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Dynamic Chiropractic – December 15, 2003, Vol. 21, Issue 26

Infant Carrier and Car Seats - Safety Tips to Share With Parents

By Claudia Anrig, DC
As family doctors, we often have opportunities to discuss various issues with parents - including proper use of car and infant carrier seats. A survey of the Fellows of the American Academy of Pediatrics revealed that nearly 90 percent of pediatricians have had a discussion with approximately 75 percent of parents regarding child passenger restraint systems.1 However, as children grow older, counseling of parents/patients takes a marked drop % School-aged children only have 56 percent pediatrician involvement; this figure drops to 49 percent for children ages 10 to 14, and 50 percent for children ages 14 and older.

So, how frequent is the message given to parents/patients regarding child seat safety? Fifty-eight percent of pediatricians discuss the use of passenger restraint systems at every "prevention" office visit for infants; this drops to 51 percent with toddlers. From ages 9-14, this number will vary from 36 to 39 percent, or approximately four out of 10 pediatricians.

Is this enough discussion to protect the child? Probably not, particularly considering the error rates of car and infant seat installation/use.

NHTSA Recommendations

So, what is safe for children? The National Highway Traffic Safety Administration (NHTSA)2 offers the following suggestions:

Infants (birth to one year of age, or weighing at least 20-22 lbs) require a rear-facing convertible seat; always make sure the harness straps are at or below shoulder level.

Toddlers (over one year of age and weighing 20-40 lbs) need a forward-facing convertible seat, with harness straps at or below shoulder level. (Most seats require a top slot to accommodate forward-facing.)

Young children (ages 4-8 years, unless at least 4'8" tall and weighing more than 40 lbs) need a seat belt-positioning booster seat in a forward-facing seat position; the belt positioning booster seats must be used with both lap and shoulder belts. Make sure the lap belt fits low and tight across the lap and upper thigh area, and that the shoulder belt fits snug crossing the chest and shoulder, to avoid abdominal injuries.

The NHTSA also warns that all children age 12 and younger should ride in the back seat.


LATCH is the acronym for the "Lower Anchors and Tethers for CHildren" system. This new configuration will likely decrease the problems related to child seats that are not safely installed.

As of September 2000, all new automobiles (except convertibles) are required to have a special attachment that secures the tether strap found on most new child safety seats. The purpose of the adjustable straps is to secure the seat to the rear window shelf, floor or back of the vehicle seat. The strap will keep the child from moving too far forward, reducing the possibility of head injuries in crashes.

In September 2002, a second feature was required: a lower attachment bar with a matching feature on a safety seat (buckle, hook, or connector) that snaps onto the lower anchor bar in the vehicle. Additionally, The Injury Prevention Program (TIPP) suggests that the most important safety tip to prevent injury or death in children in the first year of life is to make sure the baby's car seat is installed correctly.3

The U.S. Consumer Product Safety Commission conducted a national study of thrift stores and discovered 69 percent of them were selling at least one type of hazardous consumer product, including children's products (cribs, clothing drawstrings, playpens, etc). Car seats were included on this list. This report warned buyers to confirm that children's products are not on a recall list before purchasing them.4 This warning for thrift store purchases should also include yard sale purchases and hand-me-down car seats.

Car Seat Recalls

Why are car seats recalled? The majority of time, it is because models can unexpectedly release when used as carriers outside of a car. An infant could fall forward and strike the ground if the handle disengages.

Consumer Reports reported that easy and safe installation was critical, often meaning the difference between life and death in a crash.5 It was noted that four out of five seats were installed improperly. Part of the problem was that, often, the instructional manuals were written at a 10th-grade reading level and too difficult to understand.

Additionally, parents should be advised how to take their infants out of cars and infant carriers, and be shown how to lift and lower their infants' necks and bodies carefully into and from the carriers. Far too often, I've seen a parent pull an infant up by his or her arm (tractioning the upper extremities) or allow the infant's head to flop from side to side.

If you have patients who are first-time parents, offer to go out to the parking lot and show them how to be ergonomically correct when placing their infant into the car seat. Also provide parents handouts with safety tips for infant carrier seats and the LATCH system.*

Assume that these patients are part of the 80 percent who are incorrectly using their car seats. Ask them to call 866-SEAT-CHECK (866-732-8243) or to visit to locate a seat-inspection facility in their area.

Considering that car injuries are a leading cause of death and bodily injury to the young, family chiropractors should take the extra time to review these life-saving tips.


  1. (car seats).
  5. (key words: child seats).

This is provided at my Web site,, under "articles."

Claudia Anrig, DC
Clovis, California

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