1.  Child Safety Restraints
2.  Booster Seats
  1. Car Safety Seats May Place Preterm Infants at Risk for Respiratory Problems
  2. Cosco Infant Car Seat/Carrier Recall Involves Free Repair Kit
  3. Federal Standard Revised To Improve Child Safety
  4. More Action Needed to Boost Child Passenger Safety
  5. NHTSA Announces Recall of Fisher-Price "Safe Embrace" Convertible Child Safety Seat
  6. Observed Patterns of Misuse of Child Safety Seats
  7. Proper Child Safety Seat Use Chart
  8. Protect Your Kids in the Car
  9. Surf's Up - A guide to Internet Sites On The Web
  10. What is the Safest Way to Restrain Children in an Ambulance?
  11. What to Know About Car Seats

Car Safety Seats May Place Preterm Infants at Risk for Respiratory Problems

Parents of premature infants have many concerns when they're preparing to bring their child home from the hospital. They may have to administer medications, watch monitoring devices closely, and practice special feeding techniques. But before getting home, they have another concern - finding a safe car seat that fits their preemie appropriately. Research from Children' Hospital-St. Paul indicates that it might be a difficult task.

Because premature infants who have been discharged from intensive care are known to be at increased risk for apnea (stopped breathing), bradycardia (slow heartbeat), and oxygen desaturation (when oxygen levels in the blood decrease) while in an upright position, a study was conducted to evaluate the safety of car seats. The study compared a group of 50 full-term infants to a group of 50 premature infants (born between 35 and 36 weeks' gestation). The car seats provided by the parents were assessed to determine if the infant fit into the seat. In addition, each infant's heart rate, breathing, and pulse rate were evaluated while they were lying down 30 to 60 minutes after a feeding. Infants were then placed into their car seats and the same tests were administered for an additional 90 minutes.

Despite the use of rolled blankets to support the infants, 24% of preterm babies and 4% of full-term babies did not fit securely into parents' car seats. The average oxygen saturation (a measurement of the oxygen in the blood) for both premature and full-term infants declined significantly after 60 minutes in their car seats. Twelve percent of the preterm infants had episodes of apnea or bradycardia while in their car seats, although none of the full-term infants did.

What This Means to You: Ill-fitting car seats aren't uncommon for premature or smaller full-term infants. To create a better fit for your child, use rolled blankets to support her head, neck, and sides. You can also place a rolled blanket between her legs and the crotch restraint, if necessary. If your child still does not fit in the car seat, car beds or car seats designed specially for preemies may be available for purchase or through the hospital car seat rental program. Although car seats are often used as carriers for infants, this study indicates that preterm and term infants should not remain in car seats for extended periods of time if they are not traveling because it may put them at risk for respiratory problems. Remove your child from her car seat or carrier as soon as possible once you've reached your destination. When driving home from the hospital (and until you child has head control), have someone sit in the back seat to assure that all is well.

Return to Table on Contents

Cosco Infant Car Seat/Carrier Recall Involves Free Repair Kit

Cosco Inc. is recalling 670,000 Arriva and Turnabout infant car seat/carriers because handle locks on each side of the seat can unexpectedly release, causing it to flip forward. If this occurs, the infant can fall to the ground and receive serious injuries.

"Even if you regularly buckle your child into the seat, parents who have this car seat should call for a free repair kit immediately," said Consumer Product Safety Commission chairwoman Anna Brown.

There have been 151 reports of the handle unexpectedly releasing, resulting in 29 injuries to children. Reports include skull fractures, a broken arm, bumps to the head, black eyes, scrapes, and bruises. Some occurred when children were in the seats.

"Parents should continue using these rear-facing infant car seats but should not use the carrying handle until a repair kit has been installed," said the National Highway Traffic Safety Administration.

The recall involves models manufactured between March 1, 1995 and Sept. 9, 1997.

For a free repair kit, call Cosco, (800) 221-6736, or visit the website www.coscoinc.com.

This document was last updated on July 28, 1999.

Return to Table on Contents

Federal Standard Revised To Improve Child Safety

On Sept. 1, the first phase of the National Highway Traffic Safety Administration's upgraded standard on child safety seats took effect. Most forward-facing child seats must now be equipped with a tether, or strap, from the back of the child seat so it can attach to the vehicle.

For passenger cars, 80 percent of those manufactured after this data must have top attachment points, and all new passenger cars and light trucks must be equipped by Sept. 1, 2000.

