Tuesday, July 27, 2010

They said it was impossible... - fitting 3 car seats across the back seat - some tips, tricks & "go to" seats

Safety 1st Go, Chicco Key Fit 30, Britax Boulevard
3 car seats in 2008 Range Rover Sport

Fitting 3 car seats across the back seat is a challenge.  Truth be told, it is not possible in many vehicles.  In other vehicles, it requires just the right combination of seats - not only a specific car seat, but putting it in the best position in the vehicle to allow the other seats to "puzzle" next to it.

You might be thinking - this is a Range Rover Sport, of course you could get 3 car seats in a huge truck like this.  But there you would be wrong - as just having a large vehicle in no way guarantees that you will be able to fit 3 car seats, just as having a small vehicle in no way guarantees that you won't be able to fit 3 car seats.  Case in point - the Range Rover HSE, which has similar exterior dimensions to the Range Rover Sport, will not accommodate 3 car seats due to the awkward layout of its back seat and the narrow dimensions of the center seat.

Having installed thousands of car seats, The Car Seat Ladies have some "go to" seats when it comes to fitting lots of seats into not a lot of space.  In the vehicle shown in the pictures (the 2008 Range Rover Sport) I installed the Safety 1st Go behind the driver (using LATCH), the Chicco Key Fit 30 in the center (using the vehicle's shoulder/lap belt), and the Britax Boulevard behind the passenger (using LATCH).  Had there been two forward-facing kids and one rear-facing, I likely would have tried the Safety 1st Go behind the driver, the Britax Boulevard forward-facing in the center, and the Chicco Key Fit 30 behind the passenger - as putting the Boulevard and the Go next to each other would allow the Go to tuck itself underneath the Boulevard and use up a little bit less space in the back seat with this overlap (each seat would be installed and the belt marked to make sure that the car seat was installed tightly INDEPENDENT of the other seat - i.e. and not relying on its neighbor to feel snug).

"Go To" Seats
  • Infant
    • Chicco Key Fit
      • with a starting weight of 4 pounds it is guaranteed to fit almost any infant
      • very narrow where the handle attaches (the widest part of most infant seats) - which allows it to fit nicely next to other car seats
      • built in locking clips - very important for an easier seat belt installation
      • 30lb weight limit so you get more use out of it than the 22lb infant seats
  • Convertible (Rear to Forward Facing)
    • Britax Marathon / Boulevard / Decathlon
      • extra tall seated height to accommodate older kids rear-facing
      • narrow where it needs to be and wide where it needs to be - making it fit in spaces where seemingly smaller seats won't
      • built in locking clips - very important for an easier seat belt installation
      • high weight limit forward-facing
    • Combi Coccoro
      • at 15 inches it is the narrowest convertible car seat
      • built in locking clips - very important for an easier seat belt installation
      •  note: it is shorter in seated height than the Britax/Sunshine Kids so will last less time rear-facing & forward-facing
    • Sunshine Kids Radian
      • high weight limit rear-facing & forward-facing
      • narrow profile
      • Note - this is typically a difficult seat to install securely using the vehicle's shoulder/lap belt as it does not have built in locking clips for either rear-facing or forward-facing.  As such, it is often not our first choice.  Installing this seat rear-facing with a shoulder belt is typically a very challenging installation as since the seat has no built in locking clips (and using the switchable retractor - the locking mechanism built into most shoulder belts - will tilt the car seat on its side) - you must use a metal locking clip to keep the seat belt tight.  A metal locking clip is a 2 person, multi-step process that is hard to do properly (and easy to do wrong).  Another issue with this seat is that in many vehicles it sits quite reclined when rear-facing which may mean that the adult in front of the car seat does not have adequate space to drive/sit comfortably. 
  • Combination Seat (5 point harness car seat to booster)
    • Safety 1st Go Hybrid
      • Narrow (17 inches) with an exceptionally narrow profile at the top due to its lack of sides (except at the child's head) - which allows it to fit very nicely next to other seats, including puzzling underneath seats with an overhang like the Britax Marathon/Boulevard/Decathlon
      • Great seat for older kids as:
        • it doesn't look as much like a "baby seat"
        • provides a 5 point harness for longer
        • allows older kids some independence as with another car seat next to them they often have difficulty buckling themselves into a booster - but with this seat they can use the 5 point harness and many kids by the age of 5 can buckle themselves in
      • Note: When installed with the vehicle's seat belt the top shoulder strap height is just 14.5 inches - but when installed with the vehicle's lower anchors (LATCH system) the shoulder strap height is 17.5 inches.  Therefore this seat must be installed with the lower anchors for most kids over the age of 3-4 as they need the additional shoulder strap height.  Since most vehicles only have the lower anchors for the side seats, this seat will usually have to go on the side.
  • Belt Positioning Booster
    • Nania High Ride
      • Narrowest backless booster - 14.5 inches wide (1 inch narrower than the next narrowest booster)
      • Note: this booster is only available in packs of 6 (with shipping it is about $15/booster) - but since it is great for fitting 3 kids across the 3rd row of a Honda Odyssey I'm sure you can find a few neighbors who will buy a few from your 6-pack
    • Ride Safer Travel Vest
      • A vest that functions like a booster - but since there is no "seat" you only need to have enough room for the child's bottom to fit instead of the extra 6-8 inches that most boosters take up

