Wednesday, March 19, 2014

Car Seat Safety

Tragically, thousands of young children are injured or killed in car crashes every year.  You already know that their best protection is a good car seat.  But did you know that you are likely using your car seat incorrectly? According to the National Highway Traffic Safety Administration, 3 out of 4 seats are used incorrectly. claims that 7 out of 10 children are improperly secured in their car seats.  These numbers are shocking. 

Unfortunately, there is no session in your birth class on choosing a car seat and installing and using it properly.  When you leave the hospital or birth center, they make sure you have a car seat, but they do not verify that it’s the right seat, or that you are using it properly.  And your child’s provider may not address car seat safety.  So when and how are you supposed to learn the ways of the car seat?

There is an excellent article on that outlines almost everything there is to know about car seats.  It is thorough and long.  Rather than reinvent the wheel, my goal in this post is only to point out some of the most common mistakes.

Photo by Bradley Gordon / bradleygee; uploaded from Flickr without amendments.

Choosing the Right Seat
·       Make sure your child is in the right car seat for her age, weight, and height.  As your child grows, keep checking the owner’s manual for height and weight limits.  Don’t try to push it past the limits just because the infant car seat is easier to use.
·       Be careful with used car seats.  Once a seat has been in a collision, it is worthless and should be discarded.
·       Do not use a seat that is more than 6 years old, has been in a collision, has signs of wear and tear, is structurally unsound, or is missing pieces.
·       Make sure your seat has not been recalled.  To do so, you’ll need to know the manufacture date and model number.  Check for recalls here.

Installing it Properly
This can get tricky:  LATCH versus seat belt; middle seat versus side seat; older cars that don’t have LATCH.  It’s not always obvious, and the owner’s manuals can be tricky to follow.  Do yourself a favor and have an expert do it for you (see resources).  Or, at least, stop by a free car seat inspection event and have an expert check your work (see resources).

Using it Properly
·       Ride rear facing until at least 2 years of age.  Don’t turn your child forward until he has exceeded the height and weight limits for his seat in the rear facing position (which usually means he can rear face long after 2 years of age). 
o   But what about his legs hitting the seat?  Injuries to legs are rare, and a child who is used to riding rear facing probably won’t be bothered since he doesn’t know the difference.
o   But I can’t interact and distract him as well if I can’t see him.  Consider this a small price to pay for a huge increase in safety. 
o   Is it really that much safer? Yes. A 2007 study in the journal Injury Prevention found that children under age 2 are 75 percent less likely to die or to be severely injured in a crash if they are rear-facing[1].  Alisa Baer, M.D., a pediatrician and nationally certified child passenger safety instructor quotes a different study showing that “rear-facing is 5 times safer for two-year-olds[2].”
·       Chest clip should be even with the bottom of the armpits.
·       The carrying handle should be placed in the retracted position.
·       Coats should not be worn.  In fact, your child can be in a onesie with an outfit over it, but nothing thicker than that.  Coats and other thick fabrics can compress in an accident, endangering your child.
·       Straps should be tight.  You should just be able to slip one finger between the strap and your child’s collarbone.
·       Do not set the car seat with baby in it
o   on top of a table, counter, etc – you would be surprised how far the car seat can fly when baby starts to wiggle
o   in the small part of grocery cart – again, the seat can fall from here, taking baby with it.  Only use the large part of the cart or your snap and go system.
o   down in the parking lot or street.  You never know when a car might lose control.  Always put the car seat directly in the car.
·       Keep your older child in her booster seat.  She must be 4’9” tall, which usually occurs around 10-12 years of age, before she can ditch the booster.  The lap belt must fit across the upper thighs, not the abdomen, and the shoulder best should fit across the shoulder and chest, not the neck and face.  She must also have the maturity to ride with her seat belt fastened correctly at all times.

Note in this picture that the chest clip is too low, the straps are loose, and the crotch strap may not be placed correctly.
Photo by Mark Evans / chimothy27; uploaded from Flickr without amendments.

