# Child safety in cars **URL:** \ **Category:** Great Debates\ **Created:** [February 3, 2011, 3:55pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035 "2011-02-03T15:55:42Z")\ **Posts on this page:** 13\ **Page:** 2
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 4, 2011, 11:02pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/21 "2011-02-04T23:02:33Z")
> [@WhyNot](#): > > … Something I didn’t know until a few weeks ago: NEVER use a lap only belt with a booster. It’s safer, if you have a booster and you have only a lap belt available, to put the kid straight on the seat of the car and put the lap belt on without a booster, just like we used to do. Boosters are not designed for lap only belts, and the angle they’re forced to obtain to make it poses a serious innards rupture or spinal injury risk. Sorry but whoever told you that has it exactly wrong. It is VERY dangerous to use a lap belt only without a booster, whether or not there is a three point, precisely because the booster positions the lap belt against the hip bone instead of into the abdomen. See [here](http://journals.lww.com/pedorthopaedics/Abstract/1995/07000/Lumbar_Compression_Fractures_Secondary_to_Lap_Belt.22.aspx) and [here](http://journals.lww.com/jtrauma/Abstract/1990/09000/The_Lap_Belt_Complex__Intestinal_and_Lumbar_Spine.9.aspx) for information about the “lap-belt complex” that the extended booster recommendation was mainly promoted to prevent. Raising up the child a few centimeters is enough to get the lap belt against the hip bone instead of riding into the belly and all its squishy innards parts. Better with a properly positioned shoulder harness as well. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [February 4, 2011, 11:33pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/22 "2011-02-04T23:33:22Z")
> [@DSeid](#): > > Sorry but whoever told you that has it exactly wrong. Interestink… but those studies don’t compare lap belts alone to lap belts with boosters, do they? I mean, I know that lap belts are horrid, but the State of Illinois and the manufacturers of booster seats seem to think lap and booster are even \*more \*horrid. It’s in the [Illinois Child Seat Safety Act](http://www.cyberdriveillinois.com/departments/drivers/programs/kiss.html). “Belt-positioning booster seats are always used with a vehicle’s lap belt and shoulder belts. Never use with lap-only belts.” and “If your child is over 40 pounds they may be transported in the back seat without a booster seat if the back seat of your vehicle is only equipped with lap belts. Booster seats should only be used with a lap/shoulder belt combination.” It’s also in all the manufacturer’s paperwork, which of course I didn’t read when I got the darn thing. Frankly, if I had lap only belts, I’d spend the extra money for one of those oversized full carseats which can accommodate a child up to 80 pounds. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [February 4, 2011, 11:37pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/23 "2011-02-04T23:37:29Z")
Ah, here’s one summary of comparison research: [http://www.iihs.org/research/topics/child\_restraints/summary.html](http://www.iihs.org/research/topics/child_restraints/summary.html) They do indeed conclude that a lap belt alone is worse than a lap belt with a booster, despite current recommendations in place, while acknowledging that their sample sizes were small and the differences in injury rates not statistically significant. So I wonder what the state and booster manufacturers are basing their recommendations on. There’s very little on Google; I’ll try the Med journals later when my internet connection isn’t so wonky. ---
**Author:** ![steronz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steronz/32/11765_2.png) [@steronz](https://boards.straightdope.com/u/steronz)\ **Post date:** [February 4, 2011, 11:55pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/24 "2011-02-04T23:55:24Z")
> [@DSeid](#): > > Um, yes it is. That’s why I pointed that fact out in what you just quoted. > > Kids are built differently. Their bodies move in crashes differently. Their bodies get injured differently. The mechanics are NOT the same. The _basic_ mechanics are still the same. 3 points are not superior to 5. The front seat is not superior to the back seat. We have recommendations and legal requirements for kids that should be just as valid for adults, but somehow adults are immune from these extra safety measures. I can understand having different equipment for differently sized and configured people (i.e., babies, toddlers, kids, and adults), but why do some rules and recommendations get thrown out the window at 16? ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 5, 2011, 12:16am UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/25 "2011-02-05T00:16:02Z")