Monday, July 19, 2010

FREAKONOMICS Fallacy: An Economist or a Pediatrician - Who Would You Trust To Keep Your Child Safe?

Economists vs Pediatricians
Who is really looking out for your child's safety?

Unfortunately, many parents have mistakenly put their trust in the economists Steven Levitt & Stephen Dubner, co-authors of the popular book Freakonomics, rather than following the advice of pediatricians and the medical community when it comes to protecting their children in the car.  In 2005 the Freakonomics authors wrote an article in the NYTimes Magazine entitled "The Seat-Belt Solutionwhich came to the sensational conclusion that "there is no evidence that car seats do a better job than seat belts in saving the lives of children older than 2." But fatalities are just the tip of the iceberg; for every death there are 19 injuries requiring hospitalization (some leading to permanent disability) and 300 requiring medical attention.

While Dubner & Levitt have "softened" their stance over the past 5 years to say that "car seats are a little better..." than seat belts and advised parents "don't throw out the car seats" The Car Seat Ladies feel like the damage has been done - and we want to try and undo it by providing you with the whole story. More people heard and remember the sensational message than Freakonomics' weak efforts to bring their message more in line with what we know to be best practice. Therefore, we at The Car Seat Lady want to provide you with the evidence so that you can come to your own conclusions and make the best decisions regarding your child's safety. As an interesting side note, both Dubner & Levitt admit to using car seats and boosters for their own children beyond the age of 2; they are willing to endanger the lives of other people's children to sell their books, but aren't willing to make their own children be the guinea pigs for their own misguided hypothesis.

Dr Dennis Durbin & Dr Flaura Winston are pediatricians at the Children's Hospital of Philadelphia and co-principal investigators for the Partners for Child Passenger Safety study, which is the largest study ever done of children in crashes. Data from this ongoing study has led to the publication of dozens of papers in some of the most highly regarded peer-reviewed medical journals including JAMA, Pediatrics, Archives of Pediatrics, Journal of Trauma, and Injury Prevention. 

Drs Durbin & Winston wrote a letter to the editor in response to the 2005 NYTimes article.   
  • "As pediatricians, scientists and leaders of the world's largest study on children in crashes, we think that overinterpretation of findings from a single source of data led Stephen J. Dubner and Steven D. Levitt (July 10) to claim that child safety seats are no more effective than seat belts for 2- to 6-year-olds. They examined children in fatal crashes (about 1,200 per year) while ignoring the equally informative data on those in nonfatal crashes (450,000 per year). Our research, which includes over 25,000 in-depth interviews and over 800 crash investigations, consistently shows that child safety seats and booster seats significantly lower the risk of serious injury compared to seat belts alone. Their conclusions stand in stark contrast to the existing body of scientific data that support current child restraint recommendations, and are, in our opinion, irresponsible and dangerous.  Learn the facts at www.chop.edu/carseat. We hope that this misleading article does not cost a child his life."
Drs Durbin & Winston followed up this letter with an study published in the June 2006 issue of the Archives of Pediatrics & Adolescent Medicine. This study was designed in direct response to Freakonomics' conclusion that seat belts are equally effective as car seats/boosters at preventing death for kids 2-6 years of age.  Drs Durbin & Winston's study found that children who were using child restraints were 28 percent less likely to be killed in a crash than children who were wearing seat belts alone - or as Dr. Durbin explained "for every 100 children who were killed in a crash wearing only a seatbelt, 28 of them would have survived if they'd been in a car seat or booster seat."  

