We depend on cars to take our kids to school, soccer practice, and friends' houses. Cars are so common in our lives that many parents underestimate the dangers that motor vehicles can pose to children.

Motor vehicle accidents
The first and greatest danger is motor vehicle crashes, which kill between 200 and 300 children in Michigan each year. But according to Elaine S. Pomeranz, MD, medical director of the Child Protection Team at the University of Michigan Health System, it is possible to reduce the chance of fatalities from motor vehicle accidents by taking necessary precautions.

The first way to protect children is using proper child restraints. All seats should be placed in the rear of the car because of the potential dangers of airbags, especially in newer vehicles with airbags on the passenger side. “Children should really not sit in the front seat until they are at least 12 years old,” recommends Pomeranz.

It is also important that children’s sizes are taken into account. Infants, classified as less than one year and under 20 pounds, should be secured in an appropriate rear facing carrier in the backseat of the vehicle. When children surpass the minimum one year and 20 pound weight recommendation, a forward-facing car seat may be used, also placed in the backseat. However, it is recommended that the child remain rear-facing as long as possible. Many newer car seats allow children to ride rear-facing up to 35 pounds.

It is also recommended that parents choose a car seat with a 5-point harness system. The five-point harness should fit snugly.

From about 40 pounds to 80 pounds, children should ride in booster seats. “Booster seats elevate children high enough that they are able to safely use the shoulder/lap harness belt systems already installed in cars,” explains Pomeranz. Some children may forego booster seats at age 8 if their seat belt fits properly. Children can safely ride using a seat belt alone if: they can sit with their lower back against the back of the vehicle seat, their knees bend naturally over the edge of the seat, the lap belt is positioned over the hips and upper thighs and the shoulder belt crosses their chest between their neck and shoulder.

Safe and secure
Properly buckling children in car seats is important. Only 25% of children killed in Michigan car crashes in a one year period were properly secured. The National SAFE Kids campaign also reports that 86 % of child restraints are used incorrectly.

Pomeranz notes that properly securing children includes two parts: how the child is buckled in the car seat and how the child’s car seat is attached to the motor vehicle. Each car seat has specific qualifications for proper use. In addition to making sure the seat belt is holding the car seat in tightly, parents are encouraged to use top tethers. Tethers limit forward movement of the child seat in the event of a crash, decreasing the possibility of head and spinal cord injuries.

If parents are having a difficult time installing the car seat tightly with a seat belt they may want to try installing it using a LATCH system. This alternative system allows parents to install the car seat using special hardware installed in the vehicle and on the seat. Parents should check the vehicle and car seat manufacturer instructions to determine if this is an option for them.

To make sure that the seat is being used correctly, many child safety organizations sponsor free car seat inspection sites across the country. Parents can locate inspections stations on the Web through the National Safe Kids Campaign, www.safekids.org, or the National Highway Traffic Safety Administration, www.nhtsa.dot.gov.

Pomeranz also stresses the importance of children staying in car seats at all times when vehicles are moving. This is a common problem, especially for toddlers once they become able to undo their car seats on their own. She recommends several strategies to keep kids buckled up. First, parents, as well as everyone else in the car, should set an example by always wearing a seat belt themselves. Rather than singling out children with reminders to stay buckled up, encourage them to take on the job of reminding others. Parents can also reward children by making certain soft, lightweight toys, books, or music is available to children when buckled up and should stop the car if children refuse to stay buckled in.

Unrestrained passengers greatly increase their chances of serious injury and are 4 times more likely to die in the event of a crash. They may also cause injury to restrained individuals. Children moving around can also distract the driver and interfere with the driver’s visibility.

Parents may have other objects in the car which could injure children. Heavy or sharp, pointed items should be placed in the trunk to prevent them from becoming “flying missiles” in a crash.

Heating up
Pomeranz also stresses that children have a lower tolerance for heat than adults do.From 1996 to 2000, more than 120 children– most three or younger–died from heat stroke after being trapped in cars. Even children who survive serious heat exposure often have severe disabilities as a result of irreversible brain damage from lack of oxygen.

Studies show interior temperatures in a parked car can rise from 96 degrees to 150 degrees in a matter of 20 minutes, even if windows are cracked open. With such temperatures, infants and young children can experience heat stroke in a matter of minutes. Heat stroke causes children's skin to become red and dry. They become unable to produce the sweat needed to reduce their core body temperature; as the heart rate quickens, children lose consciousness and organ systems start to fail. When there is not enough oxygen in the car for a long enough period of time, children may die of asphyxiation, as well as heat exposure.

For more information:

U-M Your Child: Motor Vehicle Safety
http://www.med.umich.edu/1libr/yourchild/carseat.htm

U-M Women's Health Topics: Car Safety Seats
http://www.med.umich.edu/1libr/wha/wha_carseats_hhg.htm

National Safe Kids Coalition
http://www.safekids.org

Kids and Cars
http://www.kidsandcars.org

Safety Belt Safe USA
http://www.carseat.org

American Academy of Pediatrics: Care Safety Seats
http://www.aap.org/family/carseatguide.htm