Booster Seats: Fight the Good Fight

Think Your Child is Ready for a Seat Belt? Not So Fast

I drive a carpool with five kids, ages 6 through 11. At the beginning of the school year, when one of the 6-year-olds first saw the booster seat I had ready for her, she complained.

"I'm big enough to ride without one," she said, invoking her mother's blessing and, supposedly, permission from her doctor. I didn't have time to explain that, although the law says she can ride in an adult seatbelt, it wasn't a very good idea. Nor did I think she'd want to listen. So I said the only words I could think of to defuse the conflict quickly.

"My car, my rules."

That seemed to work. She sat in the booster.

Though it's not a major war between the generations, it requires a certain amount of courage to act as though you know better than the kid, the mom and sometimes even the doctor. But I do know better. I had seen my son's pediatrician only a week earlier. He said that, although state law says that 6-year-olds are legally allowed to ride without a booster seat, the American Association of Pediatrics (AAP) strongly recommends that children age 6 and 7 stay in booster seats until they reach 4 feet 9 inches and are between 8 and 12 years of age.

That means that while many of my son's friends will be in adult belts, he'll spend a few more years in a safety seat. I could foresee the coming arguments, but then, what better to argue about than safety? Although I often allow my pint-sized Mussolini to dictate the car's radio station or the volume, this is one issue on which I would stand my ground, whining be damned.

So what's more difficult than convincing a little kid (who wants to be a big kid) to ride in a booster? Convincing adults to use boosters for kids in their cars. When I offered the other carpool parents a booster to keep in their cars for my child, they gave me a look that said "you're being overprotective." Perhaps they were even feeling defensive, as though I was implying that they didn't know how to protect children. Actually, they're like many, perhaps even most parents — just a bit uninformed. After all, how many parents are up on the latest child safety laws?

If people want to think I'm a little nuts, that's fine. The evidence is in, and it backs me up: Motor vehicle crashes remain the leading cause of death and acquired disability for children between the ages of 4 and 8 years. Young children are four times more likely to suffer devastating injuries, including severe damage to the brain, liver and spleen, if they use adult seatbelts rather than car seats or booster seats.

Children over 4 years old are injured more than younger children for several reasons. First, fewer children in this age group are buckled up. Of those who are, many of them use the adult seatbelt, but place the shoulder belt under the arm or behind the back, which is dangerous. Because their small bodies don¿t fit properly in the adult seat, they also tend to ride out of proper position for the belt to protect them, either by sliding forward to the edge of the seat or slouching downward.

The solution to this problem is, of course, increased use of booster seats. Whether you end up with a high-back or regular (backless) model, using booster seats can reduce the risk of death and injury to children through age 7 by nearly 60 percent, according to Partners for Child Passenger Safety (PCPS), a research group chartered by The Children's Hospital of Philadelphia, State Farm Insurance and the University of Pennsylvania. In particular, booster seats appear to sharply cut the risk of injuries to the abdomen and spine.

What Does It Do?

What exactly is a booster, and how does it work? For the uninitiated, a "belt positioning booster seat" simply elevates the child so that the adult lap and shoulder fit properly. For most 4- to 7-year-olds, riding without a booster will cause an adult shoulder belt to cut across the neck and the lap belt to ride too high on the abdomen. This puts the child at serious risk for internal injuries during an accident. A booster seat ensures that the lap belt rests on the upper thighs and the shoulder belt is centered on the shoulder and chest, where they belong.

It is important to make sure that a child's head is supported as well. If a child often sleeps in the car or rides in a car with a low seat back, or no head rests, a high-backed booster model is his only option. A high-back booster has a vertical panel extending up behind the child and a plastic guide for the shoulder strap. It uses both a lap and a shoulder belt.

Many newer model high-back boosters are "combination" seats, because they can convert from a five-point harness car seat to a high-back booster. For example, Graco's Treasured CarGo Hampton Booster will accommodate your child from 20 to 100 pounds, and allows different shoulder belt positions to adjust to your child's changing height — all for $60. A combination seat is a particularly good idea if you have a larger 2- or 3-year-old who is outgrowing his current car seat, because it allows him to stay in a harness until he's physically ready for a booster.

Boosters' best feature for parents is that they are so incredibly easy to use. They require none of the complications of infant car seats or forward-facing convertible seats. You can switch them between vehicles at a moment's notice. Strapping a child in is a cinch, and most kids age 5 and up will do it themselves. Although you can buy high-end models, boosters are also blessedly inexpensive. At Target.com, backless boosters start around $15; high-back models start at $25.

Easier still, Volvo has made an integrated slide-out center booster seat an optional feature on the V70, XC60, XC70, and XC90.

