Lucy Weinstein, MD, MPH, Medical Coordinator of Injury Prevention and Control at Winthrop, displays the recommended booster seat for four-to-eight-year-old children (at left), which is much more secure than an automobile seat belt, and an infant car seat (at right).

utomobile safety experts refer to them as “the forgotten children.” They are four-to-eight-year-olds who, in most states including New York, are not legally required to be restrained in a car safety or booster seat. Yet they are too small to be adequately protected by standard vehicle seat belts. As a result, children in this age group suffer hundreds of thousands of injuries in automobile collisions each year.

“Among children who do require booster seats, we found that only about seven percent were using them,” reported Lucy Weinstein, MD, MPH, Medical Coordinator of Injury Prevention and Control at Winthrop. Dr. Weinstein and her colleagues completed a study of booster seat knowledge and usage among Nassau County parents. Their findings were presented recently at the 10th Annual World Traffic Safety Symposium, held in conjunction with the New York Automobile Show at the Javits Center.

“Because there is no law stating that these children must use a child restraint, most parents believe that their children are safe using a vehicle seat belt,” Dr. Weinstein said. In actuality, children who are too small for “grown-up” seat belts but too big for “baby” car seats are at increased risk of intra-abdominal injuries such as liver, kidney, and spleen lacerations.

“Shoulder belts should sit across the child’s shoulder rather than neck,” Dr. Weinstein explained. “Unless a child’s legs are long enough for his knees to bend at the edge of the automobile’s seat, the lap belt is probably not sitting correctly across his pelvis.”

Generally children reach this size sometime between their eighth and 10th birthdays, when they weigh between 80 and 100 pounds. However, since leg length and torso length are factors, age, height, and weight guidelines cannot be easily applied.

Booster seats position lap and shoulder belts properly across the shoulder and pelvis, and may make safety belts more comfortable. This decreases the likelihood that a child will put the shoulder harness under his arm or behind his back.

“In one tragic case out of state, a four-year-old wearing a standard vehicle seat belt slipped out of the belt during a crash and was killed,” Dr. Weinstein noted. Closer to home, local hospital emergency rooms have treated numerous children with abdominal and other injuries which could have been avoided with the proper use of a booster seat.

Dr. Weinstein was one of only six safety advocates in the country, and the only one in the tri-state area, to receive a grant from the National Highway Traffic Safety Administration to heighten public awareness of this issue through education and outreach. Dr. Weinstein has been speaking to law enforcement officials, pediatricians, educators, childcare workers, and parents about the importance of correct booster seat use. For additional information, call Winthrop’s Injury Prevention and Control Center at (516) 663-2598.