Tuesday, December 13, 2016

Here we go again!

Car seating for your second child (or third, or fourth 😉)

As a parent of two- I can tell you, I made a lot of mistakes with my first that I don't intend to repeat with my second. I let my eldest keep her pacifier too long, expected too much from her too soon and worried over every milestone. I also turned her car seat forward facing at 13 months. When she was three- we were rear ended waiting to turn left into our driveway. It was this event that caused me to read more about child passenger safety and I was horrified to learn how much I had done wrong. I became a car seat safety advocate and began to follow best practice as much as possible.

As a species, human beings struggle with change. We assume that because nothing bad has happened what we are doing is correct. We aren't good at recognizing the flaws in our logic. It generally takes a big event to spur us to change. However, when we know better, we DO better. No parent wants their child to be hurt. It is my hope that if you are reading this today, this can be your wake up call. Even if you've done everything wrong until now, it's not too late to do better with your next child.

First, let's review the current best practice recommendations for transporting children:
  • All children under two years old should ride rear facing. Age 2 is the minimum age to turn forward.
  • Children should continue to ride rear facing as long as possible, until they reach the weight or height maximum of the rear facing mode of a convertible car seat (usually around 40lb/ 40", an average 4 year old)
  • Once they have outgrown a rear facing convertible seat, they should be seated in a forward facing seat with a harness (convertible or combination) until they have the maturity to sit still in a belt positioning booster 100% of the time. This age varies, some children are ready when they are 5 but most are not ready until 6, 7 or even later.
  • Children should remain in a booster seat until they are at least 57" (4'9") tall and can pass the "5 Step Test"
  • The "5 Step Test" to ride in just the seat belt:
    • Back flat against seat
    • Knees bent at the edge or beyond the edge of the vehicle seat
    • Lap belt low on the hips, touching the top of the thighs
    • Shoulder belt crosses midway between the neck and the shoulder
    • Child is mature enough to stay in this position the entire trip
  • Children under 13 should always ride in the back seat
If this isn't how your first child rode/rides- there's no time like the present to fix it!

Now, let's focus on some things that may affect you as a seasoned parent.

Car seats expire! If you have a gap of 4 or more years between your children, you will very likely need a new infant seat. Car seats have expiration dates that vary by manufacturer and seat- anywhere from 4-12 years. Generally, rear facing only seats (infant carriers with a handle) will have an expiration between 5-7 years. This information is in the manual and on manufacturers websites if you have misplaced your manual. The reasons for car seat expiration dates is the degradation of the materials (plastics, webbing, etc) and the improvements in technology over time.

If you don't have a large gap between your children and you want to reuse your infant seat from your first child there are a few things to check after getting it out of storage.
  1. Check for mold or mildew that may have grown on the straps or cover. Bleach is never acceptable to use on car seats and it's impossible to get rid of mold without it.
  2. Look for any insect or rodent damage to the straps or shell.
  3. Check the expiration date
  4. Mentally review the history of the seat. Have you ever washed the cover or straps? Car seats have explicit cleaning instructions that you may not have followed the first time. Have you ever been in any kind of accident with it? Car seats are generally a one time use item, like a bike helmet.
If any of these apply, you may want to consider getting a new seat. Alternatively, if only the cover or harness is damaged, sometimes replacements are available through the manufacturers website. All of these rules apply for reusing a convertible seat from an older child as well.
You may not have been aware of the "No Fluff" rules with your first child. Car seats should not have any aftermarket accessories added to them. This applies to strap covers, infant positioners, BundleMe sleeping bag style covers, and puffy coats. If it didn't come with the seat, don't use it in the seat. Take a look at my Winter Is Coming article for more information on how to keep your kids warm and safe in the colder months.
Don't put an infant carrier on top of a shopping cart. This used to be allowed by many manufacturers but it has been found to make carts top heavy and prone to tipping. Seats also may not securely attach to a shopping cart and fall out, injuring your baby in the fall. It's a better idea to place the car seat in the main basket of the cart or baby wear.
Don't use your car seat as a "baby holder" or a place for naps. If the car seat is not installed, it will not be at a 45 degree angle. Babies have died from positional asphyxia after being left in a too upright car seat for too long. When you are transporting your baby, always make sure that the harness is done and the straps are tight, even outside the car, on the stroller, etc. It prevents falls and strangulation from entrapment.
Congratulations on your growing family! Second (or third, or fourth) kids can be a fresh start to improve our parenting skills from the first. Don't make the same mistakes!

