When Emily Woodward, 24, attended UCHealth’s car seat education class at 37 weeks pregnant, she was astounded to discover that her baby would be safer in a car seat than in her belly — that is, if she used a car seat correctly.

According to the National Highway Traffic Safety Administration, proper use of a car seat reduces a child’s risk of death during a motor vehicle crash by 71% for infants, 54% for children ages 1 to 4, and 45% for booster-aged children. However, studies also show that car seats are misused 59% of the time.

UCHealth provides education classes about proper use of car seats for parents and caregivers to prevent unintentional injuries to children.

“At UCHealth, our mission is to improve lives, and to do that, we have to reach beyond the hospital walls if we want to reduce unintentional injuries in children,” said Jennifer Salvador, UCHealth Community Health Improvement supervisor.

From July 2023 to June 2024, UCHealth helped 211 families – 39% of which were Spanish-speaking – learn how to keep their children safe on the road. During that period, UCHealth distributed 217 new car seats and boosters.

“We were able to start with good habits because of this class,” Woodward said. “And now, I’m working in childcare, and I’m finding there are a lot of parents and people who don’t know how to use a seat correctly, so I am using what I learned to help other people.”

Car seat safety education and distribution class

In Larimer County, UCHealth offers free car seat safety classes and provides one car seat or booster per family for a $30 fee. Scholarships also are available for anyone in need. The program is part of UCHealth’s Community Health Improvement and Trauma Services initiatives and its Safe Kids partnership, which aims to equip parents with the knowledge and skills to keep their children safe and prevent injuries.

“A new car seat is about $150, or you can pay $30, get vital information and get a new seat,” Woodward said.  “I planned to find a hand-me-down car seat, and it wouldn’t have lasted, and I would have still spent that money.”

Woodward heard about the program through her doctor. As the youngest child in her family and a first-time mom, she said she “didn’t know much of anything around car seats.”

For Woodward, the class was eye-opening. Her husband, who attended the class with her, was reasonably confident about his knowledge of car seats as the oldest child in his family. Still, Woodward said even he walked away with vital information to keep their child safer.

“In my opinion, this class is good for everyone, even those who aren’t parents but watch others’ kids,” she said.

Starting with good car seat habits

In her childcare job, Woodward said she often sees people misusing car seats, so she shares knowledge from her class to educate others.

“Just the other day, a grandmother picked up a baby, and the (car seat) straps were set for a much tinier baby than she was picking up,” Woodward said, adding that she was able to show the grandmother how to reposition the straps to fit the grandchild properly.

According to the National Safety Council, the most common errors adults make with a child’s car seat or booster are:

• Loose harnesses for all car seats.
  • The harness holding the child must be snug and placed in the correct position. Harness straps that are too loose can cause injuries. For example, an infant can slide down in the seat, and the harness could potentially block their airway.
  • Do the “pinch test” to ensure the harness is tight enough. It is too loose if you can pinch the straps between your fingers at the child’s shoulders.
• An incorrect recline angle for rear-facing car seats.
  • Car seats have a leveling device on the side — a line, bubble level or recline indicator ball. The car seat angle is important to keep an infant’s head from leaning too far forward and restricting their airway. Read the recline instructions in your car seat manual.
• Loose installation for car seats.
  • It can be challenging, but it is essential that the straps securing the car seat to the vehicle are tight, whether those are anchor straps that clip into the vehicle or a seat belt. Once installed, a car seat shouldn’t move more than an inch at the belt path in any direction.
  • Use only the lower anchor straps or a vehicle seat belt to secure the seat. Don’t use both, as they work against each other, making it less safe. The same rule applies to car seat bases.
  • Always lock the seat belt if you are going to use it. You do this by completely pulling out the belt until you hear clinking when it retracts.
  • The top tethers, which go over the vehicle seat and clip behind, should always be used in forward-facing car seats, regardless of whether the lower anchors or a seat belt are being used. The top tether reduces forward head motion to reduce injury risk.
  • Most vehicles don’t have center seat anchors. To secure a center-positioned seat, use the center seat belt instead of one of the left and right anchors.
• Harness behind the child’s arms, legs or back in a forward-facing car seat.
  • The chest clip needs to be at armpit level.
  • The harness must be at or slightly above the shoulders for forward-facing seats and slightly below the shoulders for rear-facing seats.
• Improper lap belt position or shoulder belt position for smaller children.
  • Laps and shoulder belts will not be in the correct position on a child without a booster seat. Most children don’t fit properly in a regular seat belt until they are 4 feet, 9 inches tall.

Getting the right seat at the right time

While the class educates caregivers on properly installing car seats, it also provides guidance on selecting the appropriate seat based on a child’s height and weight.

 “Empowering caregivers with knowledge to keep their kids safe can trickle through our community. And just as Emily (Woodward) mentioned, one person being properly educated can help educate others. Taking the extra moments to make sure everyone is buckled up, not driving distracted or impaired, and even putting on a helmet while biking can be the difference between life and death,” Salvador said.

Unintentional injuries in children

Unintentional injuries – such as those caused by vehicle crashes, bicycle crashes and choking – are the leading cause of death in children and adolescents ages one to 19 years old and account for one-third of all deaths for this population each year, according to the American Academy of Family Physicians.

“Children are a vulnerable population,” Salvador said. “To keep them safe and healthy, we provide education in the communities where families live, as well as in the emergency room or hospital after an injury. We aim to work with parents before a preventable injury occurs.”

Research and educational resources for the program come from Safe Kids Worldwide. Smaller coalitions like Safe Kids of Northern Colorado then focus on the top injury topics in their areas. UCHealth became the regional coalition’s lead agency in 1999 and employs community educators who offer classes and administer many safety initiatives. Within the regional coalition, UCHealth offers car seat education classes and car seat consultations starting from birth, even before a parent or guardian leaves the hospital. UCHealth also provides seat belt consultations and car seat education to pregnant women and parents of children with special needs.

“We are a coalition of partners, so we are all on the same page and are not duplicating efforts,” Salvador said. “Although UCHealth is the lead agency for Safe Kids Northern Colorado, we could not do the work and have the community prevention and safety impact without the dedicated 20-plus Safe Kids partners helping us make our community a safer place to raise children.”

In addition to seat belt and car seat safety efforts, UCHealth helps fill gaps in the community by partnering with other organizations. For example, while local Safe Routes to School programs handle bike safety programs of Safe Kids Worldwide, UCHealth fills in the gap by offering bike helmets at community events, in classrooms, at Colorado State University bike shops and in emergency departments. For teens, UCHealth offers a five-hour Prevent Alcohol & Risk-Related Trauma in Youth (P.A.R.T.Y) class on teen driving and trauma.

“Our kids are our future,” Salvador said. “We need to create a culture of safety for the children in our community to help protect them from these devastating injuries and premature deaths.”