February 5, 2012

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Travel Safety for Children Over 40 Pounds

Who Should Ride in a Booster Seat?

How big does my child have to be before I put him in a booster?
It is best to keep children in car seats with harness straps until they reach the weight or height limit of the convertible, combination, or forward-facing seat—usually 40 or more pounds or 40 or more inches. Children with special needs may need the protection of a higher weight limit harness.

Does Ohio have a booster seat law?
Yes. A law will go into effect in 2009 to protect children under 8 years old and under 4'9" tall. These children will be required to use a booster seat or other appropriate child restraint while riding in passenger vehicles.

If it's not the law, why is it important?
Some states don't have booster seat laws. Even so, it is best to keep children in harnessed safety seats until they outgrow them by height or weight. Seatbelts are designed to fit and protect adults and most do not fit or protect young children well. Poorly fitting seatbelts can cause serious injuries and even death. The American Academy of Pediatrics (AAP) recommends that vehicle safety belts should not be used until the shoulder belt can be positioned across the chest with the lap belt low and across the thighs; the child should fit against the vehicle’s seat back with his or her feet hanging down when the legs are bent at the knees. A belt-positioning booster seat should be used until the vehicle safety belt fits well, as explained by the five step test.

How can I tell if my child is ready to ride without a booster?
Children are usually about four feet and nine inches tall when the seatbelt fits them properly, but good fit depends on the children’s build and the vehicles they’re riding in. There is a simple five step test that will tell you if they’re ready to ride without a booster.

1. Does the child sit all the way back against the vehicle seat?
2. Do the child’s knees bend comfortably at the edge of the vehicle seat?
3. Does the belt cross the shoulder between the neck and arm?
4. Is the lap belt as low as possible, touching the thighs?
5. Can the child stay seated like this for the whole trip?

If you’ve answered no to any of these questions the child does not pass this test.

Why is My Child Safer in a Booster Seat Instead of in Just a Seatbelt?

How do booster seats work?
They lift a child up so the seatbelt fits properly across the shoulder and hips and allow the knees to bend at the seat’s edge.

Are they secure on the seat?
Yes, all federally approved booster seats must pass performance crash tests. The job of a booster is to prevent injuries caused by poorly fitting seatbelts. Boosters do not secure to the vehicle like a car safety seat with harnesses. Boosters simply lift the child up to make the seatbelt fit better. A single layer of rubberized shelf grip liner may be used under flat-bottomed boosters to add slightly more friction. Vacant booster seats should always be secured with a lap and shoulder belt to prevent injuries to other passengers in the vehicle.

What kinds of injuries do children get if the seatbelt doesn’t fit them properly?
Severe head, neck, abdominal and spinal injuries are possible.

Are there statistics that prove boosters work?
Yes, according to crash data by Partners in Child Passenger Safety, a study conducted by The Children’s Hospital of Philadelphia and State Farm Insurance, children ages four to seven in belt-positioning boosters were 59% less likely to be injured than those in seatbelts alone. NHTSA compiles many more statistics for crash injuries and fatalities in this age group (see Additional Help).

How Do I Know Which Booster to Choose for My Child?

What options do I have for my child over 40 pounds?

1. Backless Booster: A belt-positioning booster, usually for children at least three years old who weigh from 40 to as much as 100 pounds, depending on the manufacturer and model. The child should meet weight, age and height specifications and have good head, neck, and trunk control. A lap and shoulder belt MUST always be used and the head must be supported by the vehicle headrest.
2. High-Back Booster: A belt-positioning booster usually designed for children over a year old and weighing from 30 up to as much as 100 pounds. It is safest to keep a child in a seat with a harness as long as possible, but this seat provides more trunk and head support than a backless booster. A lap and shoulder belt MUST always be used.
3. Combination Booster: A forward-facing car safety seat with a harness that is used until the manufacturer's weight or height limit is reached, up to 65 pounds or if the child’s shoulders are higher than the top set of harness slots or if the tips of the ears are above the back of the seat. When the harnessed weight or height limit is reached, the harness is removed and the seat is used as a belt-positioning booster.
4. Forward-facing with Harness: Some forward-facing car seats have weight limits up to 130 pounds. These seats are designed to give children or adults harness support beyond the typical 40 pound weight limit.
5. Integrated booster Seat: A belt-positioning booster built into a vehicle seat. Weight limits vary according to manufacturer and model.
6. Safety Vest: Safety vests are available for children over two years old and 20 to 165 pounds. They can be used in cars without lap/shoulder belts (but a tether may be required). Some are designed to provide extra trunk support or to prevent children from getting out of their seat.
7. Seatbelt: When a child passes the five step test (as previously stated) and doesn’t need the added support of a harness or booster seat.

