Most Chicago Parents Engage in At Least One Unsafe Car Seat Practice

February 09, 2023

Simple adjustments could help prevent death and severe injury from car crash

A parent survey from Ann & Robert H. Lurie Children’s Hospital of Chicago found that nine out of 10 Chicago parents have at least one unsafe habit when it comes to child car seat safety. Car crashes remain the leading cause of death for children 1 to 10 years old in the U.S. – with approximately 600 deaths per year – and thousands are treated in emergency departments for severe injuries sustained, underscoring the critical need to prioritize car seat safety before every trip.

The latest survey from the hospital’s Voices of Child Health in Chicago found the most common unsafe practices to be:

  1. Not removing bulky coats and clothes (64%)
  2. Not hooking the top tether of a forward-facing car seat to the anchor in the car (53%)
  3. Not making sure the harness clip is at armpit level (44%)
  4. Not installing the car seat tightly enough that they were unable to move it more than one inch in any direction (39%)
  5. Loosening straps for child’s comfort (21%)
  6. Using a second-hand car seat (9%)

“The rate of child car crash deaths and injuries tells us how important it is to expand transportation safety education to more parents and caregivers,” said Matthew M. Davis, MD, MAPP, Chair of the Department of Medicine at Lurie Children’s, Executive Vice President and Chief Community Health Transformation Officer at the Patrick M. Magoon Institute for Healthy Communities at Lurie Children’s, and Chair of Pediatrics at Northwestern University Feinberg School of Medicine. “There are simple solutions to keep children safer while in transit, and these small habits could have a profound impact on keeping our children safer.”

Adopting a more thorough and consistent checklist for car seat safety before driving is the best way to reduce risks while on the road. Caregivers should review these safety practices when traveling with children in any passenger vehicle, including rideshare vehicles.

  • Secure the top tether. Before doing anything else, hook the top tether strap to the vehicle’s designated anchor and tighten so you can’t pinch an inch (for forward-facing vehicles).
  • Ensure care seat is installed tightly. The car seat should not move more than an inch from side to side.
  • Remove bulky coats/clothing. For children in harnesses, nothing thicker than a sweater or lightweight fleece should be worn under the car seat harness straps. For children in booster seats or using the seat belt, remove, unzip or lift up winter coats to get the belt right on the child’s collar and hip bones.
  • Tighten harness straps until you can’t pinch strap material between your fingers.
  • Adjust height of harness chest clip to armpit level.
  • Ensure anyone responsible for driving a child (i.e., grandparents, nannies, etc.) practices this standard of car seat safety.

“With winter weather here, it is especially important to remind everyone who is buckling a child up that bulky coats prevent a car seat from doing its job. Coats create slack in the straps that can lead to injury in a crash. It is safest to go with a thin fleece under the straps and a heavy coat over top.” said Michelle L. Macy, MD, MS, Scientific Director, Community, Population Health and Outcomes, Stanley Manne Children’s Research Institute.

For more information, visit:

Safe Kids Worldwide for general car seat safety tips and to find a child passenger safety (CPS) technician nearby.

National Highway Traffic Safety Administration’s directory to locate a certified CPS technician and car seat inspection station nearby.

American Academy of Pediatrics’ product listing for all car seats available on the market with a breakdown by mode, cost, and height and weight limitations.

This report is based on data from the Voices of Child Health in Chicago Parent Panel Survey. The survey is administered to a sample of Chicago parents by Lurie Children’s and NORC at the University of Chicago via internet and telephone. The survey is administered to our panel of parents three times each year. The data in this report was collected from October through November 2021. The sample consisted of 1,142 Chicago parents, stepparents, or guardians who had at least one child under 18 years of age in the household (referred to as “parents” in this report). Parents were from all 77 community areas in Chicago. The survey completion rate was 25.4% and the cumulative survey response rate was 1.8%. All analyses were conducted with statistical weighting so that the results are representative of the parent population in the City of Chicago during the time period of data collection. For more information about the VOCHIC Parent Panel Survey, visit and the Open Science Framework page at

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.