5 things to know about car safety at all ages

Lois Lee, MD, MPH
Lois Lee, MD, MPH

Every few months a news story serves as a tragic reminder. Motor vehicle crashes continue to be the leading cause of death for school-age children to young adults, says Dr. Lois Lee, attending physician, emergency department, at Boston Children’s Hospital.

Lee, who recently published a study about motor vehicle crash fatalities, is all too familiar with what can happen when parents and family members relax car safety practices. She offers pointers for parents to keep kids safe at all ages.


Infants should remain in rear-facing car seats until age 2.

car seat 1

Parents tend to be good about making sure that infants ride in car seats, but may be unsure when to switch to a forward-facing seat. “Best practices state that the car seat should be rear facing until the child is 2 years old. This position provides better protection for the head and neck in the event of a crash,” says Lee.


Children ages 4- to 8-years-old should ride in a booster seat.

car seat 2

“We still see 4-to 8-year-olds who are not riding in booster seats. According to Massachusetts law, a child should ride in a car seat or booster seat until she is 8 years old or 4’9.”


Make sure the seat belt fits your older child or adolescent.

car seat 3

“The lap belt should not cross your child’s abdomen, and the shoulder strap should not cut across your child’s neck,” explains Lee. In the event of a crash, a child is safer when the seat belt is positioned over the pelvic bone. If the belt crosses the soft inner organs of the abdomen, those organs—rather than the bone—absorb the force of a crash. When the seat belt cuts across the neck, kids tend to put it behind their back, which doesn’t offer protection.


Be a good role model.

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“Tell teens using the seat belt is the safest way to be in the car, wear it yourself every time you are in the car, and remind them that seat belt use is the law, which may carry more weight with teens,” says Lee.


Think prevention.

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“The best way to stay safe is to avoid a crash, which means eliminating distracted driving. No texting and no talking on the phone. These can be set ups for a crash, particularly for teens who are not experienced drivers.”

More on seat belt laws

Parents and family members who want to take safety to the next level should learn about the law. Lee works with the Belts Ensure a Safer Tomorrow (BEST) coalition, which is lobbying to pass a primary enforcement seat belt law in Massachusetts.

Massachusetts has a secondary seat belt law, which allows officers to issue a ticket only if the car is pulled over for another violation. Thirty-three states have primary seat belt laws, which allow officers to issue a ticket solely for not wearing seat belts. Lee’s study showed the motor vehicle fatality rate was 17 percent lower among persons aged 10 years or older between 2001 and 2010 in states with primary enforcement laws.

Learn more about Boston Children’s Injury Prevention Program.