Seat Belt Syndrome in Children: What Are Causes & Effects? Best 2022 Expert

Parents must place children in appropriate child restraint systems to keep them safe on the road. Once children overcome booster seats, it's time for a seat belt.

However, many parents ask: What is a seat belt syndrome child & can children suffer from safety belt injuries?

We discuss seat belt injuries in children, preventing the condition, and how to keep children safe in child restraints.


Take away key points:

  • Seat belt syndrome occurs with the improper use of seatbelt systems. The crash forces attack the children’s bodies, ending in severe conditions.
  • The restraints can be either dangerous for children (when used incorrectly) or safe (when used correctly).
  • Kids can suffer from multiple injuries, including internal bleeding. They can also result in fatal consequences.
  • Perform safety tips to prevent injuries and increase children’s safety on the road. Use age-appropriate restraints, perform five-step tests to ensure the belt fit, and keep children in the back seat of the vehicle for more security.

Seat Belt Syndrome in Kids: What You Need to Know?

Kids can suffer from seat belt injuries if they don't fit the restraints correctly. Unfortunately, multiple injuries often result in fatalities. Please refer to the guidelines below to learn more about the topic and safety tips on keeping your children safe in the restraint systems.

What is seat belt syndrome?

what is seat belt syndrome

Seat belt syndrome describes an injury pattern in restrained children involved in motor vehicle collisions. The syndrome is a combination of lumbar spine injury and intra-abdominal injury.

The state occurs when sudden deceleration forces combined with seat belt compression around the abdomen cause abdominal wall bruising, spinal fractures, and intra-abdominal injuries.

The leading cause of seat belt injuries in children is the improper and infrequent use of the corresponding seat belt restraints, leading to higher risks of multiple abdominal wounds, as the experts in the Pediatric Surgery division explain.

Understanding seat belt syndrome better

To better understand the severity of the condition, you can multiply a child's weight by the car's speed in a crash. For instance, if you're driving 30 mph and your kid weighs 40 pounds, they need 1,200 pounds of restraining force to keep the kid correctly secured during the collision.

If your kid is incorrectly placed in the vehicle, they are at increased risk of propelling into the back of the front seat, windshield, or dash or being thrown out from your car through the sunroof or window.

So, are seat belts dangerous for children?

No, seat belts are not dangerous for children when using restraints properly. Children restrained in lap/shoulder belts reduce the risk of fatal injuries by 45-50%, according to older studies by the National Highway Traffic Safety Administration.

However, child restraints might be fatal for kids with improper seat belt use. Thus, the 2022 statistics show that the incorrect use of car seats (and seat belts) increased fatalities in motor vehicle crashes by 7% (9,560 victims) compared with the same data in 2021 (8,935 deaths), as the National Highway Traffic Safety Administration claims.

What does the "incorrect use of belts" mean?

The incorrect use refers to:

- Lap-belt only fit

- Ill-fitting lap portion/shoulder portion

- Moving the shoulder belt behind the kids in the car seat/booster seat or under their arms prevents the straps from rubbing children's necks.

- Too much slouching in the restraint.

When was seatbelt syndrome first recognized?

The syndrome was coined in 1962, referring to the spectrum of injuries with lap belt restraints. The pertinent physical findings included the following injuries:

  • Lumbar spine dislocation and fractures
  • Partial and full-thickness intestinal injuries
  • Mesenteric disruption in a motor vehicle collision
  • Hollow viscus injury
  • Abdominal distension
  • Abdominal lap belt ecchymosis
  • Blunt torso trauma
  • Blunt abdominal trauma
  • Coma - the stages vary according to the Glasgow Coma Scale score
  • Nausea
  • Dizziness
  • Irregular heart rate
  • High or low blood pressure

The syndrome was explained shortly after an increase in the seat belt system used by drivers and passengers. The condition was first noticed in adults. Although seat belts - especially lap belts were introduced in rear-facing car seats during the 1980s and 90s, various sources show the increased syndrome phenomenon in children.

Why does the specific pattern of injuries occur?