**WhyNot** , Very nice link and thank you for providing it. My\* guess\* is that the manufacturers had their products tested and approved to be used as belt positioning devices and that their legal advisors were clear that they must insist that they advise using them only for their designed and tested purposes and that the state went with manufacturer guidelines. If there is a car accident and a child is injured using the product not as it was designed to be used, the truth may be that they were better protected than not using it at all, but who wants to be the exposed to a lawsuit? **steronz** , 1. The risk reduction is significantly less for adults than for children, because of those very real biomechanical differences. 2. The issue of society having a vested interest in protecting children including from grossly poor parent decision making on their behalf. 3. The tradition of, OTOH, allowing allegedly competent adult individuals to do stupid things within a very broad range, so long as they do not harm others in the process. Hell, we can’t even get [motorcycle helmet laws passed](http://www.iihs.org/laws/helmetusecurrent.aspx)in many states. ---
**Author:** ![steronz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steronz/32/11765_2.png) [@steronz](https://boards.straightdope.com/u/steronz)\ **Post date:** [February 5, 2011, 12:25am UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/26 "2011-02-05T00:25:10Z")
> [@DSeid](#): > > 1. The risk reduction is significantly less for adults than for children, because of those very real biomechanical differences. > [@](#): > > CONCLUSION: We estimated that the rear seat passenger position may reduce the risk of death in a motor vehicle crash by about 39% and reduce the risk of death or serious injury in a crash by 33%, compared with the front seat passenger position. If the associations that we report are causal, sitting in the rear seat, compared with the front seat, may prevent about 4 in 10 passenger deaths, or 3 in 10 passenger deaths and injuries, that might otherwise occur. > **[Passenger seating position and the risk of passenger death or injury in...](https://pubmed.ncbi.nlm.nih.gov/14642880/)** > > We estimated that the rear seat passenger position may reduce the risk of death in a motor vehicle crash by about 39% and reduce the risk of death or serious injury in a crash by 33%, compared with the front seat passenger position. If the... So my link shows a 39% reduction in death if adults moved to the back seat, and your link showed a 28% reduction in death for child seats versus seat belts ages 2-6. So I posit that this point is wrong, with a slight concession for the rapid increase in airbag adoption since that data was collected. I’ll grant you points 2 and 3, especially for the motorcycle helmet example which somehow escaped me. I remember remarking when I moved back to Ohio how strange it was to see people riding around without helmets, and the funny looks I got for merely suggesting that it was maybe a bad idea. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 5, 2011, 1:29am UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/27 "2011-02-05T01:29:06Z")
They were cautious in their conclusion for a reason. Maybe adults who sit in the in the rear are more likely to be adults who buckle up as well. A subsequent study tried to control for confounding factors and [found](http://www.ncbi.nlm.nih.gov/pubmed/16595421) > [@](#): > > … For restrained passengers in cars with a front passenger airbag, the aRR was 0.62 (95% CI 0.48 to 0.81) for children 0-12 years, 0.96 (95% CI 0.88 to 1.06) for passengers 13-29 years, 1.03 (95% CI 0.93 to 1.15) for passengers 30-59 years, and 1.06 (95% CI 0.90 to 1.26) for passengers 60 years or older. The rear seat was associated with more protection in cars without front airbags and more protection for unrestrained passengers compared with restrained passengers. > > CONCLUSIONS: Previous studies have reported that the rear seat was safer for persons of all ages; thus seating a young child in the rear has often meant that older children and adults had to assume an increased risk of death by sitting in the front. These results suggest that when front passenger airbags are present and passengers are restrained, putting adults in front and children in back enhances child safety without sacrificing adult safety. So I appreciate the cite, but I humbly submit it is outdated by subsequent research. ---
**Author:** ![Backcountry\_Medic](https://avatars.discourse-cdn.com/v4/letter/b/919ad9/32.png) [@Backcountry\_Medic](https://boards.straightdope.com/u/Backcountry_Medic)\ **Post date:** [February 8, 2011, 5:19pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/28 "2011-02-08T17:19:04Z")
The topic has drifted a bit, but that long speech by Steve Levitt seems like it was just taken from his “Superfreakanomics” book. It was a more holistic take on car seats, especially for older kids, as in the OP. It seemed to have a fairly reasonable take on their presumed safety, and it specifically looked at how complicated they are to correctly install, thus leading to improper/unsafe use vs modifying normal car seat belts (via integrated booster seats or lower/adjustable belts). It stemmed initially from his cost analysis of airbags and seat belts and fit his point of “simpler, easy to use devices typically are much more