"Tether attachments are an important part of a new universal system that will help keep a child safety seat more securely in place in a crash, thus affording greater protection to children," said Department of Transportation secretary Rodney Slater.

The final stage, to be phased in over the next three years, will include tow lower attachment points in vehicles and on child safety seats. However, some child restraint and vehicle manufacturers are expected to comply with the lower attachment system as early as next month.

Once the entire safety seat system is phased in, NHTSA estimates as many as 50 children a year will be saved and injuries may be reduced by 3,000.

Many auto manufacturers offer free or low cost installation for the top attachment. Some child restraint manufacturers also offer tether kits for older safety seats. NHTSA encourages consumers to contact manufacturers for information.

For additional information about the universal child safety seat system, contact NHTSA, (888)327-4236; website www.nhtsa.dot.gov/people/injury/index.html

In conjunction with Ford Motor Co., Safe Ride News has published Tethering Child Restraints($21.95) for advocates and professionals who help parents use car seats correctly. For more information, contact Safe Ride News, (206) 364-5696; fax (206) 364-5992; e-mail: saferide@twbc.com

This document was last updated on October 6, 1999.

Return to Table on Contents

Hall Says More Action Needed To Boost Child Passenger Safety

Prior to his resignation, former National Transportation Safety Board chairman Jim Hall attended the North Carolina Child Passenger Safety Conference. He told attendees that he would like automobile manufacturers to design vehicles with child safety in mind. He also called for highway safety laws to provide children the same level of safety.

Hall said North Carolina is a highway leader, and the Click It or Ticket program and other highway safety efforts are a good start. But more needs to be done. In 1999, 259 children died in North Carolina motor vehicle crashes. Forty-four percent of those children were not wearing safety belts.

"In fact, no state has a child restraint law that truly puts kids first," Hall commented.

Hall wants the secretary of transportation to reconvene the Blue Ribbon Panel 11: Protecting Our Older Child Passengers and to ask the panel to revise its model law so that it recommends the highest level of safety for children.

The increased use of fitting stations has helped parents and caregivers safely install child seats. However, according to safety board estimates, about 10 million children nationwide are still being trans- ported in misused safety seats, Hall noted.

Most booster seats are designed for use with lap and shoulder belts. Currently, about 43 million vehicles on the road have lap-only belts in all back seat positions. At a December meeting, NTSB identified several actions to better protect these children: providing more child safety products that work with lap-only belts, working with retailers to make the products available in appropriate stores, and finding ways to lower the cost of restraint systems.

"Yes, there is still much to do from daily reminding parents that America's highways are the most dangerous place they take their family each and every day to working together more effectively to put children's safety first," Hall concluded at the Jan. 17 conference.

This document was last updated on March 23, 2001.

Return to Table on Contents

Recall Of Fisher-Price "Safe Embrace" Convertible Child Safety Seats

DATE August 16, 1998 Contact: Tim Hurd

Tel. No. (202) 366-9550

Contact: (Fisher-Price) Laurie Oravec

Tel. No. (716) 687-3395

The National Highway Traffic Safety Administration (NHTSA) today announced a safety recall involving about 55,000 Fisher-Price “Safe Embrace” convertible child safety seats because of a possible malfunction in the shoulder harness locking mechanism.

Until a modification kit arrives, NHTSA Administrator Ricardo Martinez, M.D., advised parents to continue to use their convertible car seat, inspecting it each time it is used by checking that the harness belts remain locked in place.

"Safety is President Clinton’s highest transportation priority,” Dr. Martinez said. “An unrestrained child is at a much greater risk of injury in a crash than a child in a restraint system."

Fisher-Price, Inc., said the recall involves Model Number 79700 Safe Embrace convertible car seats, which are used in a rear-facing position for infants up to 22 pounds and in a forward facing position for toddlers up to 40 pounds. The recalled seats were manufactured from May19,1997, through March 29, 1998.

Through its own consumer research, Fisher-Price learned that the current harness adjuster, which is used to tighten and lock the harness belts around the child, may malfunction if a spring breaks or dislocates from the correct position. When the harness adjuster fails, it may not properly lock the shoulder belts in place. If this occurs, the child would not be adequately protected in a crash. Fisher-Price is offering a modification kit that will contain a newly designed harness adjuster for consumers to install.

