Child Passenger Safety technicians Nicki Harriman, left, RN, BSN, with Mercy Hospital Washington, and Washington Police Officer Mindy Schmelz work together to intall a rear-facing convertible car seat for 8-month-old Winston Steffens, Washington.

It took about 15 minutes for Nicki Harriman, RN, BSN, to get a new rear-facing convertible car seat for 8-month-old Winston Steffens installed in his mom’s minivan.

A certified child passenger safety (CPS) technician and labor and delivery nurse at Mercy Hospital Washington, Harriman was switching out Winston’s rear facing infant car seat to a rear-facing convertible car seat that he will use until he’s around 2 years old or about 40 pounds.

At that point, the car seat can be turned around as a forward-facing seat until Winston hits its upper weight and height limits. That will probably be when he is between 4 and 6 years old, said Harriman.

Winston’s mom, Jessica Steffens, Washington, who works alongside Harriman as a labor and delivery nurse at Mercy, is familiar with these guidelines, recommended by Safe Kids Worldwide, even as they have changed somewhat over the years.

But most parents are not.

The reality is that between 70 and 90 percent of car seats are either installed incorrectly or are being used incorrectly, said Harriman. That includes having the right size child installed in the right size seat.

Despite parents’ best intentions to keep their young children safe in the car, many overlook the best practices to do so, said Harriman. And probably none of them even realize they are doing that.

Washington Police Officer Mindy Schmelz, who recently completed her CPS tech training, said it’s always hard after a car accident to hear a parent say something like, “I wish I would have known” or “I wish someone would have told me that wasn’t safe . . . ”

For all babies born at the hospital, Harriman is available to help families install their car seats correctly before they are discharged. She also takes appointments for any time before or after the baby is born. Call 636-239-8645.

The same is true for the two officers who are CPS techs with the Washington Police Department. Call 636-390-1050.

The CPS techs also participate in public events, like the 42nd Annual Bicycle Safety Rodeo being held this Saturday, May 20, beginning at 9 a.m. under the swine pavilion at the Washington Fairgrounds. They will check and install car seats and distribute new car seats to families in need of them.

The event, hosted by the Washington Optimist Club and Washington Police Department, also will include helmet fittings and distribution by the Mercy Hospital Washington trauma department and Missouri Child Identification registration by members of Hope Lodge 251, Washington, for use in emergency situations when a child goes missing.

Why Car Seats Are a Challenge to Install

“The challenge to getting car seats installed correctly is that each car seat is different and each car is different,” said Officer Schmelz.

“And each seating position in the car is different,” Harriman added.

“So you have to look in the manuals — both for the car seat and the car — to see where each seat goes and how to install it,” Schmelz explained. “They all have certain rules for where a seat can and cannot go.”

As a child grows and the seat has to be repositioned, it’s necessary to check the installation again.

Seats that are installed incorrectly or being used incorrectly (based on the size and weight of the child) can become unattached in a crash, said Officer Schmelz.

“If the seat is forward-facing, and you don’t have that back tether attached, the front of the car seat can fly up into the seat in front of it and hit the child’s head,” Officer Schmelz said. “If it’s too loose at the bottom, whether it be at the seat belt or the anchors, it will fly forward.”

Washington Police Officer Mike Grissom, who is a CPS tech, said there recently was a car accident in town where he believes the car seat saved that child’s life.

“The child was brought to Mercy Hospital Washington before ultimately being flown into St. Louis, but there is no doubt in my mind that the car seat saved his life,” Officer Grissom said.

“Based on the amount of intrusion on the side of the vehicle, if it had been an adult, it might have been a fatality. But car seats do a great job of protecting kids, if they are used properly,” he said.

Rear-Facing Until Age 2, Forward-Facing Car Seat Until Age 4

It may surprise a lot of parents to learn this, but currently best practices for child safety include keeping children in rear-facing car seats until they are 2 years old or the weight limits of the seat.

“Kids can sit in the seat with their legs crossed or however is comfortable. The goal is to protect the head, neck and spine,” said Harriman.

That’s a change from past recommendations, but it has been found to be more effective at keeping children safe, Harriman stressed.

