Study: Most parents fail child car safety seat test

— -- After hitting road debris, their car slid into a guardrail and spun across the highway before flipping over and landing upside down on rocks.

Emergency medical technicians later told parents Jeff and Anne Hamilton that when they see cars as crushed as theirs was in March, they assume any children inside are dead.

Anne Hamilton, however, is trained to install child seats and had each of her three children in the best possible seat and position for their ages. She's convinced it prevented what could have been life-threatening injuries to the three girls, then ages 2, 4 and 6. The worst injury was a broken leg suffered by the 4-year-old.

Most parents aren't using child seats correctly, research released Thursday from the non-profit group Safe Kids USA shows. Only 30% are using the tether straps that keep the tops of child seats — and children's heads — secured in crashes, and many are not using the safest seats for their children's ages.

In what is believed to be the largest study ever done of child seats, Safe Kids reviewed 79,000 car seat checklists collected at inspection events the group held in 2009 and 2010. Because parents voluntarily take their vehicles to checkups, the rate for proper usage is likely even lower, Safe Kids says, which underscores the need for more education.

Although the death rate has declined, car crashes remain the leading cause of death for children ages 3 to 14, according to National Highway Traffic Safety Administration data. Properly used child safety seats decrease the risk of death by 71% for infants and 54% for toddlers, NHTSA says. Children are 59% less likely to be injured in a booster seat than if they were using seat belts only.

"As a parent, if something ever happened to my child when I was driving, I'd have to know I did everything possible right or I wouldn't be able to sleep at night," says Lorrie Walker, Safe Kids' child passenger safety technical adviser and co-author of the report.

The American Academy of Pediatrics, Safe Kids and other safety organizations recommend that children stay rear-facing in vehicles until they are 2. Safe Kids said that parents were "doing a better job" keeping kids rear facing, but that more needs to be done to educate parents about the importance of doing so longer.

Top concern: Tether straps

Safe Kids spokesman Kyle Johnson says it was impossible to quantify how many kids had moved out of the right seat for their age, but many showed up at checkpoints in the wrong seat or none at all. That was especially common for children ages 7 or 8, who should have still been in booster seats.

But the low rate of tether strap usage was the biggest concern.

Tether straps and their in-car attachment points have been on child seats and new cars for more than a decade. They are part of the LATCH (Lower Anchors and Tethers for Children) system that was required as part of a $152 million federal rule that was phased in starting in the late 1990s. LATCH was supposed to make child seats easier to install by eliminating the need to wrestle with seat belts to secure them. And the more snugly installed seats would save lives and prevent up to 3,600 injuries a year, NHTSA said.

Child safety advocates say several factors are contributing to the disappointing showing. One is a lack of public awareness.

"As always is the case when you make a significant breakthrough, people forget if you do not have a good maintenance level" of publicity, says Stephanie Tombrello, founder of the child safety group SafetyBeltSafe.

And although the attachments dangle from all new child seat models, many parents simply resort to the seat belts they've always used or seen used. Even people trained to install child seats correctly are largely eschewing the system: Safe Kids says only 30% of the cars that drove away from checkpoints were using the lower anchors located where seat backs meet seat bottoms.

NHTSA chief David Strickland and safety advocates say that it's OK if belts are used correctly.

"Ultimately, both the LATCH system and seat belts are effective ways to secure a child seat," Strickland says. "What's most important is that parents and caregivers know how to properly install and use the right seat for their child's size and weight."

Still, the in-car options can make LATCH less alluring. Vehicles are only required to have the lower attachments in two back seat positions, so many small and midsize cars have them in the seating positions closest to the doors. The middle seat, however, is typically considered the safest as it is the farthest away from the doors in a crash. Many vehicle manufacturers also warn against using the LATCH anchors for children who weigh more than 48 pounds.

NHTSA has a research program underway to examine issues raised by consumer and safety groups, including LATCH use in the rear center seat, ways to improve tether anchorages, and the need to better educate consumers with heavier children, Strickland says. NHTSA's latest public service advertising campaign ended in July, and the agency plans another child-seat campaign later this year.

Gloria Bergquist, spokeswoman for the Alliance of Automobile Manufacturers, says the LATCH acronym can be confusing. She says the message needs to be more memorable and suggests: "Children should be tethered at all times in cars."

There was good news in the report. About 99% of children under 13 years showed up at the checkpoints in back seats, which safety advocates recommend whether or not a car has air bags. Fewer than 1% of children were unrestrained.

Safety advocates warn against using second-hand child seats because they might have been involved in crashes — which could make them less effective. Safe Kids says more than 90% of people knew the history of their child seats and only 2% had been involved in crashes.

The progress should pay off for years to come, Walker says. "When kids are properly restrained and trained at young age, as they get older they are more likely to use seat belts," she says. "It's an education process."

Crash is a powerful lesson

To those who think it's impractical — if not impossible — to keep toddlers rear facing or older children in booster seats, Hamilton's crash experience is a powerful cautionary note.

The family was driving from their home outside Los Angeles to visit friends in Phoenix in March when her husband, Jeff, hit what he thinks were truck tire treads on an unlit highway. Bridget, a month shy of her 5th birthday, was in a forward-facing child seat against the driver's side window in the third row. When the car hit the guardrail, she told her mother her "leg went up to the sky." She had the worst injuries in the family: A cut that sliced through most of her foot and a broken leg. But she's fully recovered now.

Anne, who was sitting in the second row of seats, got severe cuts on her arm and face; her husband was also badly bruised and cut up. Emma, now 7, had been using a booster seat, but her mother put her back in a forward-facing seat with a harness, knowing it would be better protection for the long ride. She was sitting in front of Bridget and sustained only cuts and bruises from what's called "road burn." Maggie, who turned 3 the following month, was riding rear facing in the third row of seats. She didn't have a scratch on her.

"I know that their properly used child seats really did save their lives," Hamilton says. "If we were going by the bare minimum of the law, I don't want to think about what would have happened."