Car Seat Safety Reminders Every Parent Should Know

By Michael Molina, community health educator at CHOC Children’s

Car seat safety: selection tips every parent should know

Car seats and booster seats are the basic protection systems for passengers who are too small to get the full safety benefits from adult seat belts. Choosing the right seat is an important part of keeping your child safe on the road.

The best seat is one that:

  • Fits your child: appropriate for the child’s age, height, weight and development level
  • Fits in your vehicle
  • Is in good condition: has not been in a crash, is not expired or recalled, and has no labels missing
  • You can afford: inexpensive seats may meet the same national safety standards as their more expensive counterparts, but may not have the same comfort features

Remember to register your car seat to ensure you receive any relevant recall information from the manufacturer.

Refer to The Ultimate Car Seat Guide produced by Safe Kids, a nonprofit organization working to help families and communities keep kids safe from injuries, for personalized car seat tips based on your child’s age and weight.

To speak to an experienced child passenger safety technician, please call CHOC Children’s community education department at 714-509-8887.

Car seat safety: direction is key

The direction your child faces in their seat matters. Many children move to the next seat stage before they are ready, potentially putting them at greater risk for injury in a crash.

Current California law requires children under age 2 to be rear-facing. This helps protect their developing fragile spinal cords during a collision by the seat absorbing the force of a crash, rather than the child taking the brunt of the impact. Keep your child rear facing as long as possible, until they reach the maximum weight or height limit of their seat. This could mean beyond two years old.

Car seat safety: location matters

The back seat is best for children under age 13. The back middle seat is the safest place for them because it will protect them from a crash and they won’t be injured by airbags. If you are unable to install a car seat in the middle seat, consider placing your child on the curb side, as opposed to the street side. Never place an infant carrier in the passenger seat, and always have children in booster seats use both the lap and shoulder belt.

Car seat safety: do’s and don’ts of installation

In the U.S., 59 percent of car seats are installed incorrectly. In Orange County, 98 percent of car seats inspected by Safe Kids’ Orange County chapter are misused. This may put your child at risk for injury in a crash.

Do’s Don’t’s
Do read and follow your car seat instructions and vehicle owner’s manual. Don’t use the seat belt and the lower anchors together to install car seats.
Do use tether anchor for forward-facing car seats. Don’t sacrifice the middle seat just because it doesn’t have a lower anchor system. Try using the seat belt for installation and make sure it doesn’t move more than 1 inch from the belt path.
Do lock the seat belt if you are installing your car seat with the seat belt and not the lower anchors. Don’t use a lap-only belts for children using booster seats. Use a 3-point lap-and-shoulder belt to have full upper body protection.
Do the 5 Step-Test for your booster seat child to know if he or she is ready to ride without a booster. Don’t ignore the labels on the car seats.
Do choose a car seat that you will correctly and consistently use Don’t install a car seat in the front passenger seat. The back seat is the safest location for your child to ride. If there is no back seat, make sure to turn off the front passenger air bags.


Car seat safety: harnessing 101

Proper use of the harness or seatbelt ensures your child is securely positioned in a car seat, booster seat, or vehicle seat, and provide optimal protection in the event of a crash. Here are some helpful tips for adjusting the harness and seatbelt securely for your child.

Rear facing:

Children in rear-facing car seats should have the harness straps at or below shoulder level. This ensures that your child doesn’t slide upwards in a crash.

Forward facing:

Children in forward-facing car seats with a harness must have the straps at or just above the shoulders.

Both forward facing and rear facing:

  • To ensure your harness is tightly adjusted, do the “pinch test” at shoulder level. If you can pinch any material of the harness at the child’s shoulder, it is still too loose.
  • Avoid wearing thick, padded clothing when your child is in their car seat. Wearing them will prevent the harness from being effective in a crash because the padding will compress in an event of an impact which will cause injuries.
  • The chest clip is at armpit level.
  • Always buckle both the harness straps and the crotch belt buckle.

Booster seats:

  • Always wear a lap AND shoulder seatbelt when your child is using a booster seat
  • Do not transition your child out of the booster just because he is 8 years old. Use the 5 Step Test to determine if your child is ready to ride without a booster.

Car seat safety: getting your car seat inspected

A list of car seat resources, including where to get a car seat inspection, is available in the OC Child Passenger Safety Resource Guide.

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Quiz: Snakebites First-Aid

Summer temperatures and an increase of rain can mean increased snake encounters in Orange County. More rain means more flash floods, which destroy snakes’ homes, forcing them to seek shade and water elsewhere. Rain allows for more vegetation, which allows for more rodents, and – you guessed it- more rodents mean more food for the snakes! We encourage parents to learn how to prevent or treat a snakebite.