What is a belt-positioning booster (BPB)?
A car safety seat with or without a back that raises the child to allow the lap/shoulder belt to fit properly. Must always be used with a lap and shoulder belt!

What is the difference between a high-back and backless booster?
High-back boosters give more head, neck and trunk support to the child. They also give support behind the head in vehicles that have low seat backs and don’t have headrests. It’s important to always have support behind the neck to protect against whiplash, but most vehicle seats are high enough to support children and adults.

Why do some boosters have harness straps that come off and how do I know when to take them off?
Combination seats (boosters with harnesses) are often advertised for children over a year old between 20 and 80 or more pounds. Read the directions carefully, because most combination seats require the harness straps to be removed at 40 pounds, which changes the seat to a high-back belt-positioning booster. Note: These seats are only forward-facing and children are safest rear-facing until they are at least a year old and reach the rear-facing weight limit on the convertible seat.

How can I convince my school age children to use boosters?
Be firm and explain that the booster will help protect them and that you require them to use it whenever they ride in a car. Many children find that they are more comfortable in boosters because the seatbelts fit better. They can also see out the window more easily.
How much do they cost?
Belt positioning boosters can be purchased from about $20 to $100. Expect to pay $50 to $300 for combination and traditional forward facing seats. Vests are likely to cost between $75 and $150. They’re sometimes used in combination with a belt-positioning booster. Large medical seats can cost from about $300 to $1500, but insurance companies will sometimes pay for them with a letter of medical necessity and a prescription from a pediatrician.

What if my child has special needs?

Children with behavior or support issues may not be ready for belt-positioning boosters. It’s best to work with the child’s physical therapist, occupational therapist, pediatrician or behavior specialist and to consult a certified child passenger safety technician (see Additional Help). Some traditional seats have weight limits up to 80 pounds with harness straps and medical seats are available with harness straps up to 130 pounds. Additional padding or bolsters can be ordered to provide customized support with most medical seats. Some specially designed safety vests can help with trunk support for larger children or adults. Safety vests can be ordered with rear fasteners that are designed to prevent children from unfastening them and getting out of the vehicle seat without adult assistance.
Special needs such as those listed below must also be considered:

1. Medical conditions: Breathing problems, fragility, brittle bones, tracheotomy, halo, feeding tube, neck brace, casts, and other medical problems
2. Child’s positioning needs: Ability to sit up unassisted; head, neck and trunk control; breathing issues
3. Child’s behavioral needs: Ability to sit still, in proper position, and remain buckled in the seat
4. Vehicle limitations/accommodations: Lap and shoulder belts are needed for belt positioning boosters (no harness straps), properly working and locking seatbelts are needed for child safety restraints; child should not sit next to or in front of air bag
5. Medical equipment requirements: Can all necessary equipment be safely transported with child?
6. Family size: Some specialized child safety restraints take up more than one seating position
7. Availability of specialized restraints: Can be expensive and/or hard to get
8. Amount of travel: Is time and distance an issue for the child?
9. Funding sources/options: Insurance companies and social service agencies may help
10. Individual Education Plan (IEP): Vehicle evacuation plan if applicable; type of vehicle used by school or childcare

What Else Can I Do to Keep my Child Safe in the Car?

How can I secure my child’s oxygen tank and other medical equipment?
Sometimes an unused seatbelt can be used to secure equipment. If supplies must be placed on the floor, try to wedge them in place and cover them with pillows.

Should I buckle up my child’s service animal?
Yes, any unbuckled passengers, human or animal, can become deadly projectiles in a crash or sudden stop. There are safety harnesses, crates and other products available for traveling with service animals.

Does it matter if my child’s toys are loose in the car?
Yes; toys, bottles, and other loose objects can become dangerous projectiles in a crash.

Is it safe for my child to eat in the car?
It’s safest to park the car before feeding the child, especially if the child has special breathing or positioning concerns that could make them more susceptible to choking.

How can I be sure my child will buckle up when I’m not around?
Establish the habit of buckling up from birth and be sure your child transitions from a five-point harness to a booster seat to a seatbelt, according to the information in this guide. Never allow your child to ride unbuckled in your car and make sure that other adults who drive your child understand that you expect them to follow the same rule.

Lead by Example

You are your child’s most important role model. Studies show that generally when parents and other adults are using seatbelts young children riding with them are also buckled up. Your child’s safety is your responsibility! Be a parent.

How Do I Find Help If I Have More Questions?

To find the Ohio Occupant Protection Regional Resource Coordinator in your county:
Call the Ohio Department of Public Safety (614) 466-3250 or choose “Help” on the home page of this web site then choose “State Agency Locator” on the help page.

Other Helpful web sites:
American Academy of Pediatrics www.aap.org
National Highway Traffic Safety Administration www.nhtsa.gov
Indiana University Automotive Safety Program www.preventinjury.org
Safe Kids Worldwide www.safekids.org