Trolling for Safety

Earlier this week, a post popped up on a Facebook group I belong to for child passenger safety technicians. The tech who shared the link was concerned because the post was a review of a car seat, which showed a car seat being used entirely incorrectly. The straps were positioned wrong, the chest clip was too low and worst of all, a child who could not be more than 6 months old was pictured forward facing in the seat. The review itself mostly skirted by discussing anything of substance and instead was largely focused on how pretty the colors were.

I was alarmed on a few levels. I knew that if that child was in that seat, as pictured, and in a crash, she would likely be severely injured, if not killed. It doesn’t matter how many safety features are built into a car seat, if you use it against the manual and against the law and all safety recommendations, it’s useless. I was also frustrated because I think that reviews like that make parents look stupid. I may be a car safety nut, but every parent I know cares more about how long their child will fit in a seat, how it will fit in their car, if it’s relatively straightforward to use, etc., rather than what colors it comes in. But this second issue is beside the point.

After several of us (politely) expressed our concerns to the car seat company, the review was pulled and pictures were retaken with the child rear facing. The straps were still wrong and the review at no point acknowledged that the previous picture were misleading. In fact, in the comments, the poster was endorsing forward facing children at 1 and 20 pounds, which absolutely everyone in the car seat world agrees is entirely unsafe.

Once again, some CPSTs reached out to the poster in the comments of the post. I was one of them and I can tell you that my comment was 100% polite and simply trying to explain why recommending 1 and 20 pounds was not a good idea. As she had told another CPST to “do some research” I included a few links that would be useful for her and other parents interested in the seat and in car seat safety. Not only did my comment not get published, but I’ve been blocked from the website. This blogger wants parents to do research but doesn’t want any research to be shared?

Honestly, this is part of a bigger issue I’m personally struggling with. This person is calling me a “troll” because I want to help keep children safe by providing research. My only goal in sharing what I’ve learned about car seats is to keep children safe. I have no ulterior motive. I don’t think I’m a better parent. I really just want to help change the fact that car collisions are the #1 killer of children and that 75% of car seats are being used incorrectly. I’m not afraid to be blocked by people over this, I just wish there was a better way.

How do we incite change without being blocked and being called trolls? How can we teach parents what’s best if any attempt to do so is seen as a personal affront? I’m genuinely asking because I don’t even know anymore. We have a major issue with car seat safety in this country and it seems to be more difficult than ever to help parents learn how to keep their children safe in the car.

Baby Month!

It’s August 1st, which means that I will officially be having a baby this month (trust me, if he’s over 2 weeks late, I will perform my own c-section before September rolls around). Tomorrow I hit 38 weeks, which means my due date is in 15 days. Which is bananas.

The last time I was this pregnant, I was psychologically a disaster. My OB had assured me that Eli would arrive by the end of April. When May rolled around, I lost it. I was angry and frustrated and more than anything, I was anxious to meet my son. I was experiencing the normal discomforts of late pregnancy, but nothing serious. It was a head game.

This time, it’s very much the opposite. I do want to meet this baby and I am excited beyond description for him to arrive, but I am not, at least psychologically, in a rush. I want him to stay in until he’s ready. But holy crap is this pregnancy physically a lot more awful. (Let’s be clear- none of this is atypical, none of this is worse than anyone else’s pregnancy experience. I have good perspective here, it doesn’t mean that parts of it don’t suck.)

For the past 6 weeks I’ve had pubic symphysis pain like I did not know could exist. It feels basically like someone kicked me in the crotch all day long. It’s good times. On top of that, the headaches that have been so delightfully absent since the 2nd trimester blood volume increase have come roaring back, almost daily. And, because that isn’t fun enough, I can’t feel 3 of my fingertips on my right hand, because apparently you can get carpal tunnel from pregnancy. THE MORE YOU KNOW.

This morning my OB sent me over to labor and delivery to be monitored because the baby has been minimally active and my fundal height/weight aren’t increasing the way they’d like. Happily, the baby looks awesome (and he sucks his thumb!), and despite having contractions every 3-5 minutes, a cervical check showed that I am clearly not having this baby imminently. Wah wah.

In the meantime, we’re continuing to try to get Eli excited about being a big brother, which so far is not going well at all. We bought him a baby doll, hoping it would increase his interest in babies. Let’s just say, it did not. He does not want the pretend baby to touch anything of his. He does not want the pretend baby to be near him and there is absolutely zero chance that he will considering holding or intentionally touching the baby.

He did get marginally excited about the prospect of being a big brother after reading a book where the big brother saved the little brother last night (Come Out and Play Little Mouse), but that’s about it so far. I know he’ll come around, I just feel bad for the way his life is going to change, even though I know in the long term it’s going to be great.

So now we wait. And hopefully soon we’ll have more excitement to report. Let’s go August!

Why we’re Voting NO on Proposition 46

If you’re not from California, this post maybe won’t necessarily impact you directly, but it is something important enough and close enough to my heart that I’m going to post it here regardless. I will preface this with the fact that my husband is a physician in California. We’re not hiding that fact, but even if he wasn’t, we would still vote the same way.

There is a proposition on the ballot this November called Prop 46. At first glance, it has a lot of really appealing ideas. It requires mandatory drug testing of physicians and punishes those who test positive. It requires physicians to consult with a national database before prescribing controlled substances, as a way to reduce prescription drug abuse and doctor shopping. Oh and it raises medical malpractice payouts to 1.1 million (from $250,000).