After a child reaches age 2, a forward-facing car seat can be used until the child is age 4 and 40 pounds.

By Missouri law, children should not be using booster seats until they are at least 4 years old and 40 pounds. However, best practices are to keep a child in a forward-facing car seat even longer, with some car seats designed to hold children until they are 5 or 6 years old and 65 pounds.

“Many booster seats in the stores say for age 3 and 30 pounds, but Missouri law is age 4 and 40 pounds, so even if a child maxes out the 40 pounds for a forward-facing seat, parents could look into getting a seat that goes up to 65 pounds to keep their child harnessed longer,” said Harriman. “Most 3-year-olds don’t have the ability to know how to stay safe with just a seat belt.”

Use a Booster Seat Until 4 Feet, 9 Inches

Once children hit age 4 and 40 pounds and switch to using a booster seat in the car, best practices call for using it until they reach a height of 4 feet, 9 inches up to age 12 — regardless of their weight.

“The reasoning is that before they are that height, the child doesn’t fit right in the seat without a booster,” said Officer Schmelz. “The seat belt will come in across their neck on their carotid artery.

“The booster seat raises them up to where that seat belt will come across their shoulder and chest in the right place. And the lower part of the belt should cross over their lap, not their belly,” she explained.

Seat belts are designed to work on areas where there are bones, not soft tissue, said Officer Grissom. A lap belt that cuts across a person’s abdomen can cause a lot of internal injury in an accident.

Of course, getting an older child who is 10 or 11 but shorter than 4 feet, 9 inches, to use a booster seat can be a challenge, Officer Schmelz noted. But it’s something the parents should be tough about if they want to protect their child.

“There are some booster seats out there that blend into the seat more so it’s not as noticeable that the child is sitting on a booster,” said Officer Schmelz.

No Front Seat Until Age 13

The recommended age for allowing children to ride in a car’s front seat is 13. The back seat is safer for several reasons, but the main one is to protect them from the air bag, which can be deadly.

Air bags are designed to hit someone in the chest area, said Officer Grissom. But children under age 13 generally are not tall enough yet, so the air bag hits them in the face or on the head.

“The force can snap their spine,” he said.

Children have weaker back, neck and stomach muscles, and it’s harder for them to stay upright in a collision, which means they are likely to get hit in the face with an air bag, said Harriman, noting a deployed air bags inflates at around 200 miles per hour.

YouTube videos of crash test dummies illustrate the point pretty clearly, said Harriman.

No Coats in Car Seats

The CPS techs had a few other best practice suggestions for parents with children using car seats:

• Coats or snowsuits should be removed before strapping a child into a car seat.

“The child is wearing a big, puffy coat in the car seat, and you think you have the straps on tight, but on impact, that puffy coat compresses, and the kid can slide out,” said Harriman, noting that has been seen in crash testing.

“So take their coat off, get them all strapped in and then put a blanket over them,” she said.

Likewise, accessory items like buntings, shoulder pads and head supports that people buy to make the car seat more comfortable can actually be a danger.

“None of it has been crash tested. It’s not to say it’s going to cause an issue, but we just don’t know,” said Officer Grissom.

Toys that parents hang on a child’s car seat also can pose a danger. On impact, those will hit the child in the head or face, Officer Schmelz noted.

Helmets for Any Activity With Wheels

Children participating in the Bicycle Safety Rodeo this Saturday should arrive with their helmets. Children who don’t have a helmet will be given one through the Head Safe Program at Mercy Hospital Washington.

Volunteers from Mercy’s trauma department will be on hand to make sure helmets are fitted and worn properly.

With helmets, the best practice is to wear a helmet for any activity that involves wheels, said Heather Pratt, Mercy trauma nurse coordinator.

That includes bicycles, but also skateboards, scooters, roller blades, hover boards, long boards . . .

“Those long boards can get going up to 40 or 50 miles per hour going down a big hill,” Pratt noted.

Wearing a helmet is not required by law or even a Washington city ordinance, Pratt understands, but it is a common sense practice for protecting yourself while doing these activities. The sad truth is that accidents while doing these activities without wearing a helmet can and have resulted in death for too many young people.

