Danielle LeBlanc caved on the car booster seat issue about a year ago, when her daughter was in first grade.
"I kept her in a booster seat as long as I could. But when they get older, it's embarrassing. They think car seats are for babies," said LeBlanc.
But the 28-year-old Brandon mom insisted that her daughter always wear a seat belt and ride in the back seat, as state law requires.
Now she knows that following the law was not enough to protect her daughter.
Kaylin, now 8, has been in St. Joseph's Children's Hospital in Tampa for more than a week. She has shoulder-length blond hair and a blackened right eye. She's surrounded by balloons, flowers, cards and a long pink banner with get-well wishes from her second-grade classmates. She has been fed through a tube for most of her stay. She sits up in bed and tells her mother where it still hurts.
Kaylin was in a car accident early last week while riding in the back seat of her dad's car. She sat in the center position, wearing a lap belt. The impact threw her body forward, smashing her face into the front center console. That's how she got the black eye and several facial fractures.
Worst of all was the injury found after a CT scan: a torn small intestine that required emergency surgery.
It's the kind of injury familiar to hospital emergency departments. On a youngster like Kaylin, "the belt sits on the soft part of the belly, instead of across the thighs, and cuts them in half, so to speak, when there's an impact," said Dr. Maximo Luque, a pediatric emergency medicine specialist at the Steinbrenner Emergency/Trauma Center for Children at St. Joseph's Children's Hospital.
"The belt doesn't have any 'give' and kids don't have a lot of fat and tissue to cushion the area. So the belt can injure any soft organs in the tummy: the liver, the spleen, it can perforate the intestines, cause internal bleeding. Those all need surgery and long hospitalizations," Luque said.
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Seat belts save lives, but they can also cause serious injury if they don't fit properly or aren't worn properly, such as when children place the shoulder strap behind themselves if it rubs against their neck or face. "So in addition to the internal injuries we see neck, face and head injuries if there's a car accident," Luque said.
Florida law requires passengers age 3 and younger to ride in a federally approved car seat when in a vehicle. From age 4 and up seat belt use is required.
But most states do a better job of protecting children, said Bevin Maynard, a child advocate at St. Joseph's Children's Hospital who has been asking legislators to support two proposed bills that would require use of booster seats that, in Kaylin's case, would likely have prevented her most serious injury.
Standard car seat belts are designed for people 4 feet 9 and taller. That means children like Kaylin, who is 4 feet 6, have outgrown car seats but aren't yet tall enough for standard seat belts. Booster seats elevate children several inches so that the lap and shoulder belts can be properly positioned. The lap belt should lie across the top of the child's upper thighs and the shoulder strap should reach across the middle of the chest.
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Earlier this month, the American Academy of Pediatrics and the National Highway Traffic Safety Administration issued updated advice on car seat use.
• Children should ride in rear-facing car seats until age 2, instead of the previous guidance to use them until age 1.
• Older children who've outgrown front-facing car seats should ride in booster seats until the lap-shoulder belt fits them.
• Children younger than 13 should ride in the back seat.
Many families are taken aback by the guidance to keep most infants in rear-facing car seats until the age of 2, said Amy Heinzen, an outreach coordinator and child passenger safety technician and instructor at All Children's Hospital in St. Petersburg.
She explained that parents want to see their child's face. And many worry about the child's growing legs reaching the back of the seat.
But in a crash, she pointed out, the rear-facing car seat helps prevent head and neck injuries. "It's a lot easier to fix a broken leg than it is to fix a brain injury or a neck injury or a spinal cord injury," Heinzen said.
She called the booster seat guidelines especially important in Florida, one of only three states without a booster seat requirement for older children.
House Bill 11 would make booster seats mandatory for those between ages 4 and 7. Senate Bill 238 would apply to children between ages 4 and 7 or those shorter than 4 feet 9. "That's a better rule," said Maynard, adding that height, not age, is what really matters.
Some advocates worry that the Legislature's current antiregulatory mood might doom these bills. But people like Maynard and LeBlanc plan to keep speaking out about booster seat use.
"We parents are endangering our children and don't realize it," said Leblanc, who is putting booster seats in her family's cars.
"I am insisting on it."
Staff writer Letitia Stein contributed to this report. Irene Maher can be contacted at firstname.lastname@example.org