Incorrect use of car seats widespread on first trip home from hospital, research shows

A study of 267 families at Oregon Health and Science University Hospital showed that 93 percent made at least one critical error in positioning their infant in a car safety seat or when installing the safety seat in the vehicle. The National Highway Traffic Safety Administration has defined critical errors as those that put infants at increased risk for injury in a crash.

"Car safety seats can be difficult to use correctly for many families, and we need to provide the resources and services they need to help ensure the safest possible travel for newborns and all children," said Benjamin Hoffman, MD, FAAP, lead author of the study "Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at Initial Hospital Discharge."

Dr. Hoffman and his colleagues enrolled randomly selected mother-infant pairs in the hospital's mother-baby unit from November 2013 to May 2014. Infants born at less than 37 weeks' gestation and those who stayed in the neonatal intensive care unit for more than four hours were excluded from the study.

A certified child passenger safety technician observed new mothers or a designee position the newborn in the car safety seat and install the seat in the vehicle in which they would be leaving the hospital. The technician recorded all misuses based on car safety seat and vehicle manufacturer recommendations. Prior to departure, technicians helped caregivers correct all mistakes.

The most common errors in positioning the infant included harness being too loose (69 percent), retainer clip too low (34 percent), use of after-market product not approved with seat (20 percent), harness too high (18 percent) and caregiver not knowing how to adjust the harness (15 percent).

The most common installation errors were car safety seat installed too loosely (43 percent), angle of car safety seat incorrect (36 percent), safety belt used but not locked (23 percent) and incorrect spacing between car safety seat and vehicle front seat (17 percent).

Families with increased risk for one or more critical errors tended to be of lower socioeconomic status, had less education, were non-white, did not speak English, and were unmarried or without a partner. Families who had worked with a certified car seat technician prior to their child's birth were 13 times more likely to position their baby correctly and install the car seat correctly in their vehicle.

"We need to move beyond the idea that we cannot afford to develop and support child passenger safety programs," said Dr. Hoffman, professor of pediatrics and medical director of the Tom Sargent Children's Safety Center at Doernbecher Children's Hospital, Portland, Ore. "Car crashes kill more kids that any other cause; we can't afford not to."