Parents should start from the time their child is young to insist on him or her wearing a helmet. Although some parents don’t recognize the seriousness of the danger, admits Pratt.

That’s why the Head Safe program strives to educate children about the risk.

“What we tell kids when we do helmet fittings is if you fall off your bike or your scooter, and you break your arm, we can fix that, put your arm in a cast. But if you fall off and break your head, it isn’t that easy,” said Pratt.

“If your brain gets scrambled and you have a bad head injury, well your brain controls the rest of your body, so the rest of your body isn’t going to work if you have a bad head injury. A helmet is the only thing protecting your head,” she said.

As an incentive for children to wear their helmets while riding their bikes or skateboards, Washington police officers carry coupons for free ice cream and they hand those out to children as a reward for doing the right thing, said Officer Schmelz.

Equally as important as wearing a helmet is making sure that it fits correctly, said Pratt. Otherwise it won’t provide full protection.

“You want to make sure that it fits snuggly on the head. So put it on their head and, grasping the top of the helmet, try to turn it from side to side,” said Pratt. “The child’s head should turn with the helmet. If the helmet turns alone, then it’s not snug enough.”

The helmet needs to be down on the forehead with only two finger widths above the eyebrows.

“A lot of kids set it back farther on their head, so it’s not protecting their frontal lobe,” said Pratt.

The straps should be positioned so that the V falls right under the ear, and then snaps closed with space enough for only two fingers between their chin and the strap.

“It needs to be that snug or it can fall off,” said Pratt.

Any child who does not have a helmet but needs one can get one for free through Mercy’s Head Safe Program.

They just need to come to the hospital’s emergency department. If Pratt is not working, the security officers know where the helmets are kept and how to fit them.

In addition to taking the Head Safe Program to public events like the Bicycle Safety Rodeo, Pratt and other trauma department volunteers make visits to area schools. They take the time to educate kids and hand out helmets because in the 10 years or so that they have offered the program, they have seen the difference it has made.

“We have had a 65 percent reduction in head injuries,” said Pratt proudly.

Photos, Fingerprints, Dental Impressions

Parents can take safety precautions for their children a step further by filling out a Missouri Child Identification Program or MO CHIP packet.

This only takes about 15 minutes and when it’s completed, parents take home a CD that includes a digital record of their child’s fingerprints, dental impressions, photos from three sides, list of any identifying features and a DNA swab.

“They even take a photo of the ear, because the ear is just like a fingerprint,” said Joseph O’Bryant Sr., worshipful master with with Hope Lodge 251, Washington, which conducts the program here.

There is no charge to parents to complete the packet, and it’s something that can be vitally important in an emergency where a child goes missing, said O’Bryant.

The CD containing the information is compatible with the Amber alert program and only readable by law enforcement, O’Bryant noted.

The Hope Lodge volunteers retain no information concerning the child.

Parents who have completed the packet in previous years can bring the disc back to have it updated with new photos and information.

The program is funded by the Grand Lodge of Missouri.

For more information, people can go to

Bicycle Safety Rodeo

Registration for the event starts at 9 a.m. at the Washington fairgrounds swine pavilion. Children from ages 5 to 13 may participate in the event.

There will be five skill stations at the rodeo that aim to teach children bicycling skills such as slow speed riding and balance, circling and changing directions, short radius turning, straight line control and weaving.

Each participant must bring their own bike and wear a bike helmet during the skill stations.

Children will compete in three age groups, 5 to 6, 8 to 10 and 11 to 13. Trophies will be awarded for each age group with the best score and the girl and boy with the best score in the whole competition will win a bike. Revolution Cycles will inspect and repair all participants’ bikes prior to the competition.

Riders of bikes with training wheels are allowed to do the skill challenges but will not be scored for the competition or be eligible for trophies.

An obstacle course for children 5 and under, dubbed Safety Town, was provided by Kohls4Kids and SSM Health Cardinal Glennon Children’s Hospital. Children may ride through the town on trikes provided by the hospital.

The annual Bike Safety Rodeo is sponsored by the Washington Optimist Club and the Washington Police Department.