The most dangerous thing you do with your child on a regular basis is get into the car. The most common cause of death in children under the age of 15 is unintentional injury, and the most common cause of unintentional injury is car accidents. Between 2010 and 2014, 2,885 children died in motor vehicle accidents nationwide — an average of 11 children a week. The Atlanta area, in particular, is known for its terrible traffic and thus high rate of car accidents: An average of five people a day or 31 people a week die in Georgia accidents. In Georgia, there were 1.53 deaths per 100 million vehicle miles traveled. The U.S rate was 1.42 deaths per 100 million vehicle miles.

As patients of Briarvista Pediatrics already know, I am car-seat safety advocate. That means that I am committed to keeping your children safe by reviewing the standards of car safety at each and every well-child visit. I will be posting a series of articles regarding safety at each stage of infancy/childhood, going more into depth on a few of these topics, but here are the top ten things I want you to know:

#1) The BEST car seat is the one that fits your child, your car, your budget, and is both installed and used properly each and every time. Car seat safety guidelines are pass/fail only; scores are not released. Thus the $50 car seat is JUST AS SAFE, as far as anyone knows, as the $400 car seat. Higher price tags typically correlate to higher height/weight limits, easier installation, more luxurious fabrics, and extras such as cupholders. But do not feel like you need to spend a lot of money to keep your child safe; if the $400 seat is installed or used improperly, it is more dangerous than the $50 seat installed and used correctly.

#2) ALWAYS read the manual! No one buys a new piece of technology without reading the instruction manual. A car seat is no different. You need to read it through, front to back, before attempting to install or use it. And don’t forget to register the car seat — that’s how the manufacturer will reach you if there are any recalls.

#3) Aim for MAXIMUMS, not minimums. Every time you “graduate” your child from one stage of car seat safety to the next — e.g. from a rear-facing seat to a forward-facing one, or from a harnessed seat to a booster seat — you lose points. Each step “up” is really a step “down.” So aim to reach the maximums of your seat, not the minimums. Rear-face as long as possible. Keep your child in a harnessed seat as long as possible. Do not move out of the booster simply because your child is the minimum height.

#4) Make sure you know what the maximums actually are: Most car seats have a “whichever comes first” rule for maximums, not a “whichever comes last.” In other words, it’s EITHER/OR, not BOTH. An infant seat, for example, may have a 30lb weight limit and a 30″ height limit. That means that when your child is 30″ tall — no matter the weight, which is typically still less than 30lbs — the carseat is outgrown. Most harnessed forward-facing seats are outgrown when the child’s shoulders are above the highest harness position — no matter if the child has reached the height OR weight limit! This information will be found in your manual.

#5) Do not use ANY after-market products. That means that if it did not come in the box, it is not safe to use with the car seat (with very few exceptions for when the manufacturer sells their own products separately). These products inlude, but are note limited to: strap covers, infant body support cushions, seat protectors, cold-weather snuggle systems, and more. Check out the Car Seat for the Littles post for some more examples of after market products

#6) No bulky clothes in the car. Adding bulk — such as from heavy, puffy coats — leaves space between the strap and the body. That slack can mean the harness or seat belt cannot function as it’s supposed to in the event of a car accident. No one — including adults — should be wearing bulky clothes in the car. If it’s particularly cold out and you cannot pre-warm your car, I suggest using jackets as blankets and putting them on top of the harness or belt; you can put the coat back on properly once you arrive at your destination. Here’s a crash-test video that demonstrates this point. One layered fleece jackets are okay to use in the car. There are also some car seat specific winter coats on the market, but that seems to be overkill for Atlanta, where it’s only really cold for a few weeks out of the year.

#7) Rear facing is always safer. No child should be turned forward facing before the age of 2 years, but it’s absolutely a safer choice beyond the 2nd birthday. Again, aim for the maximums of the seat. Remember that when rear facing, harness straps should come from at or below the child’s shoulders.

#8) Harnessed is always safer. That’s why race car drivers and astronauts have harnesses! Moving from a harnessed seat to a booster + seatbelt requires that the child take responsibility for his or her own safety. Harnessing means you have taken responsibility. Aim for the maximums. Remember that when forward facing, harness straps should come from at or above the child’s shoulders.

#9) Your child needs to stay in a booster seat until 4’9″ tall — at MINIMUM. Once reaching that height, you can stop using the booster IF the child passes the 5 step test.

#10) No child younger than 13 years old should be in the front seat of a car. It does not matter how tall or heavy he is. It does not matter how mature she is. Front seats — airbags, in particular — were designed for adults. Period.

So there you have it. Watch the blog for more details about some of these points in upcoming posts, and feel free to ask me about anything mentioned here. My job is to review the basics — your job is to keep your child as safe as possible. Buckle up and drive safely!