The growing awareness of safe driving and state safety laws have alerted the general public and parents to the importance of using car seats for their small children whenever and wherever they are driving. Most states require the use of car seats for children under the age of 4 and weighing less than 40 pounds. However, these safety rules aimed at protecting children may cause serious neck and spinal injuries and can even be deadly if the child car seats are used incorrectly.

The American Chiropractic Association (ACA), its Council on Occupational Health and ACA member Dr. Michael Freeman, trauma epidemiologist and clinical assistant professor of public health and preventive medicine at the Oregon Health Sciences University School of Medicine, have developed the following general guidelines and safety tips to ensure proper car seat safety.

• Make sure the child safety seat is appropriate for the age and size of the child. A newborn infant requires a different seat than a 3-year-old toddler.
• Car seats for infants should always be rear facing as the forces and impact of a crash will be spread more evenly along the back and shoulders, providing more protection for the neck.
• Car seats should always be placed in the back seat of the car-ideally in the center. This is especially important in cars equipped with air bags. If an air bag becomes deployed, the force could seriously injure or kill a child or infant placed in the front seat.
• Make sure the car seat is properly secured to the seat of the vehicle and is placed at a 45-degree angle to support the head of the infant or child.
• The lap harness should be fastened low, as close to the hips as possible; the harness should never be fastened around the waist.
• Make certain the shoulder harness is fastened securely and the straps lay flat against the body. Twisted straps can cause additional injury that might prevent the seat from working properly.
• Use a retention clip (if provided by the manufacturer) when securing a child safety seat with the shoulder harness. The retention or shoulder harness clip is an added safety feature and must be fastened close to the armpit of the infant or child.
• Borrowing or purchasing a used car seat can be dangerous; there is the possibility of unknown or undetected damage. Car seats that have been in a serious accident should never be used again.
• Be sure the seat meets federal motor vehicle safety seat standards. Consult the owner's manual or contact the manufacturer for that information. All car seats should have an owner's manual and instruction booklet.
• Be sure the clip between the legs of the child is fastened snugly.

While car accidents can be dangerous for all passengers, small children are especially at risk, according to Dr. Scott Bautch, past president of ACA's Council on Occupational Health. "The weight of the head of a child makes the cervical spine much more vulnerable to injury," Dr. Bautch explained. "The infant has little control in the muscles of the neck, and the head can bounce from side to side and fall forward, which can cause serious spine and neck injuries. Children have more flexible upper bodies and shoulders. Make sure the harness comes up, way up, over the shoulders."

Underscoring the importance of proper car seat use, a recent article in Nation's Health reported the findings of a study conducted in Kentucky by the Centers for Disease Control and Prevention. The study found a 37 percent drop in infant fatalities since the 1982 enactment of the state law mandating the use of child car seats. "To continue this decline, prevention efforts now must focus on the proper use of the seats to maximize their life-saving potential," the researchers said.

The key when traveling with small children is to be aware of and follow these rules and tips to ensure proper car seat safety. And remember everyone: Buckle up!

If you or one of your children have been involved in a serious automobile accident and have experienced neck and back discomfort, you should consider a visit to a chiropractor.

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