For each question, choose the best answer. Then, click through to download the answer key.

  1. Which of the following is a good way to avoid a snakebite?
  1. If you see a snake, make sure to look at it in the eye and display dominance. Stand over it and appear threatening. This will scare it away.
  2. Be aware of your surroundings! Snakes may be swimming in the water or hiding under debris or rocks.
  3. If a snake bites someone, be sure to trap, catch, or kill the snake to prevent it from biting other people.
  4. If you see a snake, ignore it and leave it alone.

2. Which of the following non-venomous (non-poisonous) snakes live(s) in Orange County?

  1. California striped racer
  2. California kingsnake
  3. San Diego gopher snake
  4. All of the above.

3. All of the following are venomous (poisonous) snakes EXCEPT:

  1. Red coachwhip

red coachwhip

b. Southern Pacific rattlesnake

southern pacific rattlesnake

c. Red Diamond rattlesnake

red diamond rattlesnake

d. Southwestern Speckled rattlesnake

southwestern speckled rattlesnake

4. Which of the following are good first-aid techniques for snakebites?

  1. Keep the person still and calm.
  2. Call 911 and seek medical attention as soon as possible.
  3. Remove jewelry or restrictive clothing from the affected limb.
  4. Cover the bite with a clean, dry dressing.
  5. Give the person a Coke or Pepsi. Apply a tourniquet, then slash the wound with a knife, suck out the venom, and apply ice.
  6. A, B, C, and D
  7. All of the above.

5. How should you position the bite wound in relation to the person’s body?

  1. Elevate the bitten area above the heart.
  2. Keep the bitten area at the same level as the heart.
  3. Lower the bitten area below the level of the heart.

6. What are some helpful details to remember about the snake?

  1. The color of the snake.
  2. The shape of its head.
  3. Whether or not it had a rattle.
  4. All of the above.
Download the answer key

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Minimizing Health Effects of Wildfires

During a wildfire, the biggest health risks to children are fire and smoke. Health effects can include any or all of the following symptoms, per the American Academy of Pediatrics:

  • Chest tightness or pain
  • Shortness of breath
  • Wheezing
  • Coughing
  • Burning or stinging of the nose, throat and eyes
  • Dizziness or lightheadedness
How can parents protect kids from the harmful health effects of fire and smoke?
  • Evacuate the area if recommended by authorities.
  • Stay indoors and minimize smoke exposure. Close all windows and doors.
  • When driving, keep windows and vents closed. Turn the air-conditioning to re-circulate.
  • Avoid sports practices, games or extreme exertion if the air quality is poor.
  • Do NOT give your child a mask to filter contaminants, since masks do not work when not fitted correctly. Smaller sized masks may appear to fit a child’s face, but no manufacturers recommend their use for children.
  • Increase water intake to avoid dehydration, which can happen quicker when breathing is compromised.
  • Continue to minimize exposure to other sources of air pollutants such as cigarette smoke, smoke from wood or coal-burning furnaces, or smoke from a barbecue, as the combined effect of these smoke sources can have a greater impact on your child and family than the fire alone.
  • Children with chronic respiratory problems, such as asthma, are at increased risk. Children at increased risk should remain in a clean-air environment, and be kept indoors until air quality improves. Administer any protective medications to your child as directed by your provider. They should be monitored closely for signs or symptoms of harmful health effects. If they are showing these symptoms and their usual medications cannot bring them under control, they should be taken to a nearby medical facility, despite the risks of traveling.


Parents should be mindful of the signs and symptoms of respiratory distress, says Dr. Charles Golden, executive medical director of the CHOC Children’s Primary Care Network.

What are the warning signs of respiratory distress?
  • Rapid breathing
  • Use of accessory muscles (the muscles in the chest, rib cage and neck) become noticeable with each breath
  • Fatigue, lack of energy, and increase in sleepiness in addition to the above symptoms
  • Flaring of the nostrils or grunting with each breath
  • Bluish/purplish discoloration of the lips, tongue and inner mouth in combination with the above symptoms

If your child has these symptoms, seek urgent medical attention despite the risks of travel and outdoor air exposure. If these symptoms are severe, call 911.



Nursemaid’s Elbow in Kids Caused by Common Activities

Nursemaid’s elbow is one of the most common injuries in small children, and it can happen during the most innocent activities, like swinging a child by the arms or playing tug-of-war.