Seat belts prevent multiple injuries, including:

how long does seat belt syndrome last
  • Ejection from the vehicle - associated with more severe injuries
  • Decelerating the occupant - preventing sudden deceleration referred to striking multiple objects - windscreen or similar items
  • Distributing forces to the larger area of the bony skeleton - the belts will prevent soft tissues and direct the motor vehicle crash impacts to the sternum, clavicle, and iliac streets.

On the other hand, the lap belt has a specific design. The lap belt is created to cover the anterior iliac spine. Therefore, it can easily reach the abdomen or lower chest in the case of a motor vehicle crash.

A fast deceleration causes a child to hyperflex their torso over the lap belt, leading to abdominal wall compression. The flexion-distraction forces will also act on the lumbar spine and cause intra-abdominal injuries.

This is how the misuse of seat belts creates a pattern of abdominal injuries in kids. Again, you can refer to the study for a better understanding.

Can a vehicle seat belt increase risks in children?

Modern motor vehicles have replaced lap belts (2-point harness systems) with specific shoulder and lap belts (3-point harness systems). However, as the lap and shoulder belt system reduces the risk of the seat belt sign in kids, the restraints cannot completely exclude it. So, your children are at risk of severe injuries for multiple reasons.

Some of the injuries sustained in lap seat belt systems include:

- Poor fitting in the safety belt 

- Spine fractures

- Intra-abdominal wounds

1. Poor fitting in the safety belt

If kids are not ready, yet parents restrain them in the adult seat belt systems, the shoulder strap will cover their neck, instead of chest and shoulder, according to the AAP.

In addition, rear seat passengers can quickly move the shoulder strap behind their back or under the arm, immediately converting the three-point harness into a two-point system.

Children tend to scoot forward in the car seat, enabling their knees to bend over the seat's edges. However, this state exacerbates the poor child's fit, thanks to the "slouch" factor.

While looking for the most comfortable seating position, kids can unconsciously jeopardize their safety. The belt won't be able to protect them correctly in the case of a car accident, and they can suffer severe injuries. You must supervise children's actions and take immediate steps if you notice improper restraint use.

2. Spine fractures

Spinal fractures are more prone to injuries in the pediatric population than in adults. The undeveloped pelvis is not as strong as the well-developed iliac spine. This way, the lap seat belt will easily reach the children's abdomen.

In addition, the abdomen has more subcutaneous tissues and thinner muscles than adults, increasing the risk of abdominal injury.

3. Intra-abdominal wounds

The increased head size (causing increased flexion around the belt system) combined with a smaller portion AP diameter of kids (driving a shorter distance for applying a deceleration force) also increases the risk of secondary compression of the internal injuries of intra-abdominal organs between the spinal column and belt system.

Recognizing children with the seat belt sign

The seat belt sign in kids indicates all children with higher risks of spinal and abdominal injury caused by motor vehicle crashes. The primary concern is the identification and management of life-threatening indicators.

For instance, a well-looking kid with a seat belt sign and abdominal tenderness must undergo an abdominal CT scan. The scan will show if there's a need for surgical intervention after detecting bowel perforation.

In addition, a well-looking kid lacking abdominal tenderness will remain at higher risk of internal injury symptoms compared with a kid without a seat belt sign. According to experts in Pediatric Emergency Medicine, these children are also at increased risk of gastrointestinal injuries.

Although the data in the pediatric population is limited, the non-trivial rate - 2% claims that repeated physical examinations at the pediatric emergency care for signs of a solid organ injury must be performed.

Kids with abdominal injuries caused by blunt trauma may have absent physical findings, requesting repetitive examining procedures. For instance, even a CT scan might not show a hollow viscus injury, so the surgeons must continually inspect the children.

The first lap belt injury symptoms caused in motor vehicle crashes might occur days after the accident. So, the abdomen examination after blunt trauma is always mandatory as clinical or psychological signs might be missed when a kid arrives at a hospital.

The rate above emphasizes requested acute awareness of the:

- Full spectrum of intra-abdominal and lumbar spine injuries in restrained pediatric passengers
rear seat restraints, including shoulder belts.

