Most parents do not set up the car seat correctly.
In 2013, around 8,500 infants under 1 year of age needed hospitalization or emergency care, and 135 died following road traffic accidents. Used correctly, car seats can reduce the risk of infant death and injury by 71%.
Many hospitals have child passenger safety programs, and prenatal classes often address safe transportation of newborns, but the content is variable due to constraints on time, staffing needs, financial resources and risk management concerns.
The US National Highway Traffic Safety Administration (NHTSA) recommend a small, portable rear-facing car seat for newborns up to 8-9 months. In a crash, it will cradle and move with the child to minimize stress to the fragile neck and spinal cord.
Dr. Benjamin D. Hoffman and colleagues, from the Oregon Health & Science University, WA, surveyed families being discharged from the hospital with a healthy newborn between November 2013 and May 2014.
Of 404 families randomly sampled, 291 agreed to participate. Those who chose not to were mostly younger, covered by Medicaid and already had other children.
Over 90% of families made errors with car seat use
Each family was asked to position the newborn in the car seat and, if not already done, install the car seat. Certified car safety technicians evaluated the positioning and installation, noting and correcting all instances of misuse. The technicians spent an average of 35 minutes with each family.
At least one error in car seat use was made by 95% of families, and 91% made a serious error. The most common errors included loose harness and car seat installation, low chest clip and incorrect recline angle. Of the 15% of families who had already worked with a certified car safety technician, 83% still had at least one error in use.
In addition, six families had an expired car seat, and three seats had visible damage that made them unusable.
Factors contributing to a higher rate of car seat misuse included lower socioeconomic status, lower educational attainment and non-English primary language.
The researchers recommend that families work with certified car seat technicians before hospital discharge, but they say that more needs to be done to ensure infant safety, such as a review of the safety programs provided.
NHTSA recommendations on use and installation of a car seat for an infant include the following points:
- Choose a rear-facing seat
- When installing, read the instruction manuals for both the car seat and the vehicle, because seats and vehicles vary
- Use either the lower anchors or the seat belt to secure the seat; if using the seat belt, make sure you know how to lock it
- Place the car seat in the back seat of the vehicle, tightly secured and unable to move side-to-side or front-to-back more than 1 inch when pulled at the belt path
- Ensure the seat is installed at the correct recline angle by using the built-in angle indicator or adjustor.
Dr. Hoffman notes:
"Car safety seats are much more difficult to use correctly than they should be. Vehicle and car seat manufacturers must work together to develop systems that are easier for consumers to use and understand. Further, health systems should provide resources and support both before and after birth, especially to the most vulnerable infants, to ensure the safe use of car seats."
Medical News Today recently reported on the dangers posed to babies by crib bumpers.