of the manufacturers and a lot of the retails stores, they understand this--that not every seat is going to work for every child. So, it's really good that they're very happy allowing you to take out a demonstrator seat, put it on the ground, take a look at it, put the child in. Make sure the child fits. Make sure that the child's within the manufacturer's recommendations for the weight and the length or height. Then, you have to take a look at it and see if you think it'll fit in your car. Whether or not you're going to use a seatbelt to secure it or anchor it in the car or the lower anchors and tethers for children's system, known as LATCH.

MELANIE: So, once you've found one that fits your lifestyle, fits your child, fits your car, whether or not you have to bend in and hook that thing up or whether it stays permanently in there which is something I preferred because I'm only 4'10". It was really difficult lugging those things around. They're facing rear because that's the safest way. Then, when do you know you can turn them around and look at them. We had those mirrors so we could look at their little faces while were, you know, up in the front seat.

O'NEILL: Well, the best answer for that is when the child reaches the highest weight and length allowed for that manufacturer for that rear-facing seat. You know, a lot of parents have concerns about their child's feet touching up against the back of the car seat, but if you think about it, that vehicle seat is one of the softest things in the vehicle and we really don't see leg injuries to children in the rear-facing position. If you think about it, the nice thing about rear-facing if, God forbid, you're in the crash, is that it takes the momentum and the force of the crash and distributes it over all the bony parts of the body which are on the back. Actually, it cocoons around the child to give a little bit of extra protection. It keeps them in the seat, in the vehicle. It helps to transfer those loads to tougher body parts and really gives great protection for the child.

We don't really start seeing a lot of injuries until we get children turning forward-facing. So, they have a lot more room to move in that case. As long as the child's in the appropriate car seat for their size, for their weight, they're going to be better protected in the case of a motor vehicle crash. What about when the kids start saying, "I don't want to be in this car seat any more," and they're 3, or 4 or 5 and they just don't want to be in the car seat any more. When do you switch to boosters?

O'NEILL: Well, that's a good point. I think a lot of times, we as parents, sort of cave in to the child and let them move to a seat probably before they're ready. What I always recommend to the parents is, you know, if you think about car seats and I try to tell the boys, especially, think about a NASCAR driver. They're in a seat that almost looks like a car seat with a five point harness and they're better protected. So, I try to use that with especially the young boys. The truth is, every time we move from a rear-facing car seat to like what you and I wear as an adult seat belt, we actually lose safety. So, as long as we can keep a child in a harness car seat as long as possible, it's better than going to a booster seat with a typical adult shoulder/lapbelt system. So, I always try to keep them in as long as possible. Then, when they outgrow that forward-facing car seat, they should go in a booster seat until they are big enough to sit in a vehicle seat using an adult-sized seatbelt.

MELANIE: Where should that seatbelt hit them so that we know? I mean, my child is tiny. My 12-year-old daughter is tiny and I'm not putting her in a booster seat now at 12, but I kept her in one until she was like 10 years old because she was so small. Where should that belt hit them?

O'NEILL: Well, you make a great point. Just because a child's older doesn't mean they've grown big enough or tall enough to safely sit in an adult-sized seat. So, they actually may be better served in a booster seat. There are some booster seats now that are more of a lower profile and blend in with seat cushions. So, that's something to keep in mind. But, when a child is big enough to sit in an adult seat, what do we mean?

Well, their bottom has to sit all the way back against the seat; their legs have to extend out over the bench and bend at the knees about 90 degrees. It doesn’t really matter as much if their feet touch the floor. They have to be able to sit up straight so that the lapbelt goes low across the hips and that the shoulder belt goes from the shoulder cap down to the hip and it stays secure and they stay in that position for the entire trip.

Then, they can sit in an adult-sized seat with a seatbelt in the car without a booster seat.

MELANIE: I guess I need a booster seat because I can barely bend my legs at the seat and I know if I shrink, I'm going to need one for sure. What about putting children, at some point, you said that its size—not age. Because so many people say, "Well, they're 8 years old. They don't need this any more because they're 8 years old." But, the size is more important than the age because so many laws around the country, Dr. O'Neill, are the age. What about when you can put a child in the front seat, 12 and almost 15, still sit in the back when I'm driving. I can't do it. Their little jaws are tender and that airbags hits them, their little faces are not ready—that bone structure—for those airbags.

O'NEILL: Well, you said all the most important points about that. So, children under the age of 13—13 years and younger—should be in the back seat. There are a lot of good reasons for that. You mentioned the first one: size. The second one is the way they're built. Young children up to really probably early adolescence, the tendons and ligaments that hold the neck together and keep it in a good position that protects our spinal cord really don't start reaching mature and reach adult levels until early adolescence. So, it's really important that a child sit in the back seat because we know that you're probably about 40% less likely to be seriously injured or killed in the back seat compared to the front seat during most of the crashes which are front or frontal oblique or slightly from the side. So, it's very important that children 12 years and younger stay in the back seat.

MELANIE: You said that so clearly. You have about 20 seconds. Please wrap up child passenger safety for us, Dr. O'Neill.

O'NEILL: Well, the best thing to do is keep your child rear-facing until at least 2 years of age or until they exceed the length and weight of the seat's manufacturer. Make sure you keep the child in the proper car seat as long as they can. Children under 12 years and younger need to stay in the back seat. Always say, "Buckle up" for every ride.

MELANIE: Great information. You can find out more on or about how to fit your child; when they should go into the rear-facing seat and the front-facing seat. Be safe, people, because it's just a matter of safety and it's your children we're thinking of. Make sure that they are big enough to sit in a seat that fits them where the seatbelt fits them, it doesn't cross up their neck. Don't put them in the front seat until they're old enough to be there.

You're listening to Healthy Children with our expert guest provided by our great friends at the American Academy of Pediatrics.

This is Melanie Cole. If you missed any of this great information, you can listen any time on demand or on the go at

Thanks so much for listening and stay well.

aap bumper