Once you get past that first glance, there are huge, serious issues here.

I’m not going to argue against drug testing for physicians. That was something that was added to the front of this proposition to try to hide what this is really about. If someone wants to draw up a clean proposition for vote that isn’t written by trial lawyers trying to make a buck, I will happily support drug testing physicians. I have been drug tested as a teacher and as a physical therapist, I have absolutely zero issue with drug testing and appropriately punishing/reporting physicians. So let’s just set that aside because it’s a trojan horse.

Malpractice Cap
A little history: The current malpractice cap was created by an act known as the Medical Injury Compensation Reform Act. The idea was to put a limit on the “pain and suffering” payouts that result from medical malpractice, as a way to help prevent malpractice insurance costs from being prohibitive to practicing medicine. It doesn’t cap payouts for medical care, it simply says that beyond the amount that will be paid to cover medical costs and medical care following an event of malpractice, you can only get an additional $250,000 for the suffering the patient/family experienced.

Proposition 46 quadruples that amount to over $1 million dollars for pain and suffering alone. Proponents of prop 46 will say that this is to correct for inflation and that the cost of increased insurance for physicians won’t be passed along to consumers, but they also don’t explain how that’s possible. Probably because it’s not.

If physicians now need to carry FOUR times their current malpractice insurance, how will they pay for that insurance increase? I know popular belief is that physicians sleep on their piles of money, but I can say with great confidence that it couldn’t be farther from the truth. To answer my own question, physicians will respond to their increased insurance in 1 of 2 ways: 1. They will stop practicing (either all together or at least in California) or 2. They will be forced to charge patients more- likely by way of yearly feeds to be a patient, charging for after hours services, or refusing to see low paying insurances.

So basically you will end up paying more out of your pocket or you will need to find a new doctor (who will charge you more). But, on the off chance that you’re one of a very tiny number of people who experience medical malpractice, you can now sue the pants off your doctor. And if you’re one of the lawyers who created this proposition, you can get 4 times as rich!

CURES Database
The other major, major issue with this proposition is the forced use of the drug history database. The Controlled Substance Utilization Review and Evaluation System (CURES) is a database that is used to track prescription use. Basically pharmacists enter schedule II-IV drugs into the system with the idea being to catch patients who doctor shop for medications and to track doctors who are “overprescribing” medications. Currently only a fraction of physicians and pharmacists use this database and it is poorly funded and doesn’t work well as a result. Prop 46 would require physicians to consult CURES before prescribing any schedule II or III medications.

I’m not going to lie, I think having physicians use the CURES database is awesome. There is strong support for this and I understand why. We DO have a problem with prescription drug abuse. We do have an issue with doctor shopping. And to a lesser extent and issue with overprescription. We need to address this, but the CURES database, in it’s current form, won’t do that.

The database isn’t ready for mandatory use. In California, once a proposition passes, it has to be enacted immediately. There is absolutely no way that the day after the election every physician or pharmacist could use CURES. It would crash within the first hour. This means doctors wouldn’t be able to prescribe, pharmacists wouldn’t be able to dispense medications. The database will take months and millions of dollars to be ready for mandatory use. Where exactly is that money coming from? And in it’s current form, the CURES database isn’t protected adequately, which means your sensitive personal medical information is at risk.

It’s really unfortunate that we’ve allowed 2 very important issues- drug abuse by physicians and prescription drug abuse by patients, get thrown together with a relatively obvious ploy for more money by trial lawyers. This proposition isn’t really about patients or protecting people, it’s about money. It’s about trial lawyers getting more money from malpractice at great cost to consumers, both financially and personally. It’s going to increase healthcare costs across the state, it’s going to cause physicians to move or retire and it’s going to put sensitive medical information at risk.

It’s just not worth it. We can do better. Voting no on this proposition doesn’t mean giving up on prescription drug abuse, it means seeing this for what it is: a wolf in sheep’s clothing. Vote no on proposition 46 and tell trial lawyers that they can’t trick voters into higher medical costs that harm patients and physicians and benefit a small group lawyers.

For more information, this is the most recent Legislative Analyst’s office report. It will better explain a lot of the costs.

Also, there’s a full list of donors who gave over $50,000 towards this proposition on this website. Interestingly, all but 2 of the donors are groups of lawyers.

(Just as an FYI, I am moderating comments on this post- but not original comments. You are free to share your opinion as to why you agree or disagree with this post and I encourage you to do so. I wrote this and am prepared to handle the disagreement, however, you are not free to harass other commenters because they disagree with you.)

Let’s Talk About Car Seats: Why Extended Rear Facing is Safest

Child and adult passenger safety has evolved tremendously in the past few decades. We went from no seat belts in cars, no car seats, to car seats that sat in the front seat or didn’t buckle in, to children in the backseat and so on. And today, we have highly complicated and specialized car seats and a lot of research telling us what does and does not work in the car.

The trouble is, not everyone has evolved with the times. Just this week I saw on FB a picture of a child who was much too young to forward face and someone politely commented that the child should still be rear facing (which, we can argue the appropriateness of this another time). And then the wrath of the uneducated masses fell upon the commenter. People repeated an unbelievably large number of falsehoods about rear facing and about why it’s not safe or best and why it’s dangerous and I just felt so very disheartened. I know that as parents we want the very best for our kids, but how can we provide that when we refuse to open our minds to the latest research?

