Keiki Car Seat Safety

Denise Lau
January 03, 2016

“I have a confession to make, when I took my little one on her first airplane ride I didn’t buy a plane ticket for her.” 

Lisa Dau, registered nurse and the Injury Prevention Coordinator at Kapiolani Medical Center, responded with, “Well think of it this way, even the coffee pot is secured in a flight, the only thing not secure would be a child in a parent’s lap. I know it’s expensive, but I always recommend you give each child their own seat even if it’s not required.” 

She reminded me that you can bring the car seat onto the plane and directly into the seat for infants if there is space, just check with the airlines. If not, you can bring the seat and check it with your luggage for free. 

Lisa shared, “While driving, the risk is greater, you don’t want to shortcut on safety, even if it’s a short ride always use a proper car seat. I’ve seen what happens in a crash when a two-year-old wears only a seat belt. You don’t want your child suffering from a lifelong injury.” 

Lisa is a wealth of information and she shared with us many tips for a safe ride with your kids. 

Be sure the car seat fits and is installed correctly; visit to find a certified car seat technician. The shoulder strap should fit without rubbing the neck (that’s too high) or so low your child can squeeze their arms out. If you can pinch a fold in the straps, you need to tighten the harness. The harness should be across your child’s chest and be sure to fasten the clip at armpit level. Your child’s head should be no closer than an inch to the top of the seat. If you feel they are outgrowing their seat, check the height and weight limits. Also, use the anchors and tethers. A top tether gives extra protection for those big enough to be forward facing. 

When in a booster, be sure your older children are using the seat belt appropriately. On the left, the strap isn't in the right place and on the right it's snug and over the shoulder. 

Keep your child rear-facing for as long as possible, following the maximum height and weight limits listed in your car seat manual. One of the common big mistakes is rushing a child from one stage to another, for example switching to forward before 2 years of age or moving an older child out of a five-point harness to a booster seat. It is five times safer for a child under 2 years of age to ride rear-facing because the child’s head, neck, and spine are supported by the car seat.

Be sure to follow the manual and avoid adding things to the seat. Lisa recommends not adding things like cute padding or other inserts, keeping in mind the seat was tested to be used by itself – you want it to protect your child the way it’s been tested. Any after-market products you add to the seat could void the warranty. Also, take off any jackets or heavy coats while in the seat, you want your child secure, not too tight or loose. 

Don’t stop using the car seat too soon. Keep your child in a booster seat until they are big enough to fit in a seat belt properly. For a seat belt to fit properly, the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember - your child should still ride in the back seat until at least 13 years of age because it’s a safe location.

Avoid using the front seat. Adults should be in the front seat of your car as much as possible. If your child is at least 13, they may be ok to sit in front but the back seats are usually safer for children even if they don’t need a booster already. You want your child in the safest seat in the car. Also, never place a rear-facing car seat in the front seat; if the air bag is deployed during a crash it can cause significant injuries or death for an infant. 

Replace the car seat according to the manual (usually around six years) and also when in a major accident, i.e. when airbags are deployed. Some car seat manuals will say it’s OK to keep the seat when in a “fender bender” or minor crash, others will say to replace the seat after any crash. This is another reason why you don’t borrow or use anyone’s older seat, you don’t always know if it was used in a crash or if it’s too old. 

Dispose of seats properly. Cut the straps and take the padding out and dispose of it separately from the car seat shell. Put the car seat shell in a large solid garbage bag and dispose for bulk pickup. Seats can be expensive but you don’t want to encourage others using a hand-me-down seat. We need to work together so that we see fewer children in our ER after a bad crash. 

For more information, see Kapiolani Medical Center’s Car Seat Safety webpage

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