Booster seats present themselves as an extremely convenient and less complicated solution for kids on-the-go. But do they offer enough protection in a crash? That depends.

How does a booster seat protect a child in a crash?
The name seems self-explanatory enough: booster seats boost a child up. But, why? For the adult seat belt to fit them properly, over the strongest part of their body: the collarbone, pelvis and hips. Without one, most children under age 9 (at the very least!) would find the shoulder portion of the seat belt riding up on their neck or across their face, with the lap portion of the seat belt across their soft abdomen. Just like car seats, seat belts and booster seats can only save lives and reduce injury when we use them correctly.

Seat belts are designed for adults, not children.
Seat belts are designed for adult bodies. And in terms of the size, density and shape of our bones that a seat belt’s design relies on: we’re quite different.

Consider the length of a child’s femur versus and adult’s: could most 5-8 year old children actually sit all the way back in a vehicle seat and still be able to bend their knees? If not (very likely), they’re almost certainly going to scoot forward on the vehicle seat to get comfortable. Doing so causes them to slouch, and in turn,  improperly and dangerously positions the seat belt, increasing their injury risk.

Let’s be real: even adults get frustrated when seat belts don’t fit their bodies. We’ve all seen someone modify the placement of their seat belt by pushing the shoulder portion off of their torso, leaving the shoulder portion of the seat belt behind their back, against the vehicle seat back.  Some people get so frustrated that they choose to forgo wearing a seat belt altogether. To be clear, both these things are super dangerous and put the person at risk of serious injury in a crash.

Now imagine a child who has a seatbelt across their face or rubbing against their cheek: they’re going to move it.

The risks of moving into a booster seat too soon
Moving into a booster seat before a child is large enough or mature enough to ride in one safely typically results in poor belt fit.

Poor belt fit can lead to head, neck and spine injuries, internal injuries and internal bleeding, and increase the risk of ejection from the vehicle in a crash.

Poor belt fit often stems from:

• A child that’s altogether too small for a booster seat
• A child that’s not mature enough to sit in a booster seat
• An incorrectly positioned booster, or a booster that does not jive well with the vehicle it’s going into
  • • Example: sometimes the place the seat belt comes out of,  the “retractor”, is positioned at an awkward angle or height. Sometimes it just means choosing a different seat in the back seat, and sometimes it’s a more complicated situation that can really limit what boosters are even compatible with particular vehicle.
      
      

“What does maturity have to do with it?”
When a child is properly harnessed in a car seat that fits them (and is installed correctly), they can’t (and shouldn’t) be able to wiggle into a position that puts them at heightened risk of injury. Thanks, harness!

But once they’re out of the harness, what’s holding them back? Not much, to be honest. As I’ve said, a booster’s job is to boost the child up so the seat belt will fit the child correctly, across the strongest parts of their body. Seat belts can only do that when they are worn correctly for the entire ride. A child requires a few things for this to happen:

• Impulse control – Just because they dropped a toy doesn’t mean they should loosen or undo their seat belt to reach for it. Other times they’re being sweet, wiggling around to make their sibling laugh; or they’re curious about something they saw out their window, and turn around to look out the back window. While they typically are doing those things because they’re just kids being kids, unfortunately, in those moments the seat belt is out of position and no longer protecting them. If the vehicle’s in Drive, it’s crucial sitting in their booster in a way that the booster can position the seat belt correctly.
• A good understanding of why sitting properly is so important. My own daughter has definitely had moments where she’s been tempted to lean out of position or reach for something that would compromise her seat belt fit. We have to anticipate that kids will forget or occasionally make a poor judgement call. Focus on gentle education and gentle reminders when you see it happening. Reminders go a long way when you’re transitioning into a booster seat, and it’s best to start those habits from day one.
  
  

Best practice 
Just because a child may legally be old enough, or weigh enough, to ride in a booster in your province or territory, it does not mean it will provide them with the best protection based on their development.  We strongly recommended using a harnessed car seat until they outgrow a forward facing mode by height, weight, or any other fit requirements specified in its user manual.

If you’re interested in a more in-depth look on this topic, I highly recommend that you check out my friend Jen’s article on the topic.