Most states have 1 of 2 laws on the books about rear facing. Either 1) children need to rear face until age 1 and (sometimes or) 20 pounds, or 2) children must be seated in properly used car seats and there is not a single car seat on the market that allows forward facing before age 1, so basically, it means no forward facing until 1. And for a long time, the best practice was at age 1 it was time to flip the seat around to face front. But we know now, without hesitation, that that is simply not what is best for kids.

To break down why this is the case, I want to start with the science behind it. The major issue with forward facing a child before at least age 2, but really before age 4, is head size. Look, my kid has a giant head, but this isn’t about that. Up until age 2, children have significantly disproportionately large heads. Even those that don’t have the percentiles of Charlie Brown.

(Image from: American Genetic Association – Journal of Heredity (1921) Volume 12, pg 421)

The muscles that control the head are very, very, very small, especially in comparison to the size of the head. So when forward facing in a collision, those tiny muscles are trying to control a very, very large head and they basically do a really crappy job at it. When rear facing, the child’s head and neck are supported by the seat and there is very little excursion of the neck at all. The consequence of a collision for forward facing young child is a phenomenon known as internal decapitation, where the spinal cord is severed internally and it virtually always results in death.

The other major reason that rear facing is safer, especially for younger children, is spinal maturity. The spine of a young child is made in large part of cartilage. This is why kids are so crazy flexible (okay, part of why) and it serves them well. Except in a car accident. The fact that the spine is made of cartilage and does not begin to ossify until age 4 means it’s not as solid or protective of the spinal cord as it is in older children. This image shows the difference between the vertebrae of a 1 year old and a 6 year old. The seemingly missing pieces of the 1 year old’s spine are filled in by cartilage, which is significantly more flexible and allows much more pressure and damage to occur to the spinal cord in a collision.

(Image from Human Osteology, T. White, 2000.)

So there’s the science. What the research shows is that between the ages of 1 and 2, toddlers who are forward facing have a 532% greater risk of suffering a catastrophic neck injury than their rear facing peers. Five hundred and thirty two percent greater risk. This isn’t theoretical, it’s a real scientific evidence and it’s not something we can argue with. The AAP recommends that children stay rear facing until age 2 or until they reach the maximum height or weight of their rear facing seat (they mean convertible, not infant carriers). The National Highway Transportation Safety Administration says to rear face as close to age 4 as possible. It’s a far cry from 1 and 20 pounds. The science unquestionably supports it, but why aren’t more parents doing it?

The most common concern parents state is leg injuries. Now, let me be clear: there is absolutely zero evidence of an increased risk of leg injuries from rear facing. Zero. In fact, leg injuries are the 3rd most common injury in forward facing children, but they are virtually unheard of in rear facing, even for extended rear facers with longer legs. Why? Because when forward facing, children strike the seat in front of them or the sides of the vehicle. There is much better containment when rear facing and in most crashes, the child moves towards the back of the car seat and away from vehicle seat, thus not injuring the legs (or the spine! woo!)

rear facing2

Other parents are concerned that an extended period of time with the legs in the frogged position is dangerous. Actually, the opposite of that is true. A frogged leg position is one of the best, most stable positions for the hip. When children have developmental hip dysplasia and need to have the hips stabilized that is the position they’re braced in because it helps deepen the hip socket. From a anatomical/physiological standpoint, the dangling legs that occur with forward facing are significantly worse for a child’s hips than sitting criss crossed or frogged.

The next concern is that it’s uncomfortable. I can’t speak for all children, but as the mother of an extended rear facer and the friend of many children who rear face until age 4 and sometimes beyond, it really isn’t the case. Parents want children to forward face, but most kids, especially before age 2, they have zero idea that there are any other options besides what they’re used to.

rear facing1

Eli is 26 months, his feet touch the seat in all his car seats and he’s never expressed any discomfort (and trust me, he can express it). He’s able to sleep very, very well in his car seats, which I’d argue is pretty challenging if you’re uncomfortable. Many kids who forward face have issues with the legs falling asleep and the head slumping, neither of which are an issue with rear facing.

rear facing 3
(He looks just miserable, huh?)

Another major concern is about what happens in rear ending collisions. I can see why this is a concern, unquestionably, since the back of the car will move toward the child. Rear end collisions comprise less than 20 percent of serious car accidents, so even if there was a risk to a rear facing child, it would be a rarity for it to even be an issue. Most rear ending collisions are at low speed and do not result in injuries and do not result in enough intrusion to even be a concern. However, even in higher speed rear ending collisions, a rear facing rider will be no more at risk than a forward facing back seat passenger. Their seat will move forward and they will ride into it, which moves them away from the intrusion.

The only reason for forward facing over rear facing that I have no response to is car sickness. Studies show that there’s no significant difference in car sickness in rear v. forward facing as long as the child has a clear view out a front or back window, but I know that it’s not been the case for many people. I do not recommend this, but I can absolutely understand how a child vomiting in their car seat would present a significant safety hazard (as a distraction) and may outweigh the benefits of rear facing. It’s a decision that needs to be very carefully weighed and not taken lightly.

