Answers to "Mistake Monday" 4/5/10

ANSWERS: (please see bottom of page for teaching points on LATCH)

MISUSE

• The lower anchor belt & vehicle shoulder/lap belt are BOTH used
• The lower anchor belt is used in the center seat - in a vehicle which only has the lower anchors for the two side seating positions in the back seat
• The vehicle's shoulder/lap belt is routed UNDER (instead of over) the metal LATCH bar. 

 Image: Forward-facing Britax Boulevard with vehicle's shoulder/lap belt & top tether

Note: 

• When using a lap belt (no shoulder belt), the lap belt gets routed UNDER the LATCH bar on the Britax Marathon/Boulevard/Advocate.
• The shoulder belt WAS properly routed through the built in locking clip - but it was not shown in this picture since the appropriate locking clip is on the opposite side of the seat.  For forward-facing, use ONLY the built in locking clip that is on the side opposite to where the vehicle's seat belt buckles in.  
• There is no need for a metal locking clip with this installation because 1. the Britax Boulevard has a built in locking clip for forward-facing which must be used with a shoulder belt installation and 2. this vehicle is post-1996 and therefore has a way to keep the shoulder belt locked for the car seat (in this case a switchable retractor)

TEACHING TIPS -  LATCH 101

WHAT IS LATCH?

• LATCH stands for Lower Anchors and Tethers for CHildren. It's also known as ISOFIX in Europe and LUAS (Lower Universal Anchorage System) in Canada.
• LATCH is a way to secure a child safety seat to the vehicle using straps from the child safety seat that connect to special metal anchors in the vehicle.

DOES MY CAR HAVE LATCH?

Vehicles since model year 2003 must have lower anchors in at least TWO positions and tether anchors in at least THREE positions. This means that in most vehicles, the side seats have lower anchors AND tether anchors, while the center seat has a tether anchor but NO lower anchors.  See below for info on the few vehicles that do have lower anchors for the center seat.

SOME DEFINITIONS

• VEHICLE LATCH ANCHORS
•  LOWER ANCHORS: Lower anchors are a pair of metal “u-shaped” bars hidden in the vehicle’s seat cushion (where the part you sit on meets the part that your back rests on).
• TETHER ANCHOR: A tether anchor is a metal ring found behind (or sometimes under) the vehicle seat.

This picture shows a typical back seat with the 2 pairs of lower anchors - one for each of the side seats.  The standard spacing between the lower anchors is 11 inches.  Note how the spacing between the inner most anchors is wider than 11 inches.  

***The middle in this picture - and in most vehicles - is NOT a position that has the lower anchors.

This diagram shows how variable the location for the top tether can be - always check the vehicle owners manual for details. 

•  CHILD SAFETY SEAT LATCH STRAPS
• LOWER ANCHOR STRAP: All child safety seats that use the vehicle’s lower anchors have a lower anchor strap with a hook on either end. Some child safety seats have two separate lower anchor straps, each with a hook on one end. These hooks connect to the vehicle’s lower anchors.
• TETHER STRAP: All forward-facing child safety seats that use LATCH come with not only a lower anchor strap, but also a tether strap. The tether strap comes from the top of the car seat and has a hook on the end that lets it connect to the tether anchor in the vehicle. 

An Analogy - Lower Anchor Strap:Vehicle Seat Belt as Contacts:Glasses

Lower anchors are used INSTEAD of the vehicle's safety belt to secure the child safety seat to the vehicle.  Just like you wouldn't wear contacts and glasses on the same day - as you would see worse rather than better - so too you don't want to use the lower anchors AND the vehicle's seat belt to secure the car seat.  Choose one or the other, as appropriate for the seating position where you are installing the car seat.

Note: in the future there may be a child safety seat that allows for both the lower anchors and vehicle's seat belt to be used at the same time, but currently none allow for this or recommend it.

It's ALWAYS BETTER WITH A TETHER (Forward-facing that is)

Tethers are used IN ADDITION to the lower anchors OR the vehicle's safety belt to secure a forward-facing child safety seat to the vehicle.  Tethers keep a child's brain and spinal cord much safer by decreasing how far the head moves forward - typically by 4-8 inches - which can mean the difference between the child's head hitting something hard or not.

This picture shows a real crash test (using dummies) - where one seat was installed with a top tether and one without.  Notice how the dummy's head moves 6 inches farther forward when the top tether isn't used!

Which vehicles have lower anchors for the CENTER seat?
Stay tuned - I'm off to the NY Auto Show today and will update this portion soon. 

Most common LATCH mistakes:

1. Child safety seat is installed too loosely
2. Tether not used on a forward-facing car seat
3. "Borrowing" the inner most lower anchors from the two side seats to secure a car seat in the center (as was shown in this week's mistake monday picture)
4. The lower anchor strap is not routed through the correct path on the car seat - for example, the strap may be routed through the rear-facing belt path when the seat is forward-facing.

Answers to "Mistake Monday" 3/8/10

ANSWERS: 
(please see bottom of page for teaching points & printable tip sheets for parents)

MISUSE
- Girl in front: Shoulder belt under her arm
- Girl in back: Lap belt high on her belly (note: the shoulder belt rubbing her neck is not likely to cause injury in a crash)

INJURY PATTERNS ASSOCIATED WITH THE MISUSE

HEAD AND NECK INJURIES
The head is the most important part of the body to protect.  In a crash, the head can potentially hit hard structures in the vehicle - like the seatback of the front seat, the window, the door frame, etc - all of which can cause significant injuries to the brain and upper spinal cord.  The best way to protect the head is to try and prevent it from hitting anything during the crash.  

