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Keep Kids Safe in the Car Car seats only work if you use them the right way All 50 states have a combination of laws that require drivers to restrain children in car seats, booster seats and seat belts. Specifics vary by state, based on the child's age and size. But one fact stood out in a National SAFE KIDS campaign study of 9,600 children in vehicles at 174 sites: Of children 14 and under, 14 percent were unrestrained and an additional 33 percent were improperly restrained. Kenn Saruwatari, M.D. "It takes a while to change people's attitudes about child car restraints," says pediatrician Kenn Saruwatari, M.D. "But one look at the numbers shows why improved attitudes would help." The federal government says 1,621 children ages 14 and under died in automobile crashes in 2002, while 256,000 more were hurt. "At local car seat checkups, more than 80 percent of the car seats were being improperly used. Improper installation in the vehicle and incorrect adjustment of the harness are the most common errors," adds Dr. Saruwatari. Recommended child car restraint practices: Place a child in a rear-facing infant seat or rear-facing convertible seat for as long as possible -- at least until the child is both 1 year old and weighs more than 20 pounds. Install the car seat tightly. You shouldn't be able to move it more than an inch when tugging from side to side. Make the child's harness snug. You should only be able to fit a finger or two between the harness and the child. Place a child between 20 and 40 pounds in a forward-facing seat with a harness, up to the car seat's maximum. Use a booster until your child can sit on the seat with his back all the way against the seat back with his knees bent comfortably over the edge of the seat. Keep the lap belt snug on the upper thighs or hips, not against the soft abdomen. Keep the shoulder belt snug across the chest and collarbone. "In most cases, kids are ready for a lap belt and shoulder harness by age 8, but it's important to observe your child in your car," Dr. Saruwatari says. Get your car seat checked. Kapi'olani offers free car seat checks every Wednesday by appointment. Please call 808-983-6800.