Child Safety Seats: Not an Option

Nataša Maragos, Milivoj Jovančević

If you take your children to kindergarten by car, public transport or on foot, you should certainly pay the greatest attention to their safety. The most important part of child safety equipment is the car seat. Although the arms of a parents are one of the safest places for the child in everyday life, when riding in a car they become a dangerous place. In a collision, your body could crush the child against the front windshield or seat; or, if you are wearing a seat belt (which you certainly should), the force of the impact could knock the child out of your arms. The best way to protect your child (and one of the most important safety measures) is to properly use a car seat. In Croatia, traffic accidents are the leading cause of death among children below the age of 14. In 2007 alone, 16 child passengers were killed and more than a thousand were injured on Croatian roads. This is twice the number of accidents involving child pedestrians (until recently, the most frequent cause of child traffic injuries). Research shows that half of the child casualties below the age of five were not fastened in safety car seats. In cases where children were fastened in their safety seats, they were not fastened properly. Studies have shown that, when used properly, car seats are extremely effective in preventing injury and death. In collisions at merely 25 km/h, all objects within the vehicle are affected by a force that is 20 times greater that their weight. This means that children weighing 5 kg suddenly increase their weight to almost 100 kg, which makes it impossible to hold onto them. The same force hurls the child against the inside of the car or propels them outside the vehicle, while their body structure and strength remain those of a child weighing 5 kg. Depending on the child’s stage of development, child seats are designed to provide children with optimal protection within the vehicle at the moment of collision. It is every parent’s responsibility to do all they can to protect their children. By not placing your child in a car seat during the drive, you are consciously endangering the health and life of the child, which is both unjustifiable and unacceptable. Seat belts are intended for adults. Children wearing regular seat belts can sustain severe injuries during collision. For instance, children can slide under the belt, or the shoulder belt can choke them. Moreover, the Road Traffic Safety Act of the Republic of Croatia requires drivers to fasten children below the age of five into safety seats placed on the back seat of the vehicle. By not fastening your child you are therefore not only putting your child in danger, but you also breaking the law.

The safety of child seats

The safest thing for the child is to ride in a tested child safety seat, approved and certified by the competent state institution. All safety seats must display Regulation No. 44 of the Economic Commission for Europe of the United Nations (UN/ECE R44) safety certification label. According to the Croatian Regulations on Technical Requirements for Road Vehicles, all child safety seats available on the market must display this certificate. The certificate must contain (among other things) a symbol consisting of a prominently displayed letter E and the code number of the country which issued the certificate, as well as the certificate number beginning with “03” or “04”. Each safety seat must also include an owner’s manual for weight specifications.

The safest place for a child in the vehicle

It is recommended that all children below the age of 12 be fastened in the back seat. Studies have shown that placing the child on the back (rather than the front) seat reduces the possibility of injury and death by more than 30%, regardless of whether the vehicle has a passenger seat’s airbag. In fact, activating the airbag while the child is in the passenger seat can cause serious injury. The child is safe when fastened properly in the car seat. The back seat (especially the middle one) is the safest place in the vehicle. The fact that it is farthest from any point of impact in any collision makes it the safest spot in the vehicle. If your child is in the front passenger seat while you are driving, he or she may distract you at a time when you need to have full attention on handling the vehicle. One small movement of the hand towards the child can break your concentration, causing a sudden turn of the vehicle and a collision. The common misconception that infants have to lie on a flat surface unfortunately causes many parents with small children to place their offspring in mortal danger by holding them in their arms during the drive, or placing them in a basket or carrier rather than fastening them in a reclining position in a child safety seat. Placing the child in a semi-reclining position and turning the safety seat to face the rear are necessary for the child’s safety inside the vehicle. A 45-degree angle provides the best protection for the child’s head and neck while at the same time ensuring that the respiratory tract will remain open. With greater angles, the child’s head drops forward which may cause the respiratory tract to close. With smaller angles, collisions can cause the child to slide under the seat belt and out of the safety seat. Finally, a semi-upright position allows collision forces to be distributed across the child’s body, thus avoiding concentration at a single point which may cause serious injury. There is one exception to the rule about placing children in a semi-upright position: prematurely born babies and newborns with insufficient body weight (up to 3 kg). In these cases, it is necessary to first test whether the semi-upright position in the safety seat interferes with the breathing or the heart rhythm. For some of these infants, rear-facing crash-tested car beds are more appropriate than safety seats. The car bed should be placed in a position which allows the child to lie parallel to the head rest of the back seat, with the head in the middle of the seat. While car beds are necessary in such special cases, child seats remain the safest option for infants who are not prematurely born or too small. The problem with car beds is they only provide protection in front or rear collisions; in the case of side collisions, the infant may slip out of the bed.