No one here is advocating rear facing beyond the limits of a car seat, but if a child still fits within the height and weight maximum of a seat, there is no reason to turn them around and doing so immediately reduces their safety in the car. Yes, decades ago we survived without car seats and forward facing from birth, but a lot of other children haven’t. If we want to reduce the number of fatalities and catastrophic injuries from car accidents, we have to educate ourselves and educate others. We have to move forward and not take new research and recommendations as a criticism of our parenting or the choices we made before we knew better.

It is critical that we listen to the science and that once we know better, we do better. Our children look to us to keep them safe. There is no question that rear facing, until at least age 2, or if possible, age 4, is the best way to do that in the car.

Things I’ve Learned this Week

You ever have one of those weeks where you just feel like a rookie at everything you do? Because yea, this was one of those. In no particular order, things I learned this week:

1. Just because a stuffed animal tag says to hand wash doesn’t mean that hand washing will actually get the smell of vomit out of it.
2. Stuffed animals that say they must be hand washed do just fine in a washing machine.
3. The gentle cycle was not made for items covered in vomit.
4. Sometimes, toddlers throw up in their bed for no reason and then sleep in it quietly all night.
5. Toddlers are disgusting.
6. Scentsy plug ins are the greatest invention of all time.
7. If you try to remove a Scentsy from an outlet while the wax is melted, no matter how carefully you pull, you will throw hot wax all over yourself and your surroundings.
8. Seriously, no matter how carefully you do it. Trust me.
9. The group B strep test is a horrific invasion of personal space and it turns out it’s something you might forget between pregnancies.
10. My 2 year old now has the cognitive and language abilities to have an actual argument with his father.
11. He also has the persistence to win the argument.
12. If you buy your toddler cute pajamas, they will never want to take them off and might wear them to preschool pretty much every day.
13. If you put your toddler in a normal shirt and pants, ones that would be acceptable to wear to preschool the next day, to sleep in, and feel like an evil genius for thinking of this, they will ask to change out of their jammies in the morning.
14. Eli thinks flip flops are called clip clops and that is now what they are called forever and ever.
15. Toddlers can live on air and water and bananas for days at a time.
16. Items tend to cook better in the oven when you turn it on.
17. They also cook better if you don’t accidentally turn it off halfway through.
18. The timer and the oven buttons are very close together.
19. Insurance companies can limit the number of generic Zofran you can get each month, even if your doctor prescribes a normal dosage and even if you’re pregnant with persistent nausea.
20. Because apparently insurance companies know more than physicians.
21. You can eat several pints of ice cream and all kinds of terrible things when you’re 35 weeks pregnant and not gain an ounce.
22. Somehow, pieces of tile can get into your Bisquick.
23. Bisquick takes these claims SUPER seriously and will call you at 8am the morning after you submit an email.
24. They will also tell you that it’s not tile, but hardened “product.”
25. Apparently, if the “product” is left in the equipment too long, one side lacquers itself. Or you know, IT’S A PIECE OF TILE.
26. There’s something kind of sad about your toddler switching from calling you mama to calling you mommy.
27. I have the cutest toddler on earth. Okay fine, I didn’t learn that this week.

Second Verse

I think I have been in a bit of denial about the impending birth of my second child. The first trimester was so long and so slow and I wanted it to go faster and now that I’m at the end, I am trying desperately to find more time. Despite the fact that I’m having another boy, things could not feel more different this time.

I’m less nervous about the birth than I was last time. That’s just a product of it no longer being an unknown. I know that it is going to hurt like hell and that epidurals are amazing. I know that the pain will be temporary and I am trying to not forget that the contractions don’t stop when the baby is born, because that made the second day kind of traumatically upsetting last time. I’m told it’s worse this time, but even that is short lived, I know.

I am much more nervous about breastfeeding, and then also less nervous about not breastfeeding. With Eli I was a disaster. He was born, they put him on my chest, he wiggled his way to my breast and then he did nothing. Did not root, did not suck, did not have any interest in any of that for anything other than a pillow. For two hours of bonding time we tried to convince him and he was not having it. The nurse tried to stimulate his rooting and sucking reflex and…nothing. He didn’t eat a thing for almost 24 hours.

I carry some guilt about this, because I was trying so hard to be relaxed and not one of those crazy new mothers that I didn’t ask for the help I needed. I just went with the, he’ll figure it out, and when he didn’t, I still tried to stay calm. I let lactation consultants discharge us when we weren’t anywhere near ready to be independent with feeding and then when it didn’t work out, I got so obsessed with succeeding on some level that I cried when I had to supplement with formula and I pumped 6-8 times a day for a year.

Let’s say that virtually none of that is going to happen this time around. I’m going to try to be relaxed, but I’m going to advocate for us. I’m not going to get caught up in the formula is evil for only my baby mindset and am going to feed my child however works best for us. I want breastfeeding to work, but not at the expense of my sanity. I lost so much time with Eli to pumping and crying and worrying and I will not do that this time.

While I was sure I was going to go early last time and was instead 6 days overdue, I still have a suspicion I won’t make it to my due date with this one. Partially it’s just a weird gut feeling, and partially it’s that I was already dilating and effacing at 26 weeks and have contracted all the live long day since then. If these contractions strengthen the uterus, mine is an absolute beast by now.