Tuesday, June 7, 2016

The Mifold- a unique booster seat

The Mifold booster seat is an innovative newcomer to the scene. Measuring just 9.5 inches when closed and 15 inches at is fully extended belt guides, the Mifold is tiny! The Mifold doesn't "boost" kids to fit the adult sized seat belt like a normal booster. Instead, it holds the belt down across the strongest bones, the hips and the collar bone, using reinforced belt guides and a required shoulder belt adjuster. The Mifold is marketed as "the grab and go booster seat" and the perfect solution to travel needs and three across situations.

The Mifold says that it is appropriate for children ages 4+, however, 4 year olds are not ready for the responsibility of riding in a booster seat and would be better harnessed. Children are ready for a booster when they are mature enough to sit still 100% of the time. A seat belt can only protect kids if it is in the correct position in a crash. 

Mifold Stats:
  • Ages: 4 and up (maturity is the most important factor for boostering!)
  • Weight: 40-100 lbs
  • Height: 40-57 inches
  • Expiration: 7 years from manufacture 
  • Replace after any crash
I preordered my Mifold using a CPST discount and received it at the end of May. Mifold is now available on Amazon! Click here to order yours! You can also see an interactive presentation on how to use Mifold and order directly from Mifold here,

So, does the Mifold live up to it's claims?

Folded for travel
Fully expanded size

"Installed" on a seat
Well for starters, the Mifold is tiny! It would easily pack in any backpack for carpool situations or a carry on bag for travel. It's easy to fold up and my daughter loves the color. The size of the Mifold could also potentially help older kids who don't 5-Step to be OK with using a booster seat because it's small and inconspicuous. 

When using the Mifold, you are to set the belt guides as close to the thighs as possible without touching the thighs. Then, the child sits on the seat, you thread the lap belt through both belt guides and attach the shoulder belt adjuster to the shoulder belt behind the child. The shoulder belt guide is always required for the Mifold. The belt guides have a little tab at the front to keep the belt in the guides and the shoulder belt clamps on.

How about belt fit? A properly fitted booster seat should position the belt as low on the hips as possible, contacting the tops of the thighs. The shoulder belt should cross the collarbone at the midpoint. I tested my 7 year old in 5 different vehicles in multiple seating positions and got great lap and shoulder belt fits in all of them. In two of the vehicles center positions, I had issues with the ceiling mounted seat belts not being able to fit in the belt guides correctly but I was really pleased with the results overall. Makayla is 7, 48 inches tall, 52 lbs and wears a size 7 clothing. 

2016 Honda CR-V
Outboard fit, no issues
Center fit in a three across set up
The belt fit in the center of the CR-V was good, however it was pretty tough to get everything threaded correctly with the other two seats there. She did fit in a three across in this car, but it was snug!

2009 Volkswagen Jetta

Outboard fit, fantastic!
Center fit
The center position in the Jetta is tiny. I'm using a Graco 4Ever rear facing and a Britax Parkway in this setup. The 4 Ever is not a narrow seat and it's possible with a slimmer seat she might be able to fit here but as pictured, she does not. She doesn't have enough shoulder room to sit comfortably. Also, in the center, the belt tended to bunch in the guides because it was just such a narrow position. 

2012 Honda Pilot

3rd Row fit
2nd Row fit
In the third row of the Pilot, I first ran into the issue with the ceiling mounted seat belt hardware. To use, the belt connects to a stubby female piece opposite the main buckle. The webbing was sewn on to the buckle at this point and it made it too thick and long to fit into the belt guide properly. This made it impossible to get the lap belt tight enough. So, while it appears to be a good fit, the 3rd row center is not a compatible seating position for the Mifold. Although the second row also has a ceiling mounted belt, it doesn't have the same issue. the belt geometry was just different enough to fit appropriately without slack. 

Mazda 6

The Mazda 6 had the same issue as the Pilot third row in the center position. The extra bulk at the side opposite the main buckle did not allow the lap belt to get tight enough. Once again, the outboard position was perfect.

