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Have You Ever Heard of Seat Belt Syndrome?

seat belt syndrome

What?! Seat belt syndrome? What is that?!

Before we get into explaining seat belt syndrome, let’s talk about safety tips.

We’ve all read the stats (and if you haven’t, read the car seat statistics here) about injuries and deaths related to car seat misuse or lack of use. The National Highway Traffic Safety Administration (NHTSA) found 37% of the who died in a crash in 2017 were not restrained.

seat belt syndrome

Unrestrained children are found in non fatal crashes as well. South Carolina, for example, determined 11,500 children under age 6 were involved in crashes in their state in 2017. Of those, 2,400 were not restrained. That’s 20.9% of children under age 6 not using a restraint, if you suppose all states have similar numbers.

First and foremost I want to make it clear, it is best and keeps your child safest if you:

Parents often ask Child Passenger Safety (CPS) Technicians, “how can I put my 6-year-old back into a booster seat? And why should I, he uses a seat belt?”

NHTSA recommends that children should be in a child restraint like a RideSafer Travel Vest or booster seat until they are at least 8-years-old. This age is really a bare minimum.

It is more preferable that the child be 4’9″ tall. When they reach this height, they should fit properly in the vehicle’s seat belt. A child may not reach this height until 10 or even 12 years old.

The gold standard would be when the child passes the 5-step fit test.

But the big question is, WHY? Why should a child remain in a child restraint until this time?  If you have a big enough why, you will follow through — with anything.

most common car seat mistakes

So Here’s the WHY

When children are not properly restrained, they are at greater risk of seat belt syndrome. Not properly restrained could mean they are in a lap-only belt, they are in an ill-fitting lap/shoulder belt or they moved the shoulder portion of the seat belt behind them or under their arm (whether in a booster seat or not) to keep it from rubbing their neck.

To understand seat belt syndrome it is helpful to know some math.  We apply a simple equation to understand the amount of restraining force it takes to keep an 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 would be a 40-pound child in a vehicle traveling at 30 miles per hour at the time of impact would require 1,200 pounds of restraining force to keep that child restrained during the crash.

An improperly restrained or unrestrained child would be propelled into the back of the front seat (as seen in the picture above and this crash test video), the dash or windshield, another passenger or be thrown out of the vehicle via a window or sun-roof.

A child who is too small for the seat belt system often scrouches down so their knees reach the end of the seat; this moves the lap portion of the seat belt up to their abdomen and all that nice soft tissue. If they are in a lap-only belt or put the shoulder portion behind them or under their arm, they lose upper body restraint. This can cause abdominal, spinal and/or head injuries.

This Part is a Must Read

This can get rather graphic (especially if you google seat belt syndrome images).

During a crash, using a lap-belt only or having the shoulder portion useless behind you, the crash energy propels the body forward. The body jack-knifes over the lap-belt, causing serious internal injuries.

Then the head strikes the back of the front seat, rolling backward as the body continues in its downward arc. This can break the neck. The spine stretches and this can damage the spinal cord. The 40-pound child in the example would sustain approximately 1,200 pounds of crushing force against their abdomen.

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. Doctors may not detect an occult bleed until 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.”

From what we, the technician community, have observed the group of children most likely to be at danger is the “booster age” child. That is roughly from 3 or 4 to 12 years old. The reasons for this could range from not wanting to buy yet another seat to the child feeling a booster is “too babyish”.

Download our report: Common Car Seat Mistakes and How to Fix Them

Our two older children remained in a RideSafer vest until they were 9 and 1/2 years old. Our son 5-stepped into the seat belt at that point. On the other hand, our daughter continued using a low booster seat (an Incognito – no longer available) until she was a bit older because she felt it helped the seat belt be more comfortable. They didn’t think twice about using a restraint. We always emphasized safety in the vehicle — to the point we can’t get out of the driveway without our older son telling us to buckle if we haven’t yet.

Manufacturers designed booster seats to lift the child up in an effort to make the child fit the belt. The RideSafer Travel Vest is designed to make seat belt fit the child. In addition to that, the Ride Safer design also has energy absorbing components. This padding absorbs and spreads that 1,200 pounds of force across a wider area of chest.

For more information about seat belt syndrome, you can check out these links: Crash test video of Lap Only belt or National Center for Biotechnology Information

Read about another common seat belt injury: seat belt entanglement.

By Amie Durocher, Creative Director at Safe Ride 4 Kids and certified CPS Tech since 2004

Copyright 2020 Safe Ride 4 Kids. All rights reserved. You may not publish, broadcast, rewrite or redistribute this material without permission. You are welcome to link to Safe Ride 4 Kids or share on social media.

We originally published this post in April 2013. We updated the article for accuracy and comprehensiveness.


  1. I was a victim of lap belt syndrome in 1991. I was a passenger in the back seat, lap belt only. The car hydroplaned, crashed 3 times. I was 20.

    I ended up perforating my bowel in 7 places, fracturing and separating 2 vertebrae, and crushing my tailbone.

    By the grace of God I am still here.

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