Neither Fisher-Price nor NHTSA has had any reports of injury as a result of this problem.

Consumers who own the Safe Embrace convertible car seat should contact Fisher-Price, toll-free, at 1-800-355-8882 between 8 a.m. and 6 p.m. (EDT) Monday through Friday, to obtain a replacement harness adjuster. For better service, consumers are asked to have their car seat nearby when they call the Company.

Consumers may also write to: Fisher-Price Consumer Affairs, 636 Girard Avenue, East Aurora, N.Y. 14052. Consumers who have registered their convertible car seats with the company will automatically receive the replacement harness adjusters.

NHTSA and Fisher-Price are urging every owner of this product to obtain and install the replacement part in order to prevent the possibility of problems with the harness adjuster in the future.

Consumers with questions about this or any other safety campaign should call NHTSA's toll-free Auto Safety Hotline at 1-888-DASH-2-DOT (1-888-327-4236).

Return to Table on Contents

Observed Patterns of Misuse of Child Safety Seats

While more adults and children are wearing safety belts, a new study fins that many children who are placed in child safety seats (CSSs) could be at risk of not attaining the full benefits of the seat because the CSS is not being used properly, not installed according to the manufacturer's recommendations, or that the child is being moved to safety belts too soon. Child restraints are very effective in reducing injuries and fatalities as they are currently used, but are more effective when used properly.

The national Highway Traffic Safety Administration (NHTSA) sponsored a study to observe more than 5,900 children in safety seats or wearing safety belts in suburban shopping centers in the spring and summer of 1995. The Ketron Division of the Bionetics Corporation conducted the study in Mississippi, Missouri, Pennsylvania, and Washington. They identified how CSSs were being misused, documented problems of CSS installation and vehicle occupant protection systems, and linked characteristics of the driver to misuse of child safety seats. Since the study was conducted in only four states, it is not representative of the whole nation.

Infants, Toddlers, and Pre-schoolers

The good news is that the overall restraint use for children under 60 pounds was 87.2 percent, slightly higher than the drivers' rate of 81.6 percent. Restraint use was highest for infants, and declined steadily as children grew older. This study looked at three groups of young children by weight-- infants (20 pounds and under), toddlers (20 to 40 pounds), and pre-schoolers (40 to 60 pounds).

In all four states, almost all of the infants were observed in child safety seats (96.6 percent). A few were wearing safety belts (0.5 percent), and slightly more (2.8 percent) were not restrained at all.

The picture changed for toddlers, more of who were not restrained at all (11.1 percent), or improperly moved into safety belts (21.4 percent). Two-thirds (67.5 percent) were in child safety seats. This trend continued for pre-school children, who based on their weight between 40-60 pounds, should be in booster seats. Almost one-fifth (18.6 percent) were not restrained at all, while three quarters (75.3 percent) were wearing safety belts. A few of the pre-schoolers (6.1 percent), were in child safety seats. Misuse of CSS Observed at 79.5 Percent

The research team observed how the child safety seats were being used. While one researcher interviewed the driver of the vehicle, another observed the installation of the child safety seat and how the child was restrained. Overall, only 20.5 percent of the child safety seats were being used properly. Misuse was 79.5 percent. The specific errors observed are shown in the table.

Errors observed in the way Child Safety Seats were being used*
Locking Clip (not used at all or used wrong for seats that required it) 72.0%
Harness Retainer Clip for Chest (not used at all or used wrong for seats that required it) 58.8%
Harness Strap (not used at all or used wrong) 45.8%
Safety Belt (not attached to CSS or attached wrong) 16.9%
Direction of the CSS incorrect 9.6%
Harness not attached to crotchplate 3.3%

* the potential risk factor of each of these errors has not been determined

Built-in child safety seats were used correctly more often than conventional seats. Safety seats were used correctly more often with a vehicle that had a 2-point lap belt rather than a 3-point lap-shoulder belt.

Children Moved Too Soon to Safety Belts

Children up to 60 pounds are more safely restrained in a child safety seat or a booster seat. Many children were observed using safety belts too soon, and only 32.4 percent of these children were using safety belts correctly --two thirds were not. Many of the errors were attributed to lap belts that were too high across the abdomen and belts that were too loose. Almost half of the shoulder belt errors occurred because the child was not using the shoulder belt at all when it was present. Most of the other errors occurred when the shoulder belt was too high --up near or on the child's neck.