Other tips:
o   Travel with a car seat.  Though it’s common to see children on airplanes riding in laps or squirming freely in a seat, it’s important to remember that they are safest when properly secured in their car seats. 
o   Use the car seat every time.  It may be tempting to forgo it, but remember that many accidents occur close to home, on familiar routes, and at low speeds.
o   Keep your child in the back seat until 13 years of age.
o   Everyone else in the car must buckle up too.  Having one person in the car not buckled up puts everyone else in the car at higher risk.

I know car seat logistics are not a fun thing to spend time and energy on, but I’m sure it’s worth the payoff in peace of mind and increased safety for your child.

Find where to have your car seat checked by local experts:  NHTSA
More information on car seats: Parents Central 
More information on car seats and general vehicle safety: download the “Playing it Safe” Brochure here 
More information on car seats at Kids Health  
More details on common car seat mistakes  
More information on car seats at The Car Seat Lady

Car Seat Checks:
Car seat class at Seattle Children’s Hospital
Seattle area car seat expert, who will install your seat for you and review safety tips with you: Sue, (206) 619-2871
Safety Restraint Coalition events: (425) 828-8975
Seattle Children’s Hospital events


Wednesday, March 5, 2014

Growing Healthy Eaters

Food Fights  
Not fun to watch.  Not fun for the parent.  Not fun for the kid.  And I can’t help wondering:  what sort of emotional understanding of eating does it instill in the child?  I worry that establishing a pattern where eating is associated with anxiety and struggles for control may cause emotional reactions to food in later life.   I hope I’m overreacting, for the sake of the many children I’ve witnessed having food fights with their parents. But at the very least, food fights are a major headache for the parent.  And wouldn’t it be lovely if the whole family could relax and enjoy mealtime together?

Photo credit Shutterstock; uploaded without amendment from Flickr.

My Advice
My advice on creating healthy eaters is primarily based on first hand experience, but is also rooted in the advice of Catherine Berglund, MPH, who spoke to my PEPS group when my son was learning to be a good eater, and various other food experts.  This subject matter is not easy to study, so most of what I say is not based in scientifically proven fact, but rather opinions and ideas that have been validated by my experience.  My advice applies to children of all ages, but is much easier to implement if you start right from the beginning.  Otherwise, you’ll find some habits are hard to break.

My biggest piece of advice is: BREATHE.  Your child will learn to eat, no matter what you do.  Also, your child will not starve himself.  Children know when they are hungry, and when they need to eat.  So if you are offering solids, and your child doesn’t seem interested, that’s okay.  Stop offering.  He will eat when he needs to.  This piece of advice applies to parenting in general – the more you breathe, the better off you and your children will be.

Babies Communicate
Next, know that your child is communicating with you.  She gives you cues around food; your job is to know what they are, watch for them, and respond to them. 
·       Cues baby is hungry:  looks at you when you’re offering food, opens mouth when shown food, avidly watches you eat, reaches for food. 
·       Cues baby is not hungry:  looks away or fails to look toward you when you’re offering food, closes mouth when shown food, pushes food away, or spits food out. 
Some of these may seem painfully obvious, but if you’re not watching for them, or if you’re overly interested in making baby eat a certain amount, you may miss them. 

As soon as you receive a cue that baby is full, stop the meal.  Do not try to get one more bite in.  As long as you are receiving hunger cues, continue the meal, no matter how much baby has already eaten.  

Note this baby is leaning toward the food, eyes wide open, mouth wide open.  This is a hungry baby!  Photo by pixydust8605; uploaded from Flickr without amendment.

Empower Baby
Babies learn by experiencing things.  They need to experience things on their own terms via touch, smell, taste, and sound to grasp their world. We typically allow them this freedom in the interest of fostering learning.  We let them color outside the lines; we give them finger paints and let them make a creative mess; we allow them to knock down the blocks we’ve stacked up.  These are all ways we allow baby to make a bit of a mess in the name of empowerment and learning. 

Eating is also a learned skill.  So why not approach it with the same attitude we take when they are learning to color, paint, or stack blocks?  Enforcing strict rules about how to eat, what and how much to eat may limit baby’s interest in learning. 

Babies have so little control in their young lives, and for good reason.  We parents spend most of our days keeping them safe and healthy and enriching their lives, which necessarily means we are in control most of the time.  But eating is an area we can allow to be primarily under their control.  And who knows?  Giving them control may foster interest, drive, and creativity, resulting in healthy and adventurous eating habits for life. 