2008 Ford Focus

Both positions of the Focus had a great belt fit! One big drawback for this car is that it lacks head restraints. The great thing about the Mifold is that it's not boosting the child up so their ears remain below the seat back (and their necks adequately protected from whiplash!) for far longer than they would in a standard booster. 

Overall Impressions

I am very pleased with the Mifold. I tested 12 seating positions. Two seating positions were incompatible with the Mifold. One seating position was too small with the other car seats in the vehicle. In my opinion, the Mifold is a great option for families with older children who are already accustomed to riding in boosters who would like a compact, travel friendly option. It's a great choice for a kid who carpools often. It's also great for older kids who don't want the look of a "baby seat" but are not tall enough to ride safely without a booster

Potential Drawbacks:
  • It's not going to work for every kid in every position
  • The belt guides are only 15 inches across at the widest and they can't be touching the child. If you have a child who is wider, it's not going to be a good choice for you.
  • Threading the belt through the belt guides is not as simple as buckling a standard booster. With training, I feel that my daughter got the hang of it pretty quickly, but you should still check your child after they buckle to ensure everything is correct.
If you are interested in ordering a Mifold for your child but you would like to see if it will work in your car with your child before ordering and you are in the Northeast Ohio area, please contact me at carseatsbykate@gmail.com to set up a seat check and we can give my Mifold a try in your vehicle! 

Wednesday, February 17, 2016

School Bus Safety

Buses are the safest way for children to get to and from school. By far. School buses are larger, slower and more visible than passenger vehicles. They are statistically less likely to be involved in a fatal crash than any other form of transport to and from school. On average, just 6 children die in accidents on school buses each year. In contrast, 450 children die each year being transported to and from school in personal vehicles. Does that mean we shouldn't try to improve bus safety? Of course not.

School buses do not have seat belts to restrain passengers. Instead they rely on something called compartmentalization. Basically, this means that the high padded backs of the bus seats act like an egg carton to keep kids in their seats. In a front end collision, passengers are thrown forward into the seat back in front of them and rebound back into their original positions. Compartmentalization does keep passengers in their seats, more or less, but it does have several important limitations.

1) Children must be at least 50 lbs to benefit from compartmentalization. Head Start students and preschool aged children are not large enough to rebound back into their seats and end up slipping between the seats, winding up underneath them. This increases injuries.

2) Compartmentalization only works if children are in a forward facing seated position. From my own days on the bus, this was the exception, not the rule. Children lean over seat backs to talk to their friends, lay down sideways in the seats and stand up and move about until the bus driver yells at them to sit back down. All of these actions increase injuries.

3)  Compartmentalization does not work on small buses (less than 10,000 lbs). NHTSA requires that small buses be equipped with seat belts. Before October 2011, they required only lap belts. Since that date, they require full lap/ shoulder belts in all seating positions. Lap only belts allow too much forward motion and cause an additional injury called Seat Belt Syndrome. Lap/ shoulder belts reduce this. Buses under 10,000 lbs are subject to all relevant child passenger safety laws. In Ohio, that means that children under 4 must ride in a harnessed car seat and children under 8 must ride in an appropriate booster seat. If the small bus has lap only belts, it is not able to be used with booster seats.

4) Compartmentalization is not suitable for children who are medically fragile. Compartmentalization is a rather violent form of retaining passengers in their seats. Children are slammed into the seat back in front of them. This can cause many non-life threatening injuries such as broken noses, chipped teeth, bruising, etc. Children who are medically fragile are far more likely to be injured using this system.

This is what compartmentalization looks like:

5) Compartmentalization does not work in a roll over crash. In a roll over, children riding unrestrained on buses will not remain in position. This has a high rate of injury.

Compartmentalization was introduced on buses as a means to keep passengers in their seats in 1977. This is 40 year old technology. The way we use buses today has changed a lot in 40 years. Children are bused younger, further, faster and with a lot more cargo (backpacks, musical instruments, etc) than they were in the 1970's. Buses are frequently used to travel to sporting events and field trips across the state, requiring highway speeds and much greater risks. Children wearing heavy backpacks in their seats cause them to be pushed into the seat back in front of them with a much greater force than one without and can increase neck and spine injuries. Young children are being bused to preschool and Head Start programs and they are not protected by compartmentalization. These are all good reasons to improve our school bus restraint systems.

