Tips on Child Car