Showing them from the start that you are allowing them to take the reins, and then continuing to let them be in control as they age, allows eating to be about their own experience and needs, rather than being something they do because they have to.

Ways to Empower Baby
·       Allow baby to feed herself 
o   This is one of the principles behind Baby Led Weaning (BLW).  These babies skip purees and start feeding themselves from the start.  (See my “Solid Food Introduction” blog post for more information on BLW).
o   Most babies who have not done BLW are ready to start feeding themselves around 9 months.  You will probably need to continue spoon feeding for some time, but they are ready to start trying to pick up finger foods.  (See my upcoming post on food quality for healthy finger food options.)
·       Allow her to make a mess
·       Allow her to play with her food (remember this is how babies learn)

Contain Yourself
Baby picks up on your emotions.  Probably more than you realize.  When you are visibly disappointed that he declines the bite of food you are offering, he sees that.  And when you are exuberant because he decides to take the bite he was considering declining, he sees that.  Babies may start to learn that taking in more food makes you happy, and that declining food makes you sad.  They want to make you happy, so they may start to open up just to please you.  They also may learn to compete with you for control.  This can be one of the first times they see that their actions produce certain emotional responses from you. 

So review the cues outlined above, and when you’re following them, do so without emotional attachment.  Remember, babies know when to eat, and will not starve themselves.  So don’t pretend to be emotionless about their eating – actually be emotionless about it. 

Family Meal
Eat at routine times, at the dinner table, with the family, without TV, gadgets, or other distractions.  Talk about how everyone’s days went.  Before long, your baby will participate in the discussion.  This is hard for families who have a parent who works long hours.  Do the best you can.  It is valuable to have family meals even when only one parent can be present.

The 10 Try Rule
It can take 10 trials of a food before a child knows for sure whether he likes it or not.  So if you offer chicken 6 times and baby doesn’t seem to like it, try 4 more times.  Without emotional attachment of course!

Avoid using food as a bribe, reward, or punishment.  Instead, use sticker charts, toys, activities, etc.  Food is for nourishment.  If you want to offer desert or a treat, do so.  But do not attach strings to it such as finishing your plate or cleaning your room.  Be careful offering fruit after every meal, as this can instill the need for a sweet just as if you had offered desert.

Toddlers will go through a picky phase.  They are learning exactly what they do and do not like in this life.  They are also learning their place in this world.  In my experience, the picky phase is mostly about wanting to gain control.  If food has never involved a power struggle for them, their picky phase will likely be less severe. 

Toddler nutrition spans a week, not a day.  Adults need a variety of nutrients every day for optimal health.  But toddlers do not.  So if they skip the protein for a few days, that’s okay.  Likewise, if they eat fruit for 2 days, apart from the messy diaper, that’s okay.

Consider getting creative and imaginative with food during the picky phase.  Think broccoli forests, asparagus spears, and mushroom houses.  But be careful – don’t get so wrapped up in the creativity that you get emotional about getting them to eat.

Encourage your kids to participate in food from the start.  At the store with your child, even your infant, point out what you are buying.  Let her touch produce.  Take her to the bulk spice aisle and let her smell spices.  Tell her the names of the items you are putting in the cart.  Take your child to farmers markets, community gardens, and you–pick farms.  Start your own garden and involve your child in the planning, planting, watering, and harvesting.  Involve your child in cooking.  An infant can be worn or sit in an appropriate seat in the kitchen while you are cooking.  A toddler can stand on a learning platform and watch what you are doing.  Explain what items you are using and what you are doing.  Allow older toddlers to hold spoons and help you measure and stir.  Any participation a child has in food preparation provides him with a sense of control over the food experience and piques his interest. 

NOTE:  Always follow your child’s Health Care Provider’s advice on solid food introduction and nutrition.  If your child is underweight, or has other nutritional or developmental concerns, stay in close contact with your child’s provider, and know that the approaches I’ve outlined here may not work for you and your child.


Catherine Berglund, MPH, maintains a GoodEater4Life Facebook page:

I’ve enjoyed good and healthy family friendly recipes from:
Feeding the Whole Family, by Cynthia Lair;

I have no financial interests to disclose.