cost effective than more complicated ones largely because they are used correctly much more often”. One part of his argument that really stuck out in my mind was the relative absence of crash test dummy data for kids simply placed correctly in three point devices vs car seats. He went so far as to contract with a testing facility to have them perform the test, but (per the book) her was only able to find one lab that would do the testing, he couldn’t use their name and they still tried to discourage him from running the test when he actually showed up onsite. His explanation was that these labs earn a good deal of money from testing car seats and that none of them wanted their name attached to any research the might seem to “undermine” their efficacy. In the end (and given some fairly favorable conditions for the car seats) it seemed like a properly fitting seat belt was every bit as good as a car seat. It seems to make car seats out like a minor ‘scam’, when you consider that most of them are installed incorrectly (up to 80% IIRC). Not saying anything personally to the OP, but statistically it’s likely your car seat is incorrectly installed and your child would probably be safer to be sitting in a booster the proper way, which almost every parent can do correctly their first try. I know at least anecdotaly that car seats can do some crazy things when they are improperly installed. I’ve seen them partially stuck in windows, dangling out side doors and bounced around (occasionally ejected) like a pinball during rollovers. But I’ll admit I don’t know the first thing about installing them, because in all of my time in the ER and the field I was explicitly prohibited from installing or helping to install them since I hadn’t taken the 3 or 4 day class which trained for that. I’ve taught a lot of people basic knots for rock climbing, and I swear if you give 20 inexperienced people a piece of rope, no matter how detailed you make your instructions, you are going to end up with no less than 15 different knots, most of which aren’t just unsafe, but patently dangerous. Since reading that article, I’ve come to a similar conclusion about car seats. ---
**Author:** ![suranyi](https://avatars.discourse-cdn.com/v4/letter/s/e36b37/32.png) [@suranyi](https://boards.straightdope.com/u/suranyi)\ **Post date:** [February 8, 2011, 6:53pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/29 "2011-02-08T18:53:44Z")
> [@Backcountry\_Medic](#): > > The topic has drifted a bit, but that long speech by Steve Levitt seems like it was just taken from his “Superfreakanomics” book. It was a more holistic take on car seats, especially for older kids, as in the OP. It seemed to have a fairly reasonable take on their presumed safety, and it specifically looked at how complicated they are to correctly install, thus leading to improper/unsafe use vs modifying normal car seat belts (via integrated booster seats or lower/adjustable belts). > > It stemmed initially from his cost analysis of airbags and seat belts and fit his point of “simpler, easy to use devices typically are much more cost effective than more complicated ones largely because they are used correctly much more often”. > > One part of his argument that really stuck out in my mind was the relative absence of crash test dummy data for kids simply placed correctly in three point devices vs car seats. He went so far as to contract with a testing facility to have them perform the test, but (per the book) her was only able to find one lab that would do the testing, he couldn’t use their name and they still tried to discourage him from running the test when he actually showed up onsite. His explanation was that these labs earn a good deal of money from testing car seats and that none of them wanted their name attached to any research the might seem to “undermine” their efficacy. In the end (and given some fairly favorable conditions for the car seats) it seemed like a properly fitting seat belt was every bit as good as a car seat. > > It seems to make car seats out like a minor ‘scam’, when you consider that most of them are installed incorrectly (up to 80% IIRC). Not saying anything personally to the OP, but statistically it’s likely your car seat is incorrectly installed and your child would probably be safer to be sitting in a booster the proper way, which almost every parent can do correctly their first try. > > I know at least anecdotaly that car seats can do some crazy things when they are improperly installed. I’ve seen them partially stuck in windows, dangling out side doors and bounced around (occasionally ejected) like a pinball during rollovers. But I’ll admit I don’t know the first thing about installing them, because in all of my time in the ER and the field I was explicitly prohibited from installing or helping to install them since I hadn’t taken the 3 or 4 day class which trained for that. > > I’ve taught a lot of people basic knots for rock climbing, and I swear if you give 20 inexperienced people a piece of rope, no matter how detailed you make your instructions, you are going to end up with no less than 15 different knots, most of which aren’t just unsafe, but patently dangerous. Since reading that article, I’ve come to a similar conclusion about car seats. I’m curious about one thing regarding that Levitt article, if you remember: Did the crash test simulate infants or just older children? Because I have hard time even imagining how to buckle a baby into a regular car seat. ---