Eli was an excruciating 6 days overdue and I was awful. I was homicidal. I hated everyone and everything. I won’t do that this time. This time I will remember that Eli was only 6 pounds and 15 ounces after being overdue and it’s clear my body waited for a reason. If this baby doesn’t come early, I know it’ll be for a reason. I know my doctor will monitor me and make sure everything is safe and then I have to trust that my body knows what it’s doing.

And while all of that sounds like I have things mentally in control, that’s…not entirely true. I am terrified of the transition from 1 to 2. I feel like Eli is going to struggle and it makes me sad and scared. I’m worried I won’t be able to take care of them both alone, which I will have to do a lot of and, which is not a surprise, obviously, just a fear. I fear the sleepless nights followed by the toddler mornings. I can’t even talk about how scared I am to go back to work when this baby is only 14 weeks old (I know many people have it tougher, I just had a bit more time with Eli). For all the knowns this time, there are still so many unknowns left.

I have 5.5 weeks left until my due date and I know most of this stuff will play itself out one way or another, but I am both totally ready and not even a little bit ready. Life is crazy that way. I’m horribly uncomfortable and exhausted, but I’m also comfortable with life as I know it. And we all know that change is never a good thing. I guess unless it’s tiny and cute and a baby.


For months, I’ve referred to Eli as an “easy going” kid. We had our share of struggles the first two years (transitioning out of the Rock n Play and not sleeping through the night top the list in my mind), but for the most part, he has always been pretty mellow. We never once had a sleepless night, when he didn’t get his way he would say “sorry” and cry quietly and all these things made me very hopeful that maybe, just maybe, he was one of those anomalies who wouldn’t go through the “Terrible Twos.”

And for the first few weeks of two, it appeared that way. As you can imagine, that didn’t really last.

Eli was increasingly toddlerish for a few weeks prior to when his dad went out of town mid-June, but it wasn’t anything that couldn’t be managed pretty easily. He was incredibly picky about meals, wanted to walk and touch and do anything we told him not to, but he was still redirect-able and we were managing well. Then his dad was gone for 10 days to two difference conferences across the country. I expected the worst, but those 10 days, aside from a 5 day fever and my grandfather dying, were pretty decent for Eli.

And then my husband came home and everything went to hell in a giant screaming hand basket. The first day my husband was back in town, there were at least 5 full blown tantrums. One involved near vomiting in the car, which was a real treat. He ate no lunch or dinner that day because both meals were completely overtaken by hysteria, despite both meals being things regularly atop his favorites list. I cried twice. He would recover from tantrums and I would sit there feeling like I’d run a marathon and wonder how on earth he was okay because the world felt vaguely like it was ending. This crap is intense.

And since then, it has continued. Maybe not everyday, but virtually everyday, there is at least one occasion for a tantrum. It is sometimes because we won’t let him watch endless Elmo, it is sometimes because we dare change his diaper or because we won’t let him run on the pool deck. There is nothing that feels quite as frustrating to me as planning a fun outing specifically for Eli and having it marred by a tantrum.

And there are other times where I have absolutely no idea why my child is screaming and thrashing. Like tonight at dinner. We told him dinner was approaching, so it wasn’t out of the blue. It was leftovers of a meal he loved yesterday. Nothing had changed from the 2 other meals of the day, nothing was irregular, but he lost it. Screamed to get down for at least 5 minutes (we have a rule that everyone sits at the table until we’re all finished eating, regardless of what you eat), ripped his booster straps off at least 1o times and was just crazy. And then it stopped as quickly as it started and he decided to eat like nothing had just happened.

Two is just…it’s hard. I had no idea how hard. I have babysat and nannied and been around children my whole life, and yet, it’s completely different with your own child. Because not only do I feel an obligation to handle the situation correctly- not to give in, not to let him “win” the important battles, not to let him get hurt, etc, all the things I should do to raise a good kid. But at the same time, he’s my baby and he is struggling with something. I can’t fix it, I can’t just hug him and give him what he thinks he needs and the cognitive and emotional dissonance is indescribably difficult. It’s not just the being firm, it’s being firm when all you want to do is give in.

Eli is far from a particularly difficult two year old, he’s totally normal in this way and I know it. But as normal as it is for two, it’s entirely abnormal for my parenting experience and it is difficult. I’m terrified for what will happen when we introduce a baby into the mix because I’m pretty sure that Eli having less attention isn’t going to be the answer. I love my son to the ends of the earth and truly cannot imagine my life without him, but man. Two. I was not prepared.

Please don’t comment to tell me three is worse. Denial and ice cream are pretty much my only coping mechanisms.

Let’s Talk About Car Seats: How to Install your Seat Correctly

I probably should’ve started with this post since proper harnessing is pretty much irrelevant if your seat isn’t installed correctly, but we’ll just live and learn here. This is long, but it’s not tough to read. I don’t think.

Installation can be one of the more daunting challenges to parents, especially new parents, because there is a lot to manage. The terms are unfamiliar, the rules are changing and all you really want is to keep your child safe. Every parent and caregiver should know how to install the car seats that are or could be in their car. You never know when someone will accidentally unbuckle the seatbelt holding your seat in place or when you’ll need to move it around. Having only one designated installer is a recipe for disaster.