Unbelted Drivers More Likely to Have Unrestrained Children

Drivers who were observed to be wearing their own safety belts had fewer (5.4 percent) of the unrestrained children. However, when the driver was unrestrained, almost half of the children (47.3 percent) were also unrestrained. The vehicles that had driver-side airbags or airbags on both driver and passenger sides had slightly higher use of child safety seats, but misuse patterns were similar.

Driver Characteristics

There was no particular relationship between the age of gender of the driver and the use of child safety seat. Both parents and grandparents showed the same trends. When the driver was a friend or other relative of the child, however, there was a higher percentage of unrestrained children. There were also more unrestrained children as the number of occupants in the vehicle increased. There was very little difference regardless of the distance traveled, the time from the last stop, or whether this was the vehicle regularly driven.

Who Installed the Child Safety Seat?

There was very little difference in misuse of the CSS based on the methods used to install it. When drivers learned on their own, CSS misuse was slightly higher for both CSS installation and placement of the child in the seat. When the safety seat was frequently removed from the vehicle, CSS misuse was slightly higher than when it was only occasionally or never removed from the vehicle.


The study concludes with several recommendations for CSS programs. One key recommendation is the need to conduct research to quantify the impact of various types of CSS misuse on children involved in motor vehicle crashes.


Limited copies of Patterns of Misuse of Child Safety Seats (108 pages) are available. Write to the Office of Program Development and Evaluation, NHTSA, NTS-30, 400 Seventh Street, S.W., Washington, DC 20590, or send a fax to (202) 366-7096. Michael Smith was the program manager for this project.

This document was last updated on May 30, 1999.

Return to Table on Contents

Proper Child Safety Seat Use Chart

Weight Birth to 1 year
Up to 20-22 lbs.
Over 20 lbs. - 40 lbs.
And over 1 year
Over 40 lbs.
Up to 80 lbs.
Seat Position Infant only or
Rear-facing convertible
booster seat
Always Make Sure: Children to one year and at least 20 lbs. in rear-facing seats Harness straps should be at or above shoulders

Most seats require top slot for forward-facing
Belt-positioning booster seats must be used with both lap and shoulder belt
Warning Do not place infants in the front passenger seat of cars with air bags All children age 12 and under should ride in the back seat Make sure the lap belt fits low and tight to avoid abdominal injuries

This document was last updated on February 25, 2001.

Return to Table on Contents

Protect Your Kids in the Car

The safest place for any child 12 years old and under is in the back seat.

Every child should be buckled in a child safety seat, a booster seat, or with a lap/shoulder belt, if it fits.

Riding with Babies

  • Infants up to about 20 pounds and up to 1 year old should ride in a rear-facing child seat.
    The child seat must be in the BACK seat and face the rear of the car, van, or truck.

  • Babies riding in a car must never face front. In a crash
    or sudden stop, the baby's neck can be hurt badly.
  • Infants in car seats must never ride in the front seat of a car with air bags. In a crash, the
    air bag can hit the car seat and hurt or kill the baby.
  • Never hold your baby in your lap when you are riding in the car. In a crash or sudden stop,
    your child can be hurt badly or killed.

Riding with Young Kids

  • Kids over 20 pounds and at least 1 year old should ride in a car seat that faces the front of the car, van, or truck.
  • It is best to keep kids in the foreward facing car seat for as long as they fit comfortably in it.

  • Older kids over 40 pounds should ride in a booster seat until the car's lap and shoulder belts
    fit right. The lap belt must fit low and snug on their hips. The shoulder belt must not cross
    their face or neck.
  • Never put the shoulder belt behind their back or under their arm.


  • All kids are safest in the back seat, in a safety seat or seat belt.
  • Always read the child seat instructions and the car owner's manual. Test the child seat to
    ensure a snug fit by pulling the base to either side or toward the front of the car.

For additional information, please contact the NHTSA hotline at:
1-888-DASH-2-DOT (1-888-327-4236), or the NHTSA Web site.

U.S. Department of Transportation
National Highway Traffic Safety Administration
August 1997

Return to Table on Contents

What is the Safest Way to Restrain Children in an Ambulance?