**Author:** ![Backcountry\_Medic](https://avatars.discourse-cdn.com/v4/letter/b/919ad9/32.png) [@Backcountry\_Medic](https://boards.straightdope.com/u/Backcountry_Medic)\ **Post date:** [February 8, 2011, 8:41pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/30 "2011-02-08T20:41:16Z")
The test (and argument) was definitely geared towards older children, although I can’t remember if they were talking about 2 and up or 4 and up. It was on my Kindle, which isn’t too conducive to referencing, but I’ll see if I can find it. It still had all the usual caveats: no airbags, belts had to fit across the waist/chest, etc. The point I mainly took from it was that they plurality of car seats just seemed to confuse parents and they were fairly likely to install them incorrectly and/or size them inappropriately. His point was a well fitting three point would work acceptably well on older kids, and since they were far more likely to be used correctly rather than car seats, it made more sense to push boosters and modified belt systems. It’s a lot easier to show parents how a seatbelt should fit and allow them to adjust it according to child size rather than how to properly install a carseat (which might be completely different from the one they buy 1 year later). Infants are definitely outside the human norms wrt body distribution, so you probably have to accept that they require a special 5 point, lateral support type restraint for adequate protection. He didn’t deny that, just that once kids are more proportioned like small adults they can do equally good or better without the extraneous complications a car seat entails. He definitely had an eye towards the real world, where people aren’t experts on car seats and aren’t going to bother with carseat fittings, etc. For emphasis he used a plain, flat bench seat (think 70’s pickup) with just a lap belt that fit the car seats very well and was essentially an ‘ideal’ car seat location, even though these seats are almost never found in modern cars. ---
**Author:** ![Backcountry\_Medic](https://avatars.discourse-cdn.com/v4/letter/b/919ad9/32.png) [@Backcountry\_Medic](https://boards.straightdope.com/u/Backcountry_Medic)\ **Post date:** [February 8, 2011, 8:53pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/31 "2011-02-08T20:53:44Z")
EDIT: Sorry, it was 3 year olds and 6 year olds. And it doesn’t say lap belt only seats for the carseat test, just “old-fashioned bench style rear seats”. He claims in both tests “adult seat belts passed the crash test with flying colors”. Also he attributes some of the data from seat belt caused injuries to be from misrepresentation of totally unrestrained children. It’s pretty much impossible to lie about whether or not your child was in a car seat, but every seat has a belt, so parents might use that as a convenient excuse when in reality they might not have been restrained at all. Again, just a single data point, but I think the ideas have some merit. ---
**Author:** ![Lissla\_Lissar](https://avatars.discourse-cdn.com/v4/letter/l/8491ac/32.png) [@Lissla\_Lissar](https://boards.straightdope.com/u/Lissla_Lissar)\ **Post date:** [February 9, 2011, 2:20am UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/32 "2011-02-09T02:20:25Z")
Yes, he says that up until age 2 car seats are much safer, but after age two there’s very little difference between adult seat belts and kids’ car seats or boosters. This is interesting to me because my long, thin toddler (just turned three) is no longer fitting into his car seat. We’ve got a booster, but they’re supposed to be used for kids weighing more than 40lbs, and he weighs 35. We have an almost-1 year old I’d love to stick in the toddler seat (in a month, when he’s one. He doesn’t fit in the infant seat any more without squeezing). I don’t want to endanger my 3 year old, I don’t really want to buy a second car seat for the few months it will take until he’s over 40lbs. It’s an irritating problem. ---
**Author:** ![Omar\_Little](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/omar_little/32/269_2.png) [@Omar\_Little](https://boards.straightdope.com/u/Omar_Little)\ **Post date:** [February 9, 2011, 3:08pm UTC](https://boards.straightdope.com/t/child-safety-in-cars/570035/33 "2011-02-09T15:08:51Z")
In my town, every day, I see large families with 4 or 5 kids, ranging from age 2-10, driving around with no one wearing a seat belt, riding in a booster seat or child seat. You would think that it was 1975. These are the people that these laws are targeted at. Not the people that are taking some precaution to buckle their kids up somewhere. [Previous page](https://boards.straightdope.com/t/child-safety-in-cars/570035.md?page=1)