Unsafe Car Seat Practices in Chicago

Car crashes remain a leading cause of death and severe injury for children 1 to 10 years old in the United States. Each year about 600 U.S. children in this age range die in car crashes, more than the number who die from homicide, suicide, heart disease, sepsis or influenza/ pneumonia. Thousands more are treated in emergency departments for injuries sustained in car crashes.

Many of these injuries can be prevented with the correct and consistent use of car seats and booster seats. Unfortunately, according to a 2011 study conducted by the National Highway Traffic Safety Administration, almost half of car seats and booster seats are used incorrectly.

In this month’s Voices of Child Health in Chicago report, we provide insight on transportation safety. We asked over 1,000 Chicago parents from all 77 community areas in the city about their car seat and booster seat practices.

Report Highlights

  • The majority of Chicago parents reported engaging in at least one unsafe car seat practice.
  • It is critical that parents and other caregivers secure the top tether every time they install a forward-facing car seat.
  • It is essential to remove bulky clothing such as coats and snow suits before placing a child in a car seat so that the straps are snug enough to protect from injury in a crash.

The majority of Chicago parents reported engaging in at least one unsafe car seat practice

We found that Chicago parents are practicing many unsafe car habits. The most common unsafe practices were not removing bulky coats and clothes (64%), not hooking the top tether of a forward-facing car seat to the anchor in their car (53%), not making sure the harness clip was at armpit level (44%), not installing the car seat tightly enough that they were unable to move it more than one inch in any direction (39%), loosening straps for child’s comfort (21%) and using a second-hand car seat (9%).

Overall, 90% of Chicago parents reported engaging in at least one unsafe car seat practice. In 2020, the Centers for Disease Control and Prevention (CDC) reported that 607 child passengers ages 12 and younger suffered deaths from motor vehicle crashes in the United States, with more than 63,000 injured; of the children who were killed, 38% of them were not buckled up. Using a properly fitted/installed car seat reduces the risk for injury in a crash by 71% for children, compared with using a seat belt alone.

Car seat safety information for parents

There are several car seat safety steps that all caregivers traveling with children in any passenger vehicle (including rideshare vehicles) can take to increase their child’s safety and reduce the risk of injuries in the event of a crash.

1. Secure the top tether.

When using a forward-facing car seat, hook the top tether strap to the vehicle’s designated anchor as the first thing you do with your install, so you don’t forget. Then tighten the top tether strap so you can’t pinch an inch. A tight top tether helps keep a child’s head from flying forward in a crash or sudden stop.

2. Tight installation.

The car seat should not move more than an inch from side-to-side whether it is installed with a seat belt or LATCH lower anchors. Both ways are safe, as long as installation is tight, but they do not typically work together. Check your car seat manual and your vehicle owner’s manual to choose the method that is best for you and your vehicle. When using the seat belt, be sure to lock it by pulling it all the way out before tightening it up.

3. Remove bulky coats/clothing.

For children in harnesses, it is best to have nothing thicker than a sweater or lightweight fleece under the car seat harness straps. After the child is strapped into the seat, then you can put a coat or blanket over the top of the harness straps to keep warm. Doing so will keep the child snug and secure within the straps, limiting extra movement. For older children traveling in booster seats or using the seat belt, remove, unzip or lift up winter coats to get the seat belt right on the child’s collar and hip bones.

4. Tight harness straps.

Tighten the harness straps up until you can’t pinch strap material between your fingers. We’re going for “snug as a hug” to protect from injuries in a crash.

5. Height of harness chest clip.

To keep the car seat harness straps from sliding off the shoulders, adjust the harness chest clip to be about armpit level on your child.

6. Ensure all caregivers practice car seat safety.

Make sure that anyone who drives your child, such as grandparents and babysitters, knows how to safely use a car seat.

Where to Find More Information About Car Seat Safety

Parents and caregivers who are interested in learning more about car seat safety or who want to check to make sure their car seat is installed correctly can visit the following resources for assistance:


Press Release

About the survey

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, step-parents, 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 luriechildrens.org/ParentPanel and our page on Open Science Framework at https://osf.io/cjz82/.

Suggested Citation

Pollock B, Heffernan ME, Hill A, Bendelow A, Menker C, Casale M, Smith TL, Davis MM, Macy ML. Unsafe car seat practices in Chicago, Voices of Child Health in Chicago Report. Vol 5, Number 1. February 2023. Available at luriechildrens.org/voices.


Who We Are

Matthew M. Davis, MD, MAPP
Marie E. Heffernan, PhD
Mia Casale, MPH
Tracie Smith, MPH
Anne Bendelow, MPH
Carly Menker, MS
Amy Hill, MS
Michelle L. Macy, MD, MS
Bethany Pollock, MPH

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