- The Washington Times - Friday, November 16, 2001

Parents are moving young children into adult seat belts too soon and are thus courting tragedy. Instead of taking youngsters from child car seats to booster seats and then seat belts, parents have been skipping an important step. They have been moving children from car seats directly to seat belts when the children turn 4 years of age.
Young children prematurely buckled into adult seat belts are three and a half times more likely to suffer a significant injury and four times more likely to have serious head injuries in crashes than children properly restrained in booster seats or car seats, according to Dr. Flaura Koplin Winston, a pediatrician and biomechanical engineer at The Children's Hospital of Philadelphia.
Dr. Winston conducted the first-ever research to measure the danger of putting children into seat belts too soon. Previous studies have compared children in child restraints with those who are not restrained.
Properly restraining children means using infant and convertible car seats for children under age 4 and booster seats for children from age 4 until they fit into seat belts properly. Seat belts do not fit children correctly until they are at least 4 feet 9 inches tall and 80 pounds, which usually occurs around the age of 9. Therefore, belt-positioning booster seats are a crucial safety step between car seats and adult seat belts.
How widespread is this practice of premature graduation to seat belts? "We found that nearly 40 percent of 2- to 5-year-old children are being placed in adult seat belts rather than car or booster seats, dramatically increasing their risk of injury in a crash," Dr. Winston said.
For seat belts to fit properly, the lap portion should ride low across the hips, and the shoulder belt should cross the shoulder and chest. On a small child, however, the lap portion of the belt rides up over the abdomen and the shoulder portion crosses the neck or face. This position places the child at risk for "submarining" or sliding out of the lap belt during a crash.
Also, a child could suffer "jackknife" bending, increasing the risk not only of ruptured internal organs and spinal cord injuries, but of concussions and skull fractures as the head strikes the child's knees or some part of the vehicle's interior.
To be safe, children who outgrow child seats should be in booster seats, also referred to as "belt-positioning" booster seats, which are not restraint systems; they are positioning devices that raise the child up higher to improve the fit of the seat belt.
Booster seats are of two types, either with or without a back. Although people might think backless boosters aren't as good as high back designs, that is not the case, say child passenger safety advocates like Karen DiCapua, director of child passenger safety for the National Safe Kids Campaign in Washington.
Backless boosters, sometimes called platform boosters, do a very good job of routing lap/shoulder belts correctly. They are inexpensive ($20 as opposed to $45 or $60), and older children might like them better because they don't look like the car seats they used when they were babies.
A high-back booster is needed most if a car's seatback is low and the child's head sticks up above it. In that case the child's head has no support, and there's danger of a whiplash injury, Ms. DiCapua said.
As to the question of why more parents aren't using booster seats, there is no simple answer. Word takes time to get out to people, so some parents may not know about them. Parents who do know about them may have met resistance to using them from their children.
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