Placing the shoulder belt under the arm leads to an increased risk of head and neck injuries as the head travels farther forward than it would with the shoulder belt properly positioned across the collar bone.  

These three pictures, taken from a 30mph crash test, show how far forward the head of this 6 year old crash test dummy moves.  The green line marks the farthest the head moved forward when the dummy was properly restrained in a high back booster.  The yellow line marks the farthest the head moved forward when the dummy placed the shoulder belt under its arm (and was not in a booster).  The red line marks the farthest the head moved forward when the dummy placed the shoulder belt behind its back (and was not in a booster).  Notice how the dummy's head strikes the seatback in the third photo - and in a smaller vehicle (or a large vehicle where the driver moves his seat back all the way) the dummy with the shoulder belt under the arm would also hit its head on the seatback.

 Photo: 6 y/o dummy properly restrained in high back booster - Copyright UVA 

 Photo: 6y/o dummy with shoulder belt under its arm -  Copyright UVA

Photo: 6y/o dummy with shoulder belt behind its back - head strikes the seatback - Copyright UVA

SEAT BELT SYNDROME
The lap belt is designed to rest on the strong hip bones.  The soft belly is not strong enough to withstand the forces of a crash.  Should the lap belt slide up over the hip bones and into the soft belly, the lap belt can cut through the belly all the way to the spinal cord causing injuries to the spinal cord and the soft organs in the belly.  This pattern of injuries is known as "seat belt syndrome" and is seen most often in 4-10 year olds who are not riding in booster seats - although it can be seen in anyone when the lap belt rests on the belly.

TEACHING POINTS
A shoulder belt that rubs the neck will not injure a child in a crash - but since it is uncomfortable for the child, kids often place the belt under the arm or behind the back.  Never allow a child to place the shoulder belt behind the back or under the arm - this only increases the child's risk of severe head and abdominal injury.

A lap belt that rides up into the belly can cause significant injuries to the soft organs in the belly (liver, spleen, bladder, intestines, kidneys) in addition to breaking the lower spinal cord causing paralysis.  Placing the shoulder belt behind the back or under the arm increases the risk for these belly and spinal cord injuries as without the shoulder belt to properly hold the upper body back, the body naturally folds at the waist (close to the belly button) which allows the lap belt to ride up over the strong hip bones and onto the waist, thus causing injury.

Does your child's booster make the belts fit well?

• The lap belt should rest low and flat on the tops of the child's thighs (nowhere near the belly button).  
• The shoulder belt should rest between the neck and the shoulder.

RESOURCES FOR PARENTS 
Are you a pediatrician or CPS Tech who wants to give a parents some more information on booster seats?  Here are several fantastic tip sheets that are free to reproduce.  Links will open as a PDF document.

• “Boosters Are For Big Kids” - This covers the 5-Step Test with pictures showing belt fit with and without booster.  Also available in Spanish.  
• Booster Seats and Other Products for Children Over 40 Pounds - Guidelines for size, fit, and usage; list of belt-positioning boosters with weight ranges and features.  Also available in Spanish.
• For Your Family: Belt Positioning Booster Seats.  Also available in Spanish. 
• Fotonovella (in Spanish) - designed as an educational tool to promote booster seats among Latino communities.

Monday's Mistake - can you spot the mistake/s in the picture?

To continue on our booster theme from last week, I thought I'd show two more common mistakes seen with booster seats.  Many parents think that because boosters are so easy to use (no installation required) that there couldn't possibly be a way to use them wrong.  Unfortunately, many booster seats are used improperly (like the ones below).

This picture shows two girls riding in high-back belt-positioning boosters.
The mistake on the girl in the front is much more obvious than the one for the girl in the back.
Can you identify both mistakes?
For bonus points, what type of injury pattern might you see in the girl in the front - how about for the girl in the back?
Post your answers below - and I will post the correct answer on Tuesday.

(Note: The child in the front is not riding in the front seat - this is a vehicle with 3 rows of seats)

Please note: These photos were not staged.  These photos were taken by real parents just like you who didn't know that they were using the boosters improperly.  9 out of 10 car seats are used incorrectly - don't let your child ride at risk.   If you are in the NYC or Baltimore areas, email us at info@thecarseatlady.com to schedule a private car seat installation lesson - otherwise, visit www.seatcheck.org to find someone in your area to teach you how to install your seats properly.

Monday's Mistake - can you spot the mistake/s in the picture?

These pictures show two kids riding in their Graco Turbo Booster.
Can you identify the TWO mistakes in the girl's picture and the TWO mistakes in the boy's picture?
Post your answers below - can you spot all three mistakes?

I will post the answers on Tuesday.

Please note: These photos were not staged.  These photos were originally posted by real parents just like you who didn't know that they were using the booster improperly.  9 out of 10 car seats are used incorrectly - don't let your child ride at risk.   If you are in the NYC or Baltimore areas, email us at info@thecarseatlady.com to schedule a private car seat installation lesson - otherwise, visit www.seatcheck.org to find someone in your area to teach you how to install your seats properly.