By Drs. Sally Robinson and Keith Bly

Accidents happen when you least expect them. Automobile accidents are the leading cause of death for children ages 2 to 14. In 2002, approximately six children ages 14 and under were killed every day in automobile accidents. Child safety seats can reduce the risk of a fatal injury by 69 percent in infants under 12 months and by 47 percent in children ages 1 to 4 years.

Child passenger safety seat inspection stations across the country have determined that 81 percent of safety restraints are used incorrectly and one-third of children under age 14 are riding in the wrong type of restraint for their age and size. The use of car seats for infants and toddlers has increased, with approximately 99 percent of infants and 94 percent of toddlers restrained in safety seats. However, only 83 percent of 4- to 7-year-olds are restrained appropriately in cars.

Many people may not realize that their vehicle's seatbelts are designed for adults and can injure their children if used alone. On a child, the belt strap lies across the stomach and the shoulder strap lies over the neck. In an accident, this positioning could cause serious or fatal injuries. Booster seats raise the child a few inches off the seat so that the vehicle's seatbelt fits across the child's upper thighs and the shoulder belt fits on the shoulder, close to the child's chest.

Below is a list of basic car seat guidelines:

  • Children under 12 should sit in the back seat of the car. The safest place for a child to sit in a car is in the middle of the back seat.
  • Infants weighing less than 20 pounds should sit in an infant or convertible seat, facing the rear of the car. Harness straps should be at or below shoulder level.
  • Children between 20 and 40 pounds should be in forward-facing or convertible car seats. Harness straps should be at or above the child's shoulders.
  • Children between 4 and 8 years of age, over 40 pounds and under 4 feet 9 inches tall, should sit in a belt-positioning booster seat, used with the vehicle's lap and shoulder belt.
  • Make sure that the child seat is properly installed. Child safety seat inspection stations estimate that only 21 percent of all car seats are correctly installed. Read the manual that came with the child seat, as well as your vehicle owner's manual. After it is installed, test the seat by pulling it from side to side and forward at the base. It should not move more than 1 inch in any direction. If you aren't sure if you have installed it properly, call the National Highway Traffic Safety Administration at (800) 424-9393 to find the nearest inspection station.
  • Set an example for your children and buckle up yourself. If your children see that you use your seatbelt, they will be less likely to object when you buckle them in their safety seats.

Dr. Sally Robinson is a pediatrician in the division of children's special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB. This column is not intended to replace the advice of a physician.

The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email