New research highlights widespread confusion among parents about how to position an infant in a car seat and install the car seat properly, putting babies at risk of serious injuries in the case of a crash.

Taking a newborn home from the hospital is an exciting, magical time for new parents. But a new study suggests that nearly all parents — an astounding 93 percent — make at least one critical error related to their baby’s car seat on the ride home from the hospital.

A “critical error” is defined by the National Highway Traffic Safety Administration as one that increases a baby’s risk of injury if there is a car accident. The study’s findings are worrisome, since trauma that might not harm an older child can cause serious injuries in an infant.

“Newborns are the least able to protect themselves [in a car crash],” lead study author and pediatrician Dr. Benjamin Hoffman told Healthline. “They have very large heads, very weak necks, and in general, they have a lot less resting muscle tone.” That means a newborn is more likely than a bigger kid or an adult to be injured in a crash, making correct car seat use especially important for their safety.

The study included 267 families leaving the Oregon Health and Science University Hospital over a six-month period. A certified child passenger safety technician observed as each new mother — or a person of her choice — strapped the newborn into the car seat and installed the seat in the vehicle. The technician recorded every error, and then helped parents do it the right way.

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All of the mistakes were related to either the position of the baby in the car seat or how the seat was installed. The most common errors included:

  • The car seat’s harness was too loose.
  • The car seat was installed too loosely in the vehicle.
  • The car seat’s retainer clip was too low or too high.
  • Parents did not know how to adjust the harness.
  • Parents placed the car seat at the wrong angle.
  • Parents did not lock the safety belt.
  • Parents left the wrong amount of space between the car seat and the front seat of the vehicle.

Although this research may worry parents-to-be, there’s good news: car seat errors are preventable with training and practice.

As part of the study, researchers asked participants if they had worked with a certified child passenger safety technician prior to their baby’s birth. New parents who had worked with a technician were 13 times more likely to use a car seat correctly.

Hoffman sees this as a call to arms for those who take care of newborns. “We need to think about providing resources to mitigate the risk,” he said. He is presenting his research today at the American Academy of Pediatrics national conference in San Diego.

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For parents who want to make sure they are using a car seat correctly, help is available. The National Highway Traffic Safety Administration offers a free search tool for parents to find a certified technician in their area to inspect their car seat and teach them how to use it safely. The nonprofit Safe Kids Worldwide provides a similar service and also helps families in 25 different countries find resources.

“Getting support from a technician can make all the difference to ensuring that parents are using the right seat, installing it correctly, and using it correctly every time they travel with a child,” Adrienne Gallardo, one of the certified child passenger safety technicians who assisted with the study, told Healthline.

Gallardo, who is also the Child Passenger Safety Program Manager at Doernbecher Children’s Hospital in Portland, Oregon, offered these five suggestions for parents to ensure they use their car seat the right way:

Get the right seat

“The selection of car seats can be confusing for parents,” said Gallardo, noting that it’s important to be aware of a car seat’s limits for your child’s age, weight, and height. Car seats have expiration dates to keep in mind, too. If you aren’t sure, Gallardo recommended talking to a certified technician.

Read the instruction manual

“In every instruction manual, it gives clear directions on how to install the seat and what to be mindful of when positioning the child,” Gallardo advised. Follow all of the car seat manufacturer’s recommendations. It’s also important to ensure that a child is traveling in the correct direction for their age. All infants under one year old should be in a rear-facing car seat.

Take care every time

Gallardo stressed that parents need to ensure the car seat is used correctly every single time the family travels. Parents should check that the child’s harness is snug, that the child is placed properly in the seat with the retainer clip in the right location, and that the car seat is securely installed in the vehicle.

Get good advice

“I always recommend that new parents seek out time to come to a car seat event, whether it be a one-on-one appointment or a clinic that’s happening in your community,” Gallardo said. “Read the manual, play with the car seat, and try to install it before coming to visit a technician.” That way parents will be more aware of any difficulties they are having with the seat.

Do the “inch” and “pinch” tests

As an additional measure, Gallardo said that parents can try the “inch test” and “pinch test” recommended by Safe Kids Worldwide. For the “inch test,” after installing the car seat, give it a firm shake at its base. A correctly installed car seat should not move more than an inch.

For the “pinch test,” place your child in the seat and buckle the harness with the chest clip at armpit level. Then try to pinch the strap covering your child’s shoulder: you shouldn’t be able to get a pinch of the strap if the harness is snug enough.