Car crashes are the most frequent cause of injury and injury-related death in children. Infant and child car seats have reduced these injuries by 45% since 1997. However, these seats are only effective if they are used properly.
There are two main categories of seats: rear-facing and forward-facing. Other categories include convertible, combination, 3-in-1, and booster seats.
The American Academy of Pediatrics (AAP) recommends that babies be kept in rear-facing seats for as long as possible:
- Babies should remain rear-facing until they reach the highest height and weight allowed by their seat's manufacturer or until they are two years of age.
- Harness straps should be at or below the baby’s shoulders.
- Harness chest clips should be at baby’s mid-chest level.
Rear-facing infant seats may come with removable bases. In seats with removable bases, the base stays in the car so you do not need to install it each time you put your baby in the car. Here are some tips for rear-facing infant seats:
- Again, follow the manufacturer's height and weight requirements and limits.
- The seat must face rearward only and recline at the correct angle so that the baby's head does not flop forward. Many seats have an angle indicator or can be adjusted to the correct angle.
- A seat with more than one set of slots and adjustable buckles and shields gives room for your baby to grow.
- After outgrowing their infant seats, babies can ride rear-facing in convertible seats.
Your child can ride in a forward-facing seat after he has reached two years or older, or has reached the highest height and weight allowed by the manufacturer of the rear-facing seat. Here are some additional recommendations:
- Children should ride in a forward-facing seat that has a harness until they reach the highest weight or height allowed by the car safety seat manufacturer.
- Usually children should ride in a forward-facing seat until they are at least four years old.
- Shoulder straps should be at or above your child's shoulders. Some convertible seats require the straps to be in the highest slots. Check your seat's instructions.
- The seat belt should go through the seat's forward-facing belt path.
Convertible seats can be used as both rear-facing and forward-facing seats, depending on the baby’s height and weight. They are bigger than rear-facing infant seats and can be used longer. Follow the AAP's recommendations for keeping babies rear-facing as long as possible. If your child is riding in a convertible seat, they can be turned to face forward after meeting the AAP's guidelines. Check the seat's instructions to see if the recline angle of the seat needs to be adjusted.
3-in-1 seats can be used as rear-facing, forward-facing or as a booster seat. This allows longer use of the seat as your child grows. They do not have a carrying handle or separate base, but are good because they may have a higher weight for rear-facing children (up to 40-45 pounds or 18-21 kg).
Since they are bigger, just make sure that it fits in the vehicle properly.
Combination seats have a harness that can be removed to allow the seat to function as a booster. Combination seats cannot be used rear-facing. They can be used with a harness for children who weight up to 40-80 pounds (18-36 kg). The booster can be used without a harness for children who weight up to 80-120 pounds (36-54.5 kg). If your child is using the seat without a harness, follow the recommendations for booster seats.
These are designed to allow your child to use the vehicle’s lap and shoulder belts. Your child should continue to use a car safety seat with a harness as long as possible before switching to a booster seat.
Follow the AAP recommendations for booster seats:
- Backless boosters are used with car seat belts (lap and shoulder). The seat raises the child so that the seat belts fit properly. They can be used in cars with headrests and high seat backs.
- High-back boosters are useful in cars that lack headrests or have low seat backs.
- The AAP recommends against the use of extra products to use with the seat unless they came with the seat.
- The lap belt should lie low across your child's upper thighs and fit snugly.
- The shoulder belt should cross the middle of your child's chest and shoulder.
Continue to place your child in the booster seat until he is large enough to fit correctly into an adult seat belt. This is usually when he is about 4 feet 9 inches (1.45 meters) tall and is 8-12 years old.
New or used? Keep in mind that price does not indicate the a certain car seat is best or safest. The safest is the one that works best for your child. Here are some things to look for when you are shopping for a car seat.
- Make sure that the car seat fits your child’s size and weight.
- The car seat has to install easily and fit correctly in your vehicle.
- Try out the seat before purchasing. Adjust all straps and harnesses, checking them for ease of use and security.
- Put the seat in your vehicle and make sure it fits.
- Read the instructions carefully. Illustrations and displays in stores do not always show correct use of the car seat.
When you are done with the installation, send the registration card to the manufacturer after purchase. That way, you will be notified if there are problems or recalls.
Second-hand seats are an option if you do not need a new one.
Do not use a seat if you do not know the seats history. Do not use a seat that:
- Is too old—Contact the manufacturer for recommendations on how long the seat can be used. Check the label for the date when it was made.
- Is lacking a manufacturer date and model number—These allow you to check for recalls.
- Does not have an instruction manual
- Has cracks in the frame or seat or is missing parts
- Was in a moderate or severe crash
Was recalled—Contact the manufacturer or the Auto Safety Hot Line (toll free) at 1-888-DASH-2-Dot (1-888-327-4236). You can also check at the
National Highway Traffic Safety Administration
LATCH, which stands for Lower Anchors and Tethers for Children, has been designed to make child safety seat attachment easier. Lower anchors can be used to secure the seat instead of using the seat belt. A top tether strap is attached to the back of a child safety seat. It is important to use the top tether with any forward-facing seat. As of September 2002, all new vehicles and safety seats have lower anchors and attachments.
To ensure your child’s safety, do the following:
- Always use a car seat when transporting your infant or young child.
- Read car seat instructions and vehicle owner’s manual before using the car seat. Keep all instructions and owner’s manuals. If you lose them, call the manufacturer.
- Children should ride in the back seat. Never put a child in a rear-facing car seat in the front of a vehicle with an airbag. For vehicles with side airbags, read the car seat owner’s manual for instructions on where to place the car seat.
- Always make sure that the child is snugly buckled into the child car seat. Use the correct harness slots and make sure the straps lie flat.
- Always make sure that the child car seat is securely attached to the seat of the vehicle. Push on the car seat where the seat belt passes through. It should not move more than one inch in any direction. If you cannot get the belt tight enough, use another set of belts in the vehicle. Make sure seat belts can be locked into position; check your vehicle owner’s manual. If not, you may need to buy a locking clip.
- If the seat is not reclined enough, your baby’s head may flop forward. Check the manufacturer's instructions for your seat to determine the correct angle.
- Never use a car sear outside of the car. Car seats are designed to be securely positioned in a vehicle. Falls can happen when a baby is placed in a car seat outside of the car. For example, if the seat is placed on the ground or on a table, the baby could fall and be seriously injured.
Your local police or fire station may have a program that offers a check on car seats to make sure they are properly installed. Check with your local officials.
NHTSA has a list of certified CPS technicians who can help you with any questions you may have about the proper installation and use of child safety and booster seats. A list by state or ZIP code is available on the
NHTSA website. There are also inspection stations where you can get instruction on proper installation. The list is available in English and Spanish at http://www.seatcheck.org.
American Academy of Pediatrics Policy Statement on Child Passenger Safety. EBSCO DynaMed website. Available at: . Accessed November 27, 2012.
American Academy of Pediatrics Updates Recommendation on Car Seats. American Academy of Pediatrics website. Available at: . Updated March 21, 2010. Accessed November 27, 2012.
Anticipatory Guidance. EBSCO DynaMed website. Available at: . Updated November 26, 2012. Accessed November 27, 2012.
Car Safety Seats: Information for Families for 2012. Healthy Children from the American Academy of Pediatrics website. Available at: . Updated May 18, 2012. Accessed November 27, 2012.
Last reviewed November 2012 by Brian P. Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.