- The belts can adjust straps to fit older children and small passengers.

Safety tips to prevent seat belt syndrome

There are various methods parents can apply to keep their children inside motor vehicles and exclude the possibility of seat belt syndrome. Some methods include:

symptoms of seat belt syndrome

#1. Keeping kids in age-appropriate child restraint systems

Do not rush to place your kids into convertible/booster seats if they are not ready. Booster seats also use a seat belt system, so the straps must fit your child.

The straps must cover children's bodies correctly. The shoulder strap must cover kids' chest and shoulders, while the lap belt must cover their upper thighs and hips, not their stomachs. If you notice that the child struggles with the straps, they are not ready for the booster seat.

A child must be four feet nine inches tall to use the booster seat, typically between eight and twelve years old.

#2. Do not place children in the front seat if they are not ready

Keep your children in the booster seats, in the backseat of your vehicle as long as possible. Even if they outgrow booster seats, keep them in the vehicle's back, restrained in the vehicle belt system.

Once they're thirteen, kids can sit in the front passenger seat with the belt-only system. But, again, the vehicle belt must properly restrain them; otherwise, you will jeopardize their safety.

#3. Perform the five-step tests to see if the seat belt system fits your kids

There are five criteria children should meet to use the system correctly. These include:

  • The shoulder belt crosses between the children's necks and shoulders. If the portion is too close to the neck, kids might place them behind their back for more comfort. A shoulder belt sitting off the shoulder slips off in an accident, so the system cannot protect kids.
  • The lower back is against the vehicle seat. When kids sit with their bottoms forward to let their legs fall over the vehicle's seat, there's a gap between the seat and their back. The seat belt reaches their belly. Or, there might be slack in the belt, allowing the child to move forward in the collision. Both can cause seat belt syndrome and internal organ injuries.
  • The lap belt covers the upper thighs and across the hips. When the system crosses the soft tissue of the abdomen - when the back isn't against the seat- it causes seat belt syndrome, internal injuries, and bleeding.
  • The knees bend over the seat. Kids tend to turn their legs over the seat's edges to be more comfortable. However, they can raise the lap belt to the soft tissue of the belly, causing internal bleeding and abdominal wounds.
  • Kids can ride like this during the entire ride. No one expects children to ride in the same position during the whole trip. However, changing positions to ride comfortably moves the position of the correct seat belt fit. Therefore, when children slouch, lean on the comfier side, or put the straps behind their backs, the restraint cannot protect them adequately. If you notice your child moving too much in the seat belt, they are not ready for booster seats, let alone belt-only systems. It would be better to keep them in forward-facing harness car seats.

Frequently Asked Questions

Can a seatbelt hurt a child?

Yes, a seatbelt can hurt a child and cause seat belt syndrome when children use restraints improperly. The condition refers to the state in which the rapid deceleration impacts, along with compression of the lap belt around the abdomen, affect intra-abdominal wounds, abdominal wall bruising, and spine fractures.

What injuries can seatbelts cause?

Some of the injuries include: 

- Fractured or bruised ribs

- Sternum or chest injuries

- Shoulder injuries

- Abdominal soft tissue

- Lacerations or abrasions

- Sciatica, myalgias (muscle pain), bulging or herniated discs

- Internal bleeding

How long does it take to heal from a seat belt injury?

It might take a few weeks to several months to heal from a seatbelt injury - you might need surgery, fractured ribs, or internal damage and bleeding in abdominal organs.

How many lives are saved by seat belts each year?

how to stop child taking off seat belt

More than 15,000 lives are saved each year when the seatbelt systems are used correctly, as the NHTSA states.

The Bottom Line

We hope we helped you understand the seat belt syndrome child better. As you can observe, the leading cause for the state is the improper use of vehicle seatbelts.

So, it would be best to buckle up yourself and your children properly. And if you notice irregularities, act immediately to avoid severe injuries or fatal consequences.

Avatar of Kathy Warner

Kathy Warner

Kathy is a busy mother of two and a CPS technician for more than eight years. Her mission is to awaken parents to the importance of child passenger safety and show them the right practice. You can read more about her here

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