Seat Belt Syndrome


     I want to make this VERY clear:  this article is in NO WAY intended to provide you with any kind of excuse for not wearing your seat belt.  You and all vehicle occupants are far more likely to sustain more injuries, and much more serious injuries if you and they don’t buckle-up.  I have written this article to re-enforce the reasons to use your seat belts properly and have your children properly restrained using the correct safety restraint for their size.  Seat Belts Save Lives IF you use them, and use them properly.


     Why should I put my 6 year-old-child back into a “Baby Seat”?  She doesn’t want to be seen in a car seat.  He’s been using a seatbelt for 2 years, how am I supposed to tell him he has to sit in a booster seat?

     These and many more questions have been posed because of the National Highway Traffic Safety Administration recommendations that say if a child isn’t at least 8-years-old or 4’9” tall they are probably too small for the vehicle seat belt system.  These children need to be in belt positioning Booster Seats until the vehicle seat belts fit them properly.

    It has been found in studies that only about 6.7% of Booster size children use them.  In 2003 there were 582 children killed in motor vehicle crashes in Florida, 214 were totally unrestrained.  Most of them would have survived if they were seated, wearing seat belts, or were properly restrained in Child Safety Seats or Belt Positioning Booster Seats.

     What could happen if your child were using the vehicle’s lap belt or lap/shoulder belt system putting the shoulder belt behind their back or under their arm (as I’ve seen so often)?  What if the shoulder belt part was across their neck or ear and not over the strongest part of her chest-the shoulder/collar bone area? 

     A simple rule of thumb equation can be applied to understand the amount of restraining force needed to keep a vehicle occupant secured in their seat during a motor vehicle crash.   Weight x Speed, that is the weight of the occupant times the speed the vehicle is traveling at the time of impact.  An example is:  a 40 pound child in a vehicle traveling at 30 miles per hour would require 1,200 pounds of restraining force to keep him in his seat during a crash.  An improperly or unrestrained child would be propelled into the back of the front seat, the dash or windshield, another passenger, or be thrown out of the vehicle through a window or sun-roof.  A child who is too small for the seat belt system tends to slouch down until their knees reach the edge of the seat.  This moves the lap belt up over their soft, unprotected abdomen.  If the shoulder belt rubs against their neck they tend to move it under their arm or behind their back (I’ve seen some adults do this too) causing them to lose upper body restraint and suffer head, upper body and spinal injuries which could lead to paralysis or death.  During a crash, using a lap belt alone, the body is propelled forward, jack-knifing over the lap belt that can cause serious internal injuries, and the head strikes the back of the front seat, rolling backward as the body continues in its downward arc, breaking the neck.  The spine stretches and the spinal cord can be damaged.  The 40-pound child in the example would sustain approximately 1200 pounds of crushing force against their abdomen, and the child could sustain a lacerated liver, spleen or bowel, a ruptured bladder, and internal bleeding.  Many of these internal injury symptoms don’t present themselves at the time of injury.  An occult bleed may not be detected for hours after a crash.  There have been so many of these injuries to children and partially restrained adults that the medical community has named the group of common injuries “Seat Belt Syndrome”.

Example:  A 3-year-old boy was wearing a lap belt when the vehicle he was in struck a tree.  In the Emergency Department 2 hours after the collision he could walk, but complained of his left foot hurting. The patient had a diagonal ecchymosis (bruising) in the left upper quadrant of the abdomen (the Seat Belt Sign). The following day the child could no longer bear weight on either leg. He had a flaccid weakness of both legs. The lumbar (low) spine series (x-ray) was normal. In the next 24 hours the weakness worsened, his legs became "floppy," and he developed urinary incontinence. Some leg abduction, but no adduction was present. There was no demonstrable use of the thigh flexors or extensors (muscle groups in the legs).

     Booster Seats adjust the lap belt fit, keeping it low and over the child’s upper thigh and hip.  They also adjust the fit of the shoulder belt, keeping it over their shoulder and collarbone, so it doesn’t ride over their neck or face.  Another advantage is that now the child can look out the window without kneeling on the seat.  The high back booster seat also provides some upper body, head and neck protection (great for children who nap while riding in the car).  Backless booster seats are good for older children who are not yet at least 8-years-old or 4’9” tall because they don’t look like “baby seats”.   Then there is the “Shield Booster” which is not recommended by the American Academy of Pediatrics because of the risk of submarining and ejection.  If a shield booster is used however, the shield must be removed when the child reaches 40 pounds, and the base is then used as a belt-positioning booster.  (If you have an older model shield booster on which the shield is permanently attached, throw it out, as it doesn’t meet Federal safety standards)

     The following are some of the recommendations by the National Highway Traffic Safety Administration to help protect children before a crash occurs.

     On Friday, March 2, 2001, a crash occurred on State Road 54 in which 3 children and one adult died, one adult driver was in critical condition and the other driver serious.  The information I received from the Florida Highway Patrol indicated that the 4-year-old girl who weighed less than 40 pounds was sitting in the right rear seat in a lap belt only.  Unfortunately, this child was too small to be in a seat belt alone, and was not in a child safety seat that could have saved her life.  The nine-year-old child in the front seat center position also was only wearing a lap belt and should have been in the back seat as was the surviving 14-year-old child.  Older vehicles can be retrofitted with lap/shoulder seatbelts in the rear.  This is recommended as a safety measure to best protect all vehicle occupants, especially children who should be in belt positioning booster seats until they reach 4'9" tall and 80 pounds.  Booster seats can only be used with lap/shoulder belts.  Another alternative is purchasing a safety seat with an internal harness system rated to 60-65 pounds.  These seats can be used in vehicles where only a lap belt is available. 

     If you have any questions regarding the safety of your children, call me at East Lake Fire Rescue 784-8668, or if you know of anyone who needs to contact a Child Passenger Safety Technician in another area of Pinellas County Florida, call 582-KIDS or check the NHTSA web site:, or the Safe Kids web site 


District Chief Bill Walker, RN                                                                         Revised 7/05

Child Passenger Safety Technician Instructor

East Lake Fire Rescue

Pinellas County FL