On November 8, 2015, NHTSA administrator Mark Rosekind, Ph.D said:
"NHTSA has not always spoken with a clear voice on the issue of seat belts on school buses. So let me clear up any ambiguity now: The position of the National Highway Traffic Safety Administration is that seat belts save lives. That is true whether in a passenger car or in a big yellow bus. And saving lives is what we are about. So NHTSA’s policy is that every child on every school bus should have a three-point seat belt. NHTSA will seek to use all the tools at our disposal to help achieve that goal, and today I want to launch a nationwide effort to get us there."

This is great news! Unfortunately we are a long way off from every child having a three-point belt on their school bus. So what should you, as a parent, do to make sure your child is traveling as safely as possible on the school bus in the meantime?

1) If you have a preschool age child, your child should be transported in a bus with either built in harnesses or in a child restraint system designed to be used on the bus.
Integrated harnessed seats

STAR seat system installed with CAM wraps

Alternatively, if the bus used by the preschool is a small bus (less than 10,000 lbs) it will be equipped with seat belts that you can install a regular harnessed car seat with. Do not allow children to ride in a bus equipped with only lap belts unless they are being used to install harnessed car seats. Booster seats are not allowed to be used. Small buses and large (12-15 passenger) vans are subject to all regular child passenger safety laws.

2) Teach your child about the importance of sitting in a forward facing position and staying seated on the bus.

3) Teach your child to remove their backpack and place it on the floor when they sit down.

4) Don't forget that school bus safety is about more than just what happens inside the bus. Make sure your kids know how to enter and exit the bus safely. More kids die as a result of being struck as a pedestrian outside the bus than in accidents while in the bus. Children should learn these basic safety rules:

  • Stay at least 10 feet away from a bus until it's time to get on. Then wait your turn and get on one at a time.
  • Before stepping off the bus, look to be sure a car isn't coming.
  • Don't linger or play near the bus after you leave it.
  • Take 5 giant steps out in front of the bus before you cross the street. Be sure the driver sees you and signals that it's OK to cross in front of the bus.
  • Make sure all cars on the road are stopped before crossing the street. 
Sending your child off on the bus for the first time can be scary. Please remember that even though school buses do not have seat belts, they are safer than you driving your child to school everyday. Educate your kids on how to stay safe on and off the bus. Together, we can make buses even safer!

Wednesday, January 20, 2016

Head Restraints for Everyone!

You probably don't think about the block of foam behind your head when you get in your car unless it hits you in an uncomfortable position. That block of foam is so much more than a place to rest your head for comfort. What exactly is a head restraint? A head restraint is more commonly referred to as a "head rest" and they are a critical piece of safety equipment in your car and everyone in the car needs to have one. When it comes to children and vehicle head restraints things get complicated. I hope I can help you sort it all out and keep everyone as safe as possible in your car. 

Head restraints are designed to protect the occupant from whiplash. Whiplash occurs most frequently when you are in a rear end collision and your neck is overextended backwards until the car rebounds and your head is whipped forward. It results in muscle strains and pain. Whiplash suffers take an average of 4 days off of work and some suffer chronic pain for years following the injury. 

Motions of whiplash
A study by the National Highway Traffic Safety Administration (NHTSA) in 1982 estimated that integral head restraints reduced the risk of injury by 17% and adjustable head restraints reduced the risk of injury by 10%. They theorized that this difference was due to the fact that 75% of adjustable head restraints were left in the down position and were not high enough to provide whiplash protection. As an adult driver or passenger, every time you get in to a new vehicle, you need to take the time to adjust your head restraint. Ideally, the head restraint will be adjusted so that the top of the head restraint is even with the top of your head. For taller than average people, the head restraint must reach to at least the tops of your ears (or the midline of your head) to provide adequate whiplash protection.

A poorly adjusted head restraint
A properly adjusted head restraint

The head restraint must also be as close as possible to the back of your head- no more than 4 inches. Some adjustable restraints allow the head restraint to be tilted forward to reduce the amount of backset but others require that you move the entire seat back in to a more upright position. You definitely want to avoid a steep recline while driving, not only because of the head restraint but also because in a reclined position your seat belt will not be in contact with your body and your body will travel a lot farther in a crash.

