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You’ll probably never in your life drive as carefully as you do when taking an infant home from the hospital. Suddenly, the car seat you meticulously researched and spent an hour installing seems less safe than it did before.


In this case, you’re probably right, because according to an observational study published in the Journal of Pediatrics in 2016, 95 percent of infants taken home in car seats are “Unsafe from the Start.”

Researchers at Oregon Health & Science University investigated 291 mother-infant pairs as they were nearing discharge from newborn units. Child Passenger Safety technicians observed the caregivers as they installed the car seats and placed their newborns into them.

The technicians identified errors in almost 95 percent of the study population: 77 percent of caregivers made at least one installation error, such as improperly securing the car seat within the vehicle; 86 percent had at least one positioning error, such as not tightening the harness; 89 percent of the caregivers made at least one “critical error.”

This category of error, which the researchers based off the National Highway Traffic Safety Administration definitions, included positioning issues, like leaving the harness too loose (69 percent), using an incorrect harness slot (31 percent), or using a non-regulated product, like extra cushioning (21 percent). Critical misuses related to installation included car seats that could be moved more than one inch after installation (44 percent) or had an incorrect recline angle (41 percent).

The factor most associated with correct car seat use was working with a Child Passenger Safety technician before delivery. But even those caregivers had a serious error rate of 77 percent.

This study has been making the rounds on parenting websites, giving new parents one more thing to panic about. Although the results of the study suggest that better parent education is needed, here are three important questions to ask about car seat safety:

1 | If 95 percent of parents make car seat errors, are all our children unsafe?

The itemized list of issues caregivers commonly got wrong should alleviate some concern. For example, two of the errors – twisted harness belts and improperly positioned carseat carrier handles – are not likely to result in crash-related injury.

Even some of the misuses categorized as “serious” are not necessarily dangerous. For example, 35 percent of the participants left the harness retainer clip “too low.” Those harness clips, while frequently a source of social media shaming, are not meant to hold children. The clips are pre-crash positioning devices, designed to keep children’s shoulders in the right position before an accident occurs. It’s the harness buckles that keep kids in their seats.

2 | Given that these families were using car seats to take home their newborns, is it reasonable to assume that parents using car seats for the first time are more likely to make errors? Are experienced parents more likely to get it right?

According to this study, no. The researchers controlled for “parity” – that is, the number of pregnancies carried to term – and found that first-timers were slightly more likely to get it right than their more experienced counterparts. Women who had no previous births had a serious error rate of 89.6 percent. Women with two or more births had a serious error rate of 96.6 percent.

The sample size may be too small to draw any concrete conclusions about experience level and car seat misuse, but one explanation might be that the users with visible damage to their car seats or expired seats were among the experienced parents.

Parents preparing for a second (or third, or fourth…) child should pay close attention to car seat expiration dates and replace any car seat with any visible damage.

3 | Given that 77 percent of parents who seek help from trained professionals are still doing it wrong, are car seats too complicated to be used safely?

This study indicates that nearly all caregivers need better car seat instruction. But the results of the study should not in themselves be a cause for panic.

As it has been reported, the study seems to say that even most of parents with CPS training are doomed to misuse their car seats. But the study noticed a pattern in the CPS-trained parents. They were much more likely to make positioning errors than installation errors, suggesting that they had trouble applying the lessons they’d learned to their babies.

The study authors recommend better “postnatal collaboration,” so that parents – now with a live baby instead of a pretend one – get better practice with positioning. The reduction in error rate for caregivers with previous training suggests that Child Passenger Safety technicians embedded in hospitals could help increase safety.

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