So, how do you install a car seat? I’m going to break it down into two categories- rear facing and forward facing seats. Boosters are a class of their own (most of the time you just set it in the seat and buckle your child in), so we aren’t going to touch on those today.

For either rear or forward facing, the same first 3 steps apply:
1. Read the manual. Seriously, before you touch the seat or set it anywhere near the car, read the manual.

2. Figure out what installation method you’re going to use. There are 2 basic methods- a seatbelt installation and a LATCH (lower anchors and tethers for children) installation. The seatbelt installation requires that your seatbelt is “locked” in some fashion, the LATCH installation requires that your car has lower anchors (all vehicles since 2002 have lower anchors). LATCH and seatbelt are EQUALLY SAFE when used properly and neither are tough to do once you’ve practiced a few times. There is also a new law that states that LATCH can only be used until a combined weight of 65 pounds, so find out your child’s weight and your car seat’s weight (should be available online if not in your manual) and see if LATCH is an option.

3. Pick your seat location. Statistically speaking, the middle seat is the safest position in the car. The chance of injury is 40% less in the middle, as it is farthest from any impact point. If you are choosing to do a LATCH installation, you must check your car manual to find out if you have anchors in the middle seat. Few cars have dedicated middle anchors and most cars and car seats forbid you from borrowing, or using one outside anchor from either side, to install the seat in the middle. Many car seats also forbid this, or require a very specific distance between anchors.

1. Find the angle indicator on your seat. Most infant seats have a level bubble or color zone that indicates the right angle for the seat. Many convertibles have lines that should be level to the ground. If using a convertible, your seat may need to be reclined to a certain level (specified in your manual). If using an infant seat base, you may need to rotate a dial to make the recline foot higher or lower to get the right angle. If your seat isn’t adjustable and isn’t within the proper angle range, check your manual, but most car seats allow a tightly rolled towel or a pool noodle (or a pyramid of 3 noodles) to be put under the seat at the bite (where the back and butt portion of the vehicle seat meet) to help recline it further.

This is the angle indicator on Eli’s seat in my husband’s car. It offers two zones- one for infants younger than age 1, one for older kids. Ground level should fall somewhere within those two zones (we actually have it pretty well reclined- this seat sits very upright and cause Eli’s head to fall forward when he sleeps)
angle indicator

2. Install the seat using the method chosen in step 2.

2a. Install using a locking seatbelt. Figure out how your seatbelt locks- there are a few options (all of which will be described in your car’s manual), most reasonably recently produced cars have a switchable retractor, meaning they’re not locked during normal use, but if you pull the seatbelt all the way out gently, you can feed the belt back and it will be locked. For this type of belt, thread the belt through the appropriate belt path (it will be labeled and specified in your manual, this is important) and buckle it. Then pull the belt all the way out, and feed the slack in. Put pressure on the seat and pull the belt as tight as you can, feeding the belt back into the retractor as you go. Sometimes seatbelt installations result in a slight tilt on the side opposite the buckle so you may need to put more pressure on that side of the seat to keep it straight (though a slight tilt is not a safety issue as long as the install is tight).

This is our carseat installed with the seatbelt. Our cars do not have center LATCH, so to keep Eli in the middle, we use the seatbelt. If we’re being honest, I prefer seatbelt installs almost 100% of the time.

2b. Install using seatbelt lockoffs built into the car seat. Some car seats have seatbelt lock offs built in. These work to lock the seatbelt without locking at the retractor. They’re no safer, but are sometimes easier. To install with this, thread your seatbelt through the belt path and into the lock off as described by your manual. Put pressure into the seat, tighten the seatbelt as much as possible, then close the lock off.

This is an example of a lock off (the blue thing). The seatbelt gets threaded through, then without actually locking the belt, you pull all the slack off and close it. The seatbelt is held tight and for the most part they’re pretty easy. I have lost many a finger nail on these, however.

2c. Install using LATCH. Hook your LATCH connectors onto the anchors. Put pressure into the seat, then tighten the strap until the seat is secure.

These are LATCH connectors. Some will be more like top tether hooks (pictured below), but these are the newer, easier to use style.

3. Check your installation. Double check that your angle is still within the normal range. Then check for movement. Using your non-dominant hand at the belt path, move the seat side to side and front to back using about the pressure you’d use for a firm handshake. It should move less than an inch in all directions.

4. Hook your top tether- IF APPLICABLE There are only a small handful of car seats that allow top tethering in rear facing mode (Britax, Combi, Peg Perego, Diono, that I know of) and you must check your manual. If it doesn’t specify that you can do this, then you cannot and should not do so. If your seat allows it, it will come with a D-ring that you will loop around a stationary part of your car, likely the seat track. Clip the top tether to the hole on the d-ring, then tighten just until the slack is out. Store any extra harnessing from the tether.

Here is the top tether, it’s currently not in use, but this is what they typically look like.
top tether


HOW TO INSTALL A FORWARD FACING CAR SEAT I highly, highly recommend you check the strap height on your seat before installing it. If your seat has a manual rethread harness (that is, you can’t pull a lever and raise the straps) it’s virtually impossible to do this once it’s been installed forward facing.
1. Make sure your seat is set for forward facing. Some convertible seats have a rear facing boot/recline setting, so make sure you’ve stored that or set the seat to the appropriate setting. Your manual will specify.

2. Install the seat using the method chosen in step 2 from above. The steps for this are exactly the same as above in 2a, 2b, 2c.