“There is a natural looseness in the ligaments of little kids’ elbows,” according to CHOC Children’s pediatric orthopaedic surgeon Dr. Jessica McMichael. “Nursemaid’s elbow happens when the arm gets tugged or pulled, which can partially dislocate the radial head portion of the elbow.”

The injury can happen when a baby or small child is lifted by the hands, or when a child tugs their arm while holding someone’s hand. It can also happen when an object is pulled from their hand, when a baby rolls over or because of a fall.

What are Symptoms of Nursemaid’s Elbow?

Parents can look for these characteristic signs of nursemaid’s elbow in their child:

  • The child stops using their arm normally or treats their arm gingerly
  • The elbow appears straight and the child doesn’t want to bend it
  • The child holds their arm limply and away from the body, “like a paralyzed arm”
  • The palm is rotated inward, rather than facing out toward the front of the body
  • The child complains of pain in the elbow, forearm or wrist
  • Someone holding the child’s hand may feel a pop in the child’s wrist when the injury happens

Nursemaid’s elbow is a very common orthopaedic condition treated at CHOC, according to Dr. McMichael. It is likely to happen multiple times after a child has it once.

“Nursemaid’s elbow is not threatening to the limb, but it does need to be treated,” Dr. McMichael says. “It’s okay to wait until the next morning if your child is acting okay. If your child is not acting like themselves, get it checked out.”

How to Fix Nursemaid’s Elbow

To fix nursemaid’s elbow, a medical professional will gently and quickly pop the elbow back in place. A child might feel pain for a brief moment during the procedure but should start using their arm normally within a few minutes.

If a child’s elbow pops out of place three or more times in a month, a cast may be put on to immobilize the arm and promote stiffness.

Nursemaid’s elbow can be treated by a pediatrician, a pediatric orthopaedic specialist or at a pediatric emergency department. Parents should not correct the elbow themselves unless instructed by a doctor.

Dr. McMichael encourages parents to educate people who are around their child, like grandparents, daycare staff and preschool teachers, about the safest ways to lift a child, hold their hands and play with them.

Nursemaid’s elbow is less likely to occur after age four, when the elbow ligament starts to tighten up and improves with age and growth.

To make an appointment with a CHOC orthopaedic specialist, call 888-770-2462.

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Is Your Teen a Safe Driver?

By Kambria Nguyen, pediatric resident at CHOC Children’s

Motor vehicle accidents are the number one cause of unintentional injuries in adolescents age 15-19. These accidents account for 36 percent of all deaths in this age group ― Six teens die every day due to motor vehicle accidents. Summer months have the highest rates of teen fatalities throughout the year, but it’s not just teen drivers who are at risk; teen passengers are also at increased risk.

There are many factors unique to teens that put them at increased risk of having an accident:

  • Teens are inexperienced drivers and may not be able to recognize dangerous situations.
  • Teens are also more likely to engage in risky behaviors such as speeding and leaving little room between themselves and the car in front of them (known as headway).
  • Teens have the lowest rates of seat belt use.
  • 40 percent of teens report texting while driving.
  • The risk of being in an accident increases with the number of teen passengers.

According to the Centers for Disease Control (CDC), nearly one-third of traffic-related deaths occurred due to an alcohol-impaired driving crash. However, drugged driving is on the rise. A recent study found that the number of people killed in crashes where drugs were present surpassed the number killed in crashes where only alcohol was detected.

In 2014, the most recent data available, 209 child passengers ages 14 and younger died in alcohol-impaired driving crashes. More than half were riding in the vehicle with the alcohol-impaired driver.

Safe Driving Tips for Teens

  • Always wear your seatbelts.
  • Follow the rules of the road.
  • Never drink and drive. Never get into a car with someone who had a drink. Make sure you have a designated driver or someone you can call if you are stuck.
  • Whether it be alcohol, marijuana or recreational drugs, impaired driving of any kind can be deadly.
  • Remember that your texts can wait. Distracted driving is dangerous.

How can you help your teen be a safe driver? Keep in mind the following tips to support your teen and their safe driving habits:

  • Before teens drive alone, supervise them driving during different times of the day and in different weather conditions.
  • Lead by example. Wear your seatbelt and do not text and drive.
  • Stress the importance of a good night’s rest as drowsy driving leads to accidents.
  • Prohibit teen passengers for the first year your teen is licensed. In California, you cannot drive between 11 p.m. and 5 a.m. or transport passengers under 20 years old, unless accompanied by a California-licensed, parent or guardian, driver 25 years or older, or a driving instructor.
  • Talk to your teen about drugs and alcohol. Discuss the dangers of impaired driving and distracted driving.
  • Sign a parent-teen driving agreement. The CDC has a template, or you can make your own.

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