“It’s just five minutes”
“We only use it for daycare drop-offs”
“It’s just for the rare time Grandma drives them”

These are a common statements I hear regularly — so if you’re realizing you’ve said this and you’re feeling attacked right now: please know I’m not judging you. Seriously. I often joke that I’m “✨burdened with information✨” from working in the injury prevention field, but it’s the truth and I don’t know how else to describe my situation 😅 I am a strong believer that, as parents and caregivers, we can only do our best with the information we currently have. Once we have new information, it’s up to us to weigh that new information against our individual situation and choose how to adjust our behavior in response. That being said, please let me explain why a “quick trip” is just as risky as any other trip – if not more so.

Have you ever hesitated putting your seat belt on because you’re just driving a minute down the road? Or maybe didn’t take that moment to adjust your little one’s harness with the same effort you would if you were embarking on an hour long drive?

I’ve been a Child Passenger Safety Technician (CPST) since 2015, and a CPST-Instructor since 2017. When I certify new CPSTs, I always make a strong point of ensuring they hear this particular message loud and clear: We don’t get to choose our crashes.

A 2015 study of 3,280 major trauma patients over a 5-year period found 88% percent were injured within 10 miles of their home. The median distance (the middle value when all the distances recorded were ordered from least to greatest) was actually only 0.2 miles. That’s… not good news. Of those major trauma injuries that stemmed from motor vehicle crashes, 77% of the crashes occurred within 10 miles of the patient’s home. Effectively: a quick trip doesn’t lower our risk, it appears to be where risk is at its peak. It’s long been hypothesized in the injury prevention field that because drivers are most familiar with the roads near their home, they may drive with less caution in familiar, local areas than they would drive in an area where they are unfamiliar with the roads, signs, and traffic patterns. Another unfortunate reality: We don’t get to choose who drives on the road alongside us.

Car seats and booster seats are designed to save lives and reduce injuries when they are installed and used correctly. While this is universally true for all car seats and booster seats, a “quick trip” is often used to justify misuse of boosters: putting a child in a booster before it’s truly safe, let alone legal to do so. Using a seat that a child isn’t developmentally ready for by age, size or maturity can increase the risk of traumatic injury, as it increases the likelihood of head, neck and spine injuries, soft tissue (internal) injuries, or even ejection from the vehicle.

Best practice 
Boosters are, generally speaking, a safe way for children to ride when they have outgrown a forward facing harnessed car seat. We strongly recommended continuing to use a harnessed car seat until they outgrow a forward facing harnessed mode by height, weight, or any other fit requirements specified in the car seat’s user manual. Before moving a child into a booster seat, ensure they meet the booster seat’s age, weight and height requirements and have the maturity to sit in a safe position for the entire ride.

Sources:
Haas, B., Doumouras, A. G., Gomez, D., de Mestral, C., Boyes, D. M., Morrison, L., & Nathens, A. B. (2015). Close to home: An analysis of the relationship between location of residence and location of injury. Journal of Trauma and Acute Care Surgery, 78(4), 860–865. https://doi.org/10.1097/ta.0000000000

A high back booster seat, much like a harnessed car seat, has a structured seat back/shell. A backless booster seat, you could probably guess, does not. There are benefits to both, but I strongly recommend starting with a high back booster seat for novice booster seat riders. 

This is by no means an exhaustive list, but here are some pros and cons to consider:

High back booster seats

Pros

• Great for beginner booster riders who are used to the support shell of a harnessed car seat.
• A high back booster will have an integrated head rest, which helps children stay seated in an upright position, especially if they are prone to falling asleep in the car.
• Structured shoulder belt guides built into the seat’s shell are helpful for ensuring optimal seat belt fit and help to maintain proper seat belt positioning throughout the ride for squirmier kids.
• A high back booster seat may be able to provide the required head support to the tops of a child’s ears in lieu of a vehicle head restraint for vehicle seating positions without one. However: some car seat manufacturers may require that the booster seat itself has support from a vehicle head restraint. Check the booster seat’s user manual to ensure it’s okay to use it in a seating position where there isn’t a vehicle head restraint behind it.

Cons

• Sometimes they can be cumbersome, bulky and heavy – but there ARE great lightweight and narrow options.
• Their size is generally not ideal for travel – but again, there’s some exceptions! Use the “travel-friendly” filter in the tool below if having a travel-friendly high back booster is important to you.
  
  

Backless booster seats

Pros

• Most are light weight and great for travel.
• It’s generally quick and easy to get a child in and out of a vehicle with a backless booster. They are a fan-favorite of regular carpoolers for that reason.
• Backless boosters are sometimes the missing puzzle piece that solves a difficult three-across situation.