3. Check your installation. Using your non-dominant hand at the belt path, move the seat side to side and front to back using about the pressure you’d use for a firm handshake. It should move less than an inch in all directions.

4. Attach the top tether All convertibles and combination seats should have a top tether for forward facing. This tether was created to help reduce head excursion in the event of an accident by holding the top of the car seat secure to the vehicle seat. You’ll need to check your manual for top tether locations, but as long as you have a top tether anchor, you should absolutely use it when installing forward facing. Hook the top tether to the anchor, then tighten just until the slack is out.


Later this week I’ll go over some common installation errors that I grazed over quickly here. Please know that I never judge parents for things like this. I have installed just about every one of Eli’s seats incorrectly at some point. It’s a learning experience, it’s just one where we want to eliminate as many errors as quickly as possible.

Please feel free to ask questions in the comments.

May his Memory be a Blessing

There is a Jewish phrase that is used when someone passes away that I was reminded of today. In Hebrew it is zichrono livracha but it translates to “may his/her memory be a blessing.” While my grandfather was a practicing Catholic and probably has never heard this in his life, as soon as I heard it, I knew that it was exactly the right thing for today.

My grandfather passed away this afternoon, surrounded by his family. He is no longer in pain and after 12 years apart, he has finally been reunited with his wife of 50 years. I hope they’re already playing Mario Golf.

When I was 15, I moved into my grandparents house while my mom and I waited for our new house to be built. I was a disgruntled teenager who did not want to live with her grandparents and wasn’t always pleasant to be around, to say the very least. Every day as soon as I walked in the door from school, my grandma would shoot questions at me like a machine gun. How was your day? Did you learn anything? Did you see your friends? What’re you doing this weekend? Do you want a snack? At the time I wanted to scream, but I know in hindsight that it was just her way of showing her love. She was genuinely interested in all the answers, and all too often I responded mostly with eye rolls.

But my grandpa was different. I’d finish my homework and he’d walk into the den, sit down in the chair next to me and ask me if I wanted to play a video game. No other questions, no obligations. And then we would play. The conversations were always easy and quiet and mostly revolved around just how terrible I was at Mario Golf and how if I could just be more patient, maybe I’d hit the ball straight. We never did find out whether or not that was true. Patience is clearly a virtue I did not inherit from him. But he did teach me the value of quiet, of a slower pace, and in that way, his memory is already a blessing to me.

I don’t want to paint him as a dull person because that couldn’t be further from the truth. At my sister’s wedding, he somehow got ahold of the microphone and offered up all his remaining granddaughters for any takers. I should probably add that he wasn’t sober, but it was a wedding, virtually none of us were. One year for Christmas in our gift exchange he left 2 of the 3 spots for gift suggestions blank and put “a hooker” in the remaining one. This was especially troubling because there was a $50 limit on gifts and he was like 80 at the time. He always had a good supply of jokes and had a great way of diffusing tough situations with them, even if not always intentionally. As much as he valued silence, his easy laugh and great sense of humor is another memory that will always be a blessing to me. I’d like to think that all of us who knew him inherited a bit of that.

Possibly the greatest thing I have taken from my time with my grandpa was his ability to accept life as it was handed to him. He was dealt a lot of rough hands in his 88 years: colon cancer, diabetes, the premature and sudden death of his wife, tongue cancer and then a recurrence of tongue cancer. And while I know that these things made him mad and sad and frustrated, he never seemed to let that stop him. He grieved, but then he pushed forward. He didn’t fight life, he didn’t try to control the uncontrollable. He just lived the best life he could, given whatever the circumstances were. I don’t come by this ability naturally, in fact, very few of my family members seem to, but I hope that we have enough of these memories to help us all get through these tough times.

This past Thanksgiving, our whole family, minus one of my uncles, made it home for a family dinner. I noticed that while my cousins and several aunts and uncles and I were embroiled in a rowdy conversation (about someone’s ex-boyfriend who was overly feminine), that my grandpa was sitting quietly across the room. I asked my mom if we should get him a chair so he could sit with us and she told me that she had asked him, but he said he was good there. He told her that he was just so happy to see everyone together. He understood and taught us all how important family is and I know that we have enough of those memories to bless our lives forever.

As I go to bed tonight, my heart is heavy with this loss. I was tremendously blessed to have him for 31 years and I am grateful that he is no longer suffering, but there will never be enough time. My greatest sadnesses are that my sons will not get to eat pancakes with him on Sunday mornings, climb trees or play baseball in his backyard while he barbecues. Some of the happiest moments in my childhood and adulthood took place in his presence and I know that I am a better person and a better parent for having him in my life. We will never stop missing him, but I will work each day to allow his memory to be a blessing in my life and in the lives of those I love.

And I think he really would’ve liked that.


Let’s Talk About Car Seats: Proper Buckling Edition

I realized this week that it’s been 2 months since I completed my courses and became a child passenger safety technician (CPST) and I really haven’t done much with what I learned. Mostly this is because I am bohemethly pregnant, which makes it tougher than you’d think to install car seats. But I realized that being giant shouldn’t stop me from sharing the things I’ve learned that can help keep kids safe.