For years health care providers have asked this question and never received an answer based on scientific knowledge and fact. Unfortunately the reason is because very little science, and therefore very few facts on this matter exist. We do know, however, that any unrestrained object inside a motor vehicle will become a projectile object at the moment the vehicle suddenly stops. If the object is a human being, serious and potentially fatal injuries may occur. In response, many states have enacted passenger-restraint laws. Many more states require children to be placed in crashworthy child restraint systems. But how about ambulances? Ambulances are motor vehicles. Yet, current motor vehicle laws exempt ambulances and emergency response vehicles from occupant restraint guidelines. A false sense of security exists that simply being in an ambulance is all the protection needed. Experts are just beginning to study ambulance crashes to determine the dynamics of an accident and devel-op better safety features. Until guide-lines based on science and fact are developed, a few "do’s" and "don’ts" should be followed whenever possible:

Do Restrain all Occupants.

If unrestrained, any person - young or old, patient or provider - is nothing more than a projectile. Projectiles can be severely injured or killed in a crash.

Don’t Place Children or Small Adults in the Front Seat of an Ambulance.

Children or small adults should not be placed in close proximi-ty to an airbag. In Type I, II, and III ambulances the passenger seat cannot be moved back far enough to safely place a child or small adult in that seat.

Don’t Place Children (or Adults) on the Bench Seat in the Rear Compartment of an Ambulance.

The bench seat typically has lateral mounted lap belts. Car seats would be placed at 90 degrees to the forward motion of the ambulance, not in line with that motion. None of the child safety seats have been tested for their effectiveness in this position. In addi-tion, it has been demonstrated that the lap belt is less effective, and potentially hazardous, if it is used without a shoulder harness or a three-point restraint.

Where should ill or injured children be placed? The best place is on the stretcher. If the patient is smaller than the stretcher, then a crash-tested child-restraining device or strapping system must be utilized. What if the child isn’t a patient? What if the vehicle is transporting more than one patient? Until answers based on scientific knowledge and fact become available, there is no best practice.

In conjunction with the National Highway Traffic Safety Administration, the Emergency Medical Services for Children (EMSC) National Resource Center, is organizing a panel of experts to determine the “best interim practices” for ambulance occupant safety. More information about the panel will be available in future issues of EMSC News.

From Emergency Medical Services for Children Newsletter, Volume 11, No. 3, Fall 1998

Return to Table on Contents

What to Know About Car Seats

Safe America

The rule for children in automobiles is simple, succinct and unequivocal: No matter how short the tip, or how much they fuss, children MUST be buckled in every time they get in a vehicle. You can help ensure the safety of your child while traveling if you conduct a car seat safety check-up as recommended by Cosco Inc. and the American Academy of Pediatrics.

  1. Do you have the car seat instructions? You will need them to adjust the seat as your child grows. Send in the registration card; it's important if the seat is recalled.
  2. Does your car have a passenger-side airbag? An infant in a rear-facing seat should never ride in the front seat of a car that has a passenger-side airbag.
  3. Is your child facing the right way for both weight and age? Infants should ride facing the back of the car until they weigh 20 pounds and are close to age one.
  4. Is the harness snug; does it stay on your child's shoulders?
  5. Is the car seat belt in the right place and pulled tight to keep the set in place?
  6. Have you tried the car seat in your vehicle? Not all car seats fit in all vehicles. Be sure to read the "car seat" section in your owner's manual.
  7. Is your child too tall for a convertible seat and at least 40 lbs.? If so, use a booster seat.
  8. Has your child's car seat been recalled? To check call the Auto Safety Hotline 800-424-9393.

The Safe America Foundation is a non-profit organization dedicated to injury prevention and the practice of good safety habits through the distribution of safety products and innovative educational programs. For more information call: 770-218-0071 or email: safeamerica@mindspring.com

Return to Table on Contents

The information on the Loyola University Health System (LUHS) Web site is for educational purposes only. It is presented in summary form in order to impart general information relating to certain diseases, ailments, physical conditions and their treatments. The information provided through the LUHS Web site should not be used for diagnosing or treating a health problem or a disease, nor is it a substitute for professional care. Should you have any health-care related questions or suspect you have a health problem, you should consult your health care provider.

  @1995 - 2001 Loyola University Health System.  All rights reserved.
 Disclaimer | Terms and Conditions | Privacy Policy

Loyola University Medical Center Injury Prevention Program
Loyola University Health System | Email Site Administrator

Home | Transportation | Falls | Home and Leisure Safety | Fire/Burns | Poisons | Fire Arms | Water Safety