How to Stay Safe in a Motor Vehicle

Motorized vehicle accidents are, most years, the first or second leading cause of accidental death in kids: children are improperly restrained in cars or are passengers with an impaired driver, are inexperienced teenage drivers, or are operating ATVs, dirt bikes, and Sea Doo’s…. I have nightmares.

Children are frequently in accidents when someone else is in the driver’s seat. The number one thing you can do to prevent injury to your child in an accident is to get an approved car seat of the appropriate size for your munchkin, and always latch him or her in—no matter how far you are going. No exceptions, ever. I once watched a baby die after being flung from his mother’s arms in a car going only five miles per hour in the parking lot of our children’s hospital. If the car is moving, the child needs to be locked in.  Make sure the seat fits your child, and change the seat as he or she grows. Read the manual for the car seat and for your car. If you are unsure that everything fits and is hooked up correctly, call your local fire station. Most are happy to check your child’s seat for free.

Drive rationally yourself. Leave a decent following distance.  Follow the 3 second rule (it should take you 3 seconds to reach the car in front of you if it stopped instantly), no matter what the speed. Stay off your cell phone, because studies prove distracted driving from cell phone use is as bad or worse than drunk driving. Make wearing a seatbelt such an ingrained habit that it never occurs to them not to do it, and never drive if you have been drinking.

Talk to them about getting out of a car if they don’t feel safe with the driver. Agree to pick them up anywhere, anytime if they call you. I have one patient who is alive now because he said, “No, I’ll just walk.” The boy who took his place is dead.

There is nothing to match the terror of knowing your fragile child has a driver’s licence. Most states have implemented longer required periods of time driving with learner’s permits, which has decreased injuries significantly. Graduated licenses have also helped: the more time kids drive with supervision before they are on their own, the better. Automatic seat belts and airbags are beautiful things. Also, the longer they have to drive themselves before they can drive friends, the better. When the time comes, friends bring with them a multitude of distractions: conversation, music, tech, flirting, and peer pressure.  Texting and distracted driving are the problems of the day, waiting for a solution. Talk to your children about the dangers; make sure they understand that texting and driving is never allowed, and that they must keep their attention on the road. Be a good example by doing this yourself.

If your child wants their own car, make sure they contribute to its cost in both dollars and sweat. If a child puts their hard earned money and muscle into a car he or she will take better care of it, and consequently of the person inside.

Last, the other motorized vehicles: Sea-Doo’s, ATVs and dirt bikes. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only thing that keeps them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Car Seats

When I was a kid, I used to ride stretched out in the back window of the car with my carsick bucket. Hmm, so wrong. We’ve learned a few things since then.

Even today, an average of 900 children die in car accidents every year, more than 2 little ones each and every day.  One in three children who die in motor vehicle accidents are not buckled up. There is a real racial difference: one in four of the white kids who died were not buckled; this increased to almost half in the black and hispanic children who died in accidents. There is also a socioeconomic difference: not everyone can afford a car seat. Last, there is a geographic difference: far fewer children die in car accidents in states where car seat usage is mandated by law.

Buckle your child into an approved car seat any time your car is in motion, no exceptions. Bad things happen suddenly; prevention is much easier than regret.

Which car seat you buy depends on your child’s size, his or her age, and the type of car you drive. Read your car manual and the car seat’s manual because instructions and weight limits vary quite a bit between brands. Some general guidelines:

  • Infants and toddlers under two face backward as long as they fit. You can smush them a little. Check your seat instructions: there will be a maximum height or weight listed.
  • Toddlers and young children go in forward-facing car seats as long as they fit. They no longer fit if their head is above the back of the car seat with nothing to support it. Check that maximum height or weight listed on your car seat instructions again.
  • When they no longer fit into the car seat, they go in booster seats until the seat belt fits.
  • Seat belts fit when the upper belt lies over the shoulder and chest (not the neck) and the lower belt lies across the hips. Generally, that’s when the child is between eight and twelve and about four-foot-nine.
  • Children under 13 need to ride in the back seat.
  • If you have questions or just want someone to double-check your installation, local fire or police departments are usually more than happy to help.

The American Academy of Pediatrics has a comprehensive review of car seats, kept up to date every year, at Read through it for more precise information on seats specific to your child’s age.