I frequently see pictures of kids on Facebook, twitter and Instagram who are in their car seats, smiling their hearts out, and all I can think is how terribly injured they would be in an accident. I know this isn’t because their parents don’t care about them, quite the opposite, they’re in a car seat in the back seat because their parents care, but somewhere along the line, the proper buckling/safety got lost or missed. And those kids, and thousands of others, are at risk for serious injury in an otherwise survivable car collision.

So today I want to talk about how to properly buckle a child into a 5 point harness, including some common mistakes and why we need to be careful about not making those.

This is Eli, he’s 2 years and 1 month old and he rides rear facing 100% of the time and will until he outgrows the limits of his car seat. We can talk about that another time, but he’s clearly not unhappy about it. In fact, he cried when I took him out of the car. I’m not even kidding. It might have been more because he had to put his pacifiers away, but still. He loves his seat and rides happily in it.

properly restrained 1

Here he is properly restrained. His harness is snug enough, the chest clip is positioned properly, the straps are on the right setting and his seat is properly installed (another post for another day). This is how he rides 100% of the time, regardless of whether he’s put in the car by mom or dad. We take the time to do this every single time. Even when we’re running late, which is 100% of the time.

properly restrained 2

Now, let’s look at some common errors and how to correct them.


1. Chest clip placement. This is probably the most frequent error and is a big one. I know it probably doesn’t seem that critical, but the chest clip plays a huge role in keeping your child safe in a collision. The chest clip keeps the straps properly positioned on the shoulders. In the event of a collision, if the chest clip is too low, the straps can slide off the child’s shoulders and the child can be ejected from the vehicle. Also, if it’s positioned over the belly, it may cause abdominal injuries in a crash.

chest clip

How do you know it’s in the right place? The chest clip belongs at armpit level (or nipple level, same difference). It should not be anywhere near the belly at any time.


2. Loose straps. I get how this one happens. We don’t want our kids to be uncomfortable, so we make sure the harness isn’t too tight. But in doing so, we are putting our kids at serious risk. If the harness is too loose in a rear facing seat, the child will “ride up” the seat and can be ejected. If the harness is too loose in a forward facing seat, the child will have significantly more movement forward, which could cause them to collide with the front seat, injuring arms, legs, brains and spines.

loose straps

So how do you know if the straps are tight enough? The pinch test. The pinch test is the best measure to make sure the straps are tight enough. Once you’ve tightened the harness, attempt to pinch the webbing (horizontally) at the collar bone. You may need to remove or unvelcro shoulder pads to do this, but doing it at the belly is not valid. If you cannot pinch any of the harness, it is properly tightened. If you can pinch the harness, it needs to be tighter.

Here, I can pinch the harness, so the harness is too loose.
pinch test 2

Here, when I try to pinch, I can’t grasp any of the harness webbing between my fingers, so the harness is tight enough.
pinch test 1


3. Aftermarket products on the seat. As you can see, I did this. I did it for a full year before I knew better (we can also discuss how the straps are too loose, I too made almost all these mistakes before I knew better). I thought that Eli would be more comfortable with these strap covers on and I clipped his pacifier to his harness. Why are these things wrong? Well, for starters, any object that isn’t crash tested with your car seat shouldn’t be used. Your seat was intended to work a specific way and there’s no way to know if adding something is going to be dangerous. For strap covers, the issues are that they can make the straps slippery and cause them to slide off your child’s shoulders, or, in a crash the fabric can compress (much like if you put your child in a puffy coat) and cause the harness to be too loose in the moment you need it to be tight. The pacifier should never have been clipped there because it could damage the harness and reduce it’s ability to perform correctly in a crash.


So, how can you protect the neck from strap marks? You can call your car seat manufacturer and see if there are any strap covers that they can send that have been crash tested with their seat, and many companies have these available. If that doesn’t work, you can put your child in polo shirts, you can pull their shirts up under the straps, or you can just live with it. It’s not a perfect answer, but when used properly, the harness shouldn’t damage the skin.


4. Combination loose straps and low chest clip. This is the worst. I don’t mean for this to come across meanly, but if this is how your child is buckled into a car seat, you really shouldn’t even bother putting them in a car seat. This will provide absolutely zero protection in even a mild crash. The child will be ejected at least from the seat, if not from the car, and very likely severely injured.

loose and clip

This actually happened to an infant in my area recently. The car accident was entirely survivable, but the child was ejected because she was in a seat with the chest clip at belly level and the straps too loose. It is an absolute tragedy and that’s why I’m telling you this. We all get told repeatedly by doctors and family members how to feed our kids, what the safest products are, but no one takes the time to teach parents about car seats. Car crashes kill thousands of kids each year and studies have found that more than two-thirds of car seats are used incorrectly. We need to take the time to correct our mistakes and change our ways so that we can keep our kids safe.


It takes less than a minute for me to get Eli properly strapped into his seat. I know when we’re in a rush it feels like every second counts, but safety should never be rushed. Taking those extra 30 seconds to adjust the chest clip and check the tightness are absolutely critical. I am not exaggerating at all when I say that it can literally be the difference between life and death for a child. Please take the time, pay attention and now that you know better, make the conscious decision to do better.

I'm Katie, a 30-year-old, wife, mom, former teacher-turned PT, who also had brain surgery in November of 2007. This blog chronicles my daily life, from mundane to crazy, often with far too much detail. Sit down, get comfortable and stay for a while.
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