Cons

• Because they are less structured than a high back booster seat, novice booster riders are more prone to experiencing poor belt fit: either from wiggling out of the seat belt from the lack of structure, or the lack of a solid shoulder belt guide to assist in seat belt positioning.
• Does not provide support for sleepy booster riders who fall asleep, which can compromise their safety if their seat belt is no longer positioned correctly. Many kids learn how to sleep upright in a backless booster seat by tilting their chin upward when they doze off, but it’s an acquired skill. 

Because this is a huge pet peeve of mine, please indulge me for a moment while I clear this up: LATCH stands for Lower Anchors and Tethers for CHildren. LATCH is a two-piece system combined of lower anchor connectors and a top tether.

Somewhere along the way, “LATCH” and lower anchors became kind of synonymous, but they’re not and they shouldn’t be and for some reason it really bothers me more than it should. Also, the connectors are not “lower anchors” – the metal anchors in the vehicle are the lower anchors, and the hook things (which is most definitely the technical term) attached to a car seat or booster seat are the lower anchor connectors. So. That’s my pet peeve, 🇨🇦sorry🇨🇦 for the unhinged rant.

In Canada, we have “UAS” which many people equate to LATCH, but they’re not quite the same. UAS stands for Universal Anchorage System, which is simply the “LA” portion of LATCH: a pair of lower anchors in a vehicle, matched with a pair of lower anchor connectors on a car seat (or booster seat!)

Lower anchor connectors are a common method for installing car seats, but that’s not why they’re on many booster seats. To explain this one I’m going to invite you to take a brief journey into your 🔮Mind Palace🔮:

I want you to picture a child riding in a booster seat in their family’s minivan, as it pulls up to a playground. They unbuckle their seat belt and hop out of the minivan, onto the sidewalk.

…did the child in your imagination pause before getting out of the minivan to buckle up their empty booster seat with their seat belt, as if their imaginary friend was sitting in it? No? 

Well, that’s actually what they’re supposed to do! But most kids don’t buckle their unoccupied boosters in, or even know that they should.

That’s where lower anchor connectors come in. If a booster seat is just chilling on a vehicle car seat, unoccupied by a child, but also not buckled in – it’s a huge projectile risk if that vehicle ends up in a crash. Seriously, it could knock people out cold and do some very real harm.

Lower anchor connectors on booster seats are a convenience feature that takes away the need to worry about buckling a booster in every time it’s unoccupied. They can provide peace of mind, and can be especially helpful for families that do a lot of curb-side drop-offs.

Finding a booster that fits your child and vehicle:

• If you haven’t yet, please read the section on high back vs. backless boosters.
• Use this tool to shortlist some options that meet your needs and budget.
• Then, head to a local store that sells booster seats and bring your child with you – this is crucial. I find independent baby stores are best for this, but sometimes the Target car seat aisle works if they have enough booster seats on display.
• Ask to try the seats in your vehicle, and try adjusting the seats and fitting them to your child. You want to ensure that you can get proper belt fit in your vehicle, and depending on where the vehicle seat belt emerges from the vehicle (aka the “retractor”), there can be some incompatibilities. If you have a Grand Caravan you’ve probably already been warned 😅 Some boosters will “play” with your vehicle better than others, and the only way to know this is to try.
• When trying out a high back booster, ensure the seat belt can properly retract when it is unbuckled. This is another way that some boosters and vehicles don’t get along. It’s important that vehicle belt can retract properly, so don’t compromise on this. 

Some general advice:

• Boosters are designed to be used with a lap/shoulder seat belt. If a vehicle or seating position doesn’t have one, then you can’t use a booster there.
• Everyone needs head support to at least the tops of their ears. Avoid seating a child in a backless booster in a seating position without a head restraint. If you’ve got multiple kids, this may mean swapping the booster rider’s seating position with another harnessed child’s car seat so that everyone can ride safely.
• The short and sweet version of when a booster is no longer needed: when they fit the adult seat belt better WITHOUT a booster than they do WITH a booster. We gauge this using something called the “5-Step Test” I’ll be doing more content on the 5-Step Test to determine if a child can ride safely in an adult seat belt soon; but in the meantime, I highly recommend reading my friend Jen’s thorough write-up on it, here.
• Booster seats aren’t used on planes. If you’re taking a booster seat for travel, it won’t be used on the plane (but you may be able to fit one in the overhead!)