When NHTSA implemented updates to the Federal Motor Vehicle Safety Standard (FMVSS) 202 (effective 2008) it addressed many important issues with head restraints in the front seats. It made them taller and wider, reduced the backset and generally made them more user friendly. Unfortunately, it stopped short of requiring head restraints in all seating positions. It chose to leave the back seat head restraints optional. The reasoning for this was that the back seats are much less likely to be occupied than the front seats and so the costs of requiring vehicle manufacturers to put them in the back would be higher than the medical costs of treating injuries that occur from lack of head restraints. Obviously, this doesn’t mean you don’t need them. The FMVSS 202 does state that *if* the manufacturer chooses to install head restraints in the rear seats, they must meet all the same requirements as the front seats. Unfortunately many vehicle manufacturers choose to not install a head restraint in the center position, leaving any passenger in this position at a higher risk of injury in a crash.
When it comes to child passengers and head restraints the issues can get even more muddled. To limit the amount of backset for adult (and older child) passengers, some manufacturers make the head restraints forward-leaning. Unfortunately, this can make it difficult if not impossible to install some car seats there. The manual for your car seat will tell you if this is an issue. For example, Britax requires that the head restraint not push the moveable head wings on the car seat forward out of its natural position. 

In the lowest position, this head restraint does not
 allow the seat to fit flush against the vehicle seat.
Although this is not a issue for this particular seat,
different manufacturers have different requirements.
Always check the manual!
If the head restraint is raised, the car seat sits flush
 with the vehicle seat, the head wings are not
 pushed forward and the problem is eliminated

Other manufacturers prefer that the entire back of the car seat is flush with the vehicle seat. If you have difficulty installing a harnessed seat, consult your vehicle manual to see if the head restraint can be removed. Some vehicle manufacturers allow the head restraints to be removed (some require tools to do so), some allow you to turn the head restraint backwards and some are not removable at all. If you have a harnessed seat that cannot be installed with the head restraint in place and you cannot remove the head restraint then the car seat is incompatible with that seating position. Clearly, this can get complicated!

Booster seats bring yet another complication. Most high back booster seats do not allow a gap behind the car seat. If the head restraint leaves a gap because it is forward leaning, check the vehicle manual to see if the head restraint can be removed or turned around. 

The gap left behind this booster seat is unacceptable
Turning the head restraint around fixes the
problem and prevents the head restraint from
being misplaced

You also must check your booster seat manual to see if the booster requires head support from the vehicle. Diono and many Dorel (Safety 1st, Cosco) high back boosters require head support from the vehicle as the high backs of the boosters themselves may not be strong enough to prevent injury on their own. At this point, your options are limited to purchasing a new high back booster seat that does not require vehicle support or converting the high back booster to a no back booster and using the vehicle head restraint as intended for an adult passenger.
When you have non-adjustable or non-existent rear head restraints, you must be very aware of the height of your child relative to the vehicle seat back. The best practice in this situation is to use a high back booster that does not require vehicle support until it is outgrown. At that point it is no longer safe to transport the child in this vehicle unless they are 13 and can ride in the front seat. The Britax Parkway is a good option for this situation.
Makayla's head is well below the seat back without a
booster at 7 years old but she is no where near passing
the 5 Step Test to ride without a booster. She is at risk
for severe abdominal injuries like this.
In a backless booster, Makayla's ears are just below
the seat back. Her belt fit is great like this but any
growth will put her at increased risk of whiplash injury.
This high back booster does not require vehicle head
support. I have adjusted the back to it's highest setting
here and at ~1 inch of torso growth per year, Makayla
has about 2-3 years before she will outgrow this seat.
A final option for a position with low or no head restraints is to use a lower profile no back booster like the Safety 1st Incognito (min 60 lbs), the Bubblebum or the Mifold.

Head restraints are important for every passenger in the vehicle. They prevent the pain and suffering that comes with whiplash injuries. For adults, it’s important to adjust your head restraint for ideal protection. For children in forward facing harnessed seats, it’s important to get a good installation with adequate contact between the vehicle seat and the child restraint. For children riding in booster seats, it’s important that they have the same protection (minimum to the tops of the ears) that adults have. If the booster seat does not provide this protection, then the vehicle seat must. YOU need a head restraint! And YOU need a head restraint! I feel like Oprah. As always, feel free to contact me with any specific questions about your vehicle or car seat!