Carseat.org offers a fantastic guide to help you choose the exact make and model of booster seat you need with a chart that even shows the minimum and maximum weights for each model.

Here are some other booster tips:

1. Never use a booster with only a lap belt. Many center ("middle") seats don't have shoulder belts, so put the booster on the outboard (window) seat if needed.
   
   
2. If you have an older car without any shoulder belts in the backseat, install a shoulder belt retrofit kit. These kits may be ordered from vehicle dealers for most cars built after 1972.
   
   
3. Boosters with shields are not approved for children over 40 pounds. Avoid shields.
   
   
4. Belt-positioning devices, such as clips or fabric sleeves that connect the shoulder and lap portions of the belt, actually make the booster less safe, so steer clear of them.

Above and Beyond the Law

Laws concerning car seat use are different from state to state, and some are far more progressive than others. Generally, state governments worry first about passing laws to protect infants and toddlers and are slower in enacting laws to protect older kids. Take Mississippi, for example. Although children must be restrained in a car seat through age 3, children 4 and over are allowed to use adult seatbelts. What's worse, children 8 and over are allowed to ride completely unrestrained — without so much as an adult lap belt — in the rear of the car.

Mississippi also doesn't have any public education campaign and doesn't provide public funding to assist programs that help protect children while traveling.

Hello? What are these people thinking? Forgive me, but it gets my blood boiling.

This is not to say that Mississippi is alone. Far from it. But it's a glaring example of how gaps in state laws endanger our children. There is good news, though. As of November 2005, 33 states and the District of Columbia had enacted provisions requiring booster seat use by older child passengers when necessary. Other states are considering upgrades their laws. Find out about your state's laws at The National Safe Kids Campaign Web site.

Finally, the federal government is also taking some steps. Started in 2005, a federal law upgraded testing standards for booster seats and require automakers to install lap and shoulder belts in the center rear seat of new vehicles. The lap/shoulder belt provision is aimed at making it easier for parents and caregivers to correctly use booster seats in the middle rear seat, which many safety experts consider to be the safest place in a vehicle for children. The federal measure, called "Anton's Law," is named for Anton Skeen, a Washington State 4-year-old who was killed after sliding out of his safety belt in a crash in 1996.

Graduation Plans

Children should ride in car seats with a complete harness system as long as possible because it affords the most protection. How do you know when your child is finally ready to graduate from a car seat to a booster seat? He or she should be at least 4 years old and 40 pounds. This is exactly when many parents mistakenly put their children into adult seatbelts (a practice that pediatricians call "premature graduation").

If your child is very tall and thin, his shoulders may rise above the top slot of his car seat before he reaches the seat's maximum weight limit. In this case, buy a combination car seat/ booster model. The harness on these units may be used up to 40-50 pounds, depending on the model, so check the maximum weight before you buy.

How do you know when your child is ready to go from a booster seat to the adult seatbelt? Try answering the following questions:

• Does the child sit all the way back against the vehicle's seat?
  
  
• Do the child's knees bend comfortably at the edge of the car's seat bottom cushion?
  
  
• Does the belt cross the shoulder between the neck and arm?
  
  
• Is the lap belt as low as possible, touching the thighs?
  
  
• Can your child stay seated like this for the whole trip?

If you answered "no" to any of these questions, then your child isn't ready to leave his booster, yet. Since the child's height, the shape of the vehicle seat and where the belts are attached to the vehicle will vary, it's possible for Junior to be ready for an adult seatbelt in Mom's car, but not Dad's (or vice versa).

Winning the Battle

Children naturally try to do things before they're ready, including abandoning their car seats. Depending on their age, the state may legally allow them that freedom. But it's a parent's responsibility to hold the line anyway, even if that means humbling your child a bit.

"You, as a parent, have to be an advocate for your child," says Los Angeles pediatrician Ronald Nagel, M.D. "Everyone — even adults — would be safer in car seats, but we [adults] can't drive like that." Nagel says that the AAP recommendations are just guidelines; only the child's parent can determine the right time to move a child up to the next level of restraint, depending on the child's height, weight, age, maturity and the fit of the child to the vehicle seat.

What do you do if your child says, "But I'm a big kid now"? First, try to sell him. Tell your child that boosters are for "big kids," and don't call a booster a child's seat. Show him that a booster makes the seatbelt more comfortable and gives him a higher vantage point, making it easier to see out the window. To make it even more fun, show him one of the new boosters that come with retractable cupholders, armrests, mesh pockets and two reclining positions. Some, like Graco's Turbo Booster, even feature licensed characters and fun colors that make the boosters more colorful and appealing to kids. Let him help choose his booster, and then teach him how to buckle himself in.

Finally, if you've tried all of that and it still doesn't work, there's the old standby:

"This car will not move until everybody is buckled up correctly."

Case closed.