In August 2008 Dubner & Levitt published their study concluding that seat belts are equally effective as child restraints for kids 2-6 in the journal Economic Inquiry.  A quick survey of the archives of this journal uncovers such scientifically rigorous and groundbreaking studies as "Secret Santa Reveals the Secret Side of Giving" and "The Influence of Social Forces: Evidence from the Behavior of Football Referees".

The data refuting the Freakonomics conclusion keeps coming in.  A 2009 article from the Partners for Child Passenger Safety study published in Pediatrics showed that 4-8 year olds using boosters seats were 55% less likely to be injured in a crash than 4-8 year olds wearing seat belts alone - or said another way, for every 100 children injured in a crash wearing only a seat belt, 55 of them would have been injury-free if they'd been in a booster seat. 

The Car Seat Lady feels that car seats (with a 5 point harness) are the best protection for kids until they are at least 4 years old AND at least 40 pounds (but with many seats offering the option of using the 5-point harness beyond 40 pounds we are in full support of this) - and boosters are the best protection for school age children until the vehicle's seat belt fits them properly without the booster (i.e. when they can pass the 5-step test). 

Saturday, July 17, 2010

1 Minute Tip: Learn WHY babies & toddlers ride rear-facing from this fantastic video.

Babies ride rear-facing. Everyone knows that. But do you know why (and not just because safety experts say so). This 1 minute video explains "why" more eloquently than any I've seen before. If everyone forwards this video to one parent of a toddler - think how many kids could get to ride 5 times safer!

Friday, July 16, 2010

Evidence-Based Medicine from this month's PEDIATRICS: Nearly 10,000 babies a year are injured in their car seats NOT DURING A CRASH

What the study found:
Parents use infant car seats as more than just car seats.  Babies are often carried in these seats, ride in them on stroller frames, and nap in them while in the house and on the go.  
Nearly 10,000 infants in the US are injured each year in their infant car seats NOT in crashes, but rather while using the seats outside of the car.  10% of the injuries are severe enough that the baby has to spend at least 1 night in the hospital.  

Of the injuries, 85% were related to falls - 65% of the infants fell out of the car seat, 15% fell from elevated surfaces (with shopping carts, tables, and counters being the most common surfaces).

1.  Anytime your baby is in the car seat (be it in the car, on the stroller, in your house) the harness straps must be BUCKLED and SNUG.  (When unbuckled the baby can fall out of the seat.  When buckled loosely the baby can get tangled in the straps and strangle themselves.)  
 2.  Anytime your baby is in the car seat, the car seat should either be in the car, on the stroller - or ON THE FLOOR.  Never put the car seat on a counter top, bed, sofa, table, bench, shopping cart, restaurant high chair, etc - as the car seat can fall from these raised surfaces.
    Parikh S, Wilson L. Hazardous Use of Car Seats Outside the Car in the United States, 2003–2007 Pediatrics. 2010;126:352-357. 

    Wednesday, July 7, 2010

    Video Installation Tips & Tricks: How to PUSH & PULL most effectively to get a Rear-Facing Convertible Car Seat installed tightly using LATCH

    This video highlights 2 important installation tips:
    1. On a rear-facing convertible seat, use your stomach to 1. push the car seat into the back of the vehicle seat and 2. sway the car seat side to side - WHILE you pull the belt tight
    2. Always pull the tail of the belt from "inside" the car seat - not from "outside" - see this earlier post for more on inside vs. outside
    While the seat shown in this video is a Graco My Ride 65, the techniques apply to most rear-facing convertible seats (see the above blog post for a list of seats that are the exceptions to the "inside" rule)