A Guide to Child Passenger Safety

Car seat, booster seat and seatbelt tips for kids of all ages

Dr. B. Jill McCabe and Erin Rovelli, RN serve patients at the Children’s Emergency Room at Inova Loudoun Hospital – Loudoun County’s only emergency facility solely dedicated to caring for children and adolescents. It is also the first and only sensory-friendly ER in the region. 

Did you know that motor vehicle crashes are the leading cause of unintentional death in children in the United States? According to the Centers for Disease Control (CDC), nearly 150 children ages 0 – 19 are treated in emergency departments every hour for injuries sustained in a motor vehicle crash. An estimated 1,000 children under the age of 16 die in a motor vehicle crash annually. The proper use of safety seats and belts helps keep children safe.

Facts about car safety seats

Current estimates of child restraint effectiveness indicate that child safety seats reduce the risk of injury by 71 – 82 percent and reduce the risk of death by 28 percent when compared with children of similar ages in seat belts. Booster seats reduce the risk of non-fatal injury among 4 – 8 year olds by 45 percent when compared to seat belts. However, for a car seat to do its job, it has to be the right one for your child’s age and size. It must also be used properly and adjusted to fit your child securely.

Car seat installation guidelines by age: 4 stages of child passenger safety

Before car seat installation, be sure to read the instruction manual and your car owner’s manual. The safest seating position for car seats is in the back seat, and never in front of an active airbag.

Rear-Facing Car Seats (0 – 3 years): Infant-only Car Seats or Convertible Child Safety Seats

During installation: Confirm the car seat is tightly secured in your vehicle using either the seat belt or LATCH system. Also ensure that the car seat is installed at the correct recline angle.

Adjusting to fit your child: Properly position the harness on your child; the straps should lie flat on or below your child’s shoulders. Buckle the harness and chest clip – then tighten. The chest clip should be placed at the armpit level. The harness should be snug enough when you cannot pinch any extra material at the shoulder.

When to move to the next stage: Keeping your child in a rear-facing car seat as long as possible is the recommendation. Consider moving to the next stage (forward-facing car seat) when your child has outgrown the height or weight limit allowed by the car seat manufacturer – but, never before 1 year and/or 20 pounds.

Forward-Facing Car Seats (1 – 5 years): Convertible or Combination Child Safety Seats

During installation: Confirm the car seat is tightly secured in your vehicle using either the seat belt or LATCH system.

Adjusting to fit your child: Properly position the harness on your child; the straps should lie flat on or below your child’s shoulders. Buckle the harness and chest clip – then tighten. The chest clip should be placed at the armpit level. The harness should be snug enough when you cannot pinch any extra material at the shoulder.

When to move to the next stage:  Consider moving to the next stage (booster seat) when your child has outgrown the height or weight limit allowed by the car seat manufacturer of the forward-facing car seat. 

Booster Seats (4 – 8 years): Belt-positioning Booster Seats

During installation: Place the booster seat flat on the vehicle seat.

Adjusting to fit your child: After your child is seated on the booster seat, buckle the seat belt. Confirm that the seat belt fits your child properly. Adjust the lap belt so it lies snugly across your child’s upper thighs – not across the stomach. Adjust the shoulder belt so it rests across the chest; it should never touch the neck.

When to move to the next stage:  Consider moving to the next stage (seat belt) when your child is between 8 – 12 years of age and can fit correctly in a vehicle seat belt (usually around 4 feet 9 inches tall). 

Seat Belt (8 years +): Lap and Shoulder Vehicle Seat Belt

Adjusting to fit your child: The safest seating position for a child under 13 years of age is in the back seat. The child should be tall enough to sit without slouching and be able to keep his or her back against the vehicle seat. Knees should be naturally bent over the edge of the vehicle seat and feet must be kept flat on the floor. The lap belt must lie snugly across the upper thighs – not across the stomach. The shoulder belt should lie snug across the shoulder and chest – never across the neck or face. Never allow your child to place the shoulder belt under his or her arm or behind the back – this can cause severe injuries in the event of a crash.

Other helpful car safety tips:

• Winter coats and car seat safety. It’s important to note that thick winter coats or snowsuits can compromise your child’s car seat safety. For a car seat or booster seat to function properly, the straps need to remain tight against the child’s chest. Thick winter coats and snowsuits can create slack in the harness, decreasing the effectiveness of the car seat.

• Car seats do expire! Read the label on your car seat to learn of the expiration date. Most manufacturers allow a car seat to be used for up to 5 years after the manufacturing date. Contact the manufacturer if your car seat does not have an expiration date. 
• New car seats are best. If you have to use a pre-owned car seat, confirm that it has not expired, is not damaged, has all parts (including the instruction manual), has not been involved in a crash, and that all labeling is intact.
• Car seats involved in a crash may need to be replaced. Forces in a motor vehicle crash may cause unseen damage to the seat and it may not work properly in a future crash. Visit preventinjuriesva.com to help determine if a car seat should be replaced.
• Car seat recalls. To be alerted for car seat recalls, register your contact information with the manufacturer by completing the registration information included with your car seat. You can also visit the manufacturer’s website.

Virginia booster and car seat laws

• (Code of Virginia Article 13 – Section 46.2-1095)
  • Child safety seats and booster seats are required for all children until their 8^th birthday. This law is based solely on age, with no weight or height requirement.

• (Code of Virginia Article 12 – Section 46.2-1095)
  • Rear-facing child restraint devices must be placed in the back seat of a vehicle.

• (Code of Virginia Section 46.2-1156.1)
  • Children ages 8 – 17 (until age 18) must be belted correctly in vehicle safety belts, in vehicles manufactured after January 1, 1968.

Car seat help, questions and information

• Income-eligible families can apply for a free safety seat through the Low-Income Safety Seat Distribution and Education Program

• Safety seat checks: Visit one of Virginia’s Child Safety Seat Check Stations or events for free hands-on assistance from a Certified Child Passenger Safety Technician. See all Virginia safety seat check station information and event calendar

• Call Virginia’s Child Passenger Safety Information Line at (800) 732-8333 for more information.

• Car Seats: Information for Families (HealthyChildren.org / American Academy of Pediatrics)