What kind of child safety seat should you use?

All crash-tested safety seats bearing the safety certification label are extremely safe, but only if they are appropriately used in accordance with the child’s weight, height and age. It is important to know that child safety seats bearing safety certification labels issued by the competent authorities in the country of origin are safe. Unfortunately, Croatia does not have its own system for testing and certifying car seat safety, so consumers have to rely on safety certification labels issued by the country of export. A specific safety seat model may prove to be faulty at some point; in that case, the model is placed on a list of car seats that need to be recalled or modified in order to eliminate the fault. Lists of recalled safety seats (for instance, the NHTSA – National Highway Traffic Safety Administration – Child Recall List) are widely available. When purchasing a safety seat, you should obtain a form for registering the seat with the manufacturer. The filled-in form should be sent to the manufacturer so they can inform you should they identify a problem with the safety of the seat you purchased which they will (usually) replace or modify if necessary.

There are five types of child seats:

1. Infant car bed: designed for special-needs infants such as prematurely born babies and newborns weighing less than 3 kg.
2. Rear-facing baby seat: for infants below the age of one, weighing up to 9 kg.
3. Combination seat: rear-facing (for infants below the age of one or more, weighing up to 9 kg or more) and forward-facing.
4. Forward-facing child seat: designed for children above the age of one, weighing between 9 and 18 kg
5. Forward-facing combination seat with child booster (seat or cushion) for children aged one and over, and weighing between 9 and 18 kg (some models are appropriate for children weighing up to 27 kg).
6. Booster seat for children under the age of eight, weighing more than 18 kg and at least 100 cm high (no more than 140 cm).

The rear-facing position of the child seat during the drive is the safest for children. Children below the age of one or weighing less than 9 kg must be facing the rear. In the case of a frontal collision (the most common cause of death or serious injury), the neck of a forward-facing baby can stretch by as much as 4.5 cm, while the spinal medulla can only stretch by about half a centimetre before serious injury or death occurs! Around the age of one, the child’s bones, muscles and connective tissue become stronger, which gradually reduces the risk. Regardless of this, the child should still be placed in a rear-facing position for as long as possible (in an appropriate safety seat, of course). Generally speaking, if the child is able to stand on their own (without assistance), they ready for forward-facing rides. The child is too big for a rear-facing safety seat when the top of their head reaches the point situated 2.5 cm below the top of the safety seat head rest. If the child’s head is too high, the body might be lifted from the rear-facing safety seat during collision to such an extent that the neck will be broken on the head rest. Infants often grow out of a rear-facing child seat even before it is safe for them to start riding in a forward-facing position. In that case, it is best to move the child into a combined seat which can be placed in both a forward- and rear-facing position, so the child can still ride in a rear-facing position for as long as possible. The child has outgrown a forward-facing car seat if their ears are aligned with the top of the head rest. Child safety seats can be fitted with one of two harness systems: a three-point harness (one across each shoulder and one across the groin area) used exclusively in rear-facing safety seats, and a five-point harness (one across each shoulder, one across the thighs and one across the groin area) used for forward-facing car seats, as well as some rear-facing ones. The role of the three-point harness in rear-facing safety seats is to keep the child in the seat during collision. The five-point harness should ensure that collision forces are absorbed in the area of the child’s abdominal cavity and distributed across a maximum body surface area. There are three types of five-point harness:

1. The five-point webbing harness stretches across the shoulders and both thighs; the straps are buckled into the crotch buckle.
2. The T-shield is a shoulder strap fitted with a large buckle that looks like an upside-down letter T or a large plastic triangle, fitted into the crotch buckle. This system is not appropriate for infants because the shield is placed in front of the child’s face or neck and the straps are too far away from the body.
3. The tray-shield is a three-contact harness (the strap runs across both shoulders and is fitted into the crotch buckle) and a bar that is lowered to the level of the child’s stomach, thus securing the remaining two contact points across the thighs. This system is not appropriate for infants because the shield is located in front of the child’s face or neck and is too far from the thighs.

How to appropriately install the child safety seat into the car?

According to the Croatian Road Traffic Safety Act, the child safety seat has to be located on the back seat, regardless of whether the seat manufacturer allows for its use on the front seat with the air bag switched off. Even more important is that the seat is installed in a place which best fits the seat itself: namely, a place where it can be safely installed following the manufacturer’s instructions. Depending on the individual model, safety seats for infants weighing up to 10 or 13 kilograms must always be placed in a rear-facing position. The head rest should be under a 45-degree angle in order to provide full support for the child’s head, neck and body. If the angle is greater, the infant’s head may drop forward, which can interfere with the respiratory tract function (for most infants, this is not a problem, so the angle can be inclined up to 60 degrees from the floor). With smaller angles, collision can cause extensive stretching of the neck and injuries to the spinal medulla; furthermore, the infant may slide under the harness and out of the safety seat. If necessary, place a rolled-up blanket under the safety seat to achieve the desired angle. It is extremely important that the child is not placed in a reclining position. A semi-reclining position (inclined 45 to 60 degrees from the ground) can save the child’s life and provides the most effective protection against serious injuries. When installing the safety seat into the car seat, make sure all the belts are properly tightened. Press your weight against the safety seat to achieve maximum fitting into the car seat as you tighten the belts. It is best to work in pairs: while one person is pressing the safety seat, the other can take care of the fitting and belt tightening. Do not hesitate to kneel into the seat as you press: you will not damage it (it has been tested for forces far greater than that) and will ultimately achieve much better fitting. You can test the seat by holding the head rest close to the belt slots and pulling. A well-fitted child safety seat should not allow more than two centimetres of movement forward or left to right (no matter how hard you pull!). Rear-facing seats should be able to move up or down. Some new safety seat and car models have built-in buckling systems or ISOFIX. This system enables safety seats to be directly installed into the car without the use of a seat belt, thus considerably reducing the possibility of faulty installation. To use this system, both the vehicle and the safety seat have to be ISOFIX-compatible. If you are using a three-point harness (one that also goes around the passenger’s shoulders) to install a forward-facing child safety seat, make sure you use a harness-fixing buckle. This buckle prevents the seat from becoming loose during normal driving (this may occur due to the slipperiness of the belt). Many models come with a buckle that is built in the seat itself (in the seat structure, behind the head rest); in other models, it is attached to the seat in some way, usually with a string. If you lose the buckle or it becomes inefficient for some reason, contact your safety seat distributer and ask for a replacement. When installing the buckle, follow the manufacturer’s instructions. Some vehicles have a so-called convertible seat belt system which enables you to switch the belt from a sliding system in which it freely slides in and out of the housing, into an automatic-lock system which prevents the belt from being further pulled out after it has been set to a certain length. While the automatic lock system is not suitable for fastening adult passengers’ seat belts, it is excellent for children’s safety seats as it prevents the harness from becoming loose during the drive, thus compromising the stability of the seat. In this type of convertible system, switching from a sliding to an automatic system is achieved by completely pulling the harness out of the housing; to shift the automatic system into to a sliding one, return the entire belt into the housing.

Car safety seat – always and without exception!

As you explain to your child that they have to be fastened in and why this is so, consistency is of crucial importance. There are no exceptions here: whether you are going for a short drive around town or a long trip – the child’s place must always be inside the safety seat. Children below the age of two cannot comprehend the concept of “car safety”. Therefore, it is important always to provide simple explanations, using a serious tone of voice. Bear in mind that adults serve as role models for children and as such have great influence on their behaviour. The child will therefore be more easily convinced if you say: “We are all going to put our seat belts on: daddy, mommy and you”. Of course, parents must also fasten their seat belts – in every case and without exception. The most important thing is to stimulate the child’s curiosity during the trip, regardless of its duration. Even when you are stuck in traffic or waiting at a traffic light, it is important to draw the child’s attention away from the harness. Encourage them to join you in looking out of the window, or find different ways to entertain them. Various “tricks” used to get infants’ attention also help develop their perception of space. Encourage the child to observe surrounding objects, identify them, name them, etc. If you often use the same routes when driving through town (e.g. on the way to grandma’s or the kindergarten), that can turn into a small ritual, something children at that age often need. In this way, you are encouraging the child to memorise and recognise the way. Before fastening your child into a safety seat, it is good to remove their jacket, thus leaving them with enough room to move freely. Make sure they also find their favourite toys, a blanket or pillow they are particularly fond of next to THEIR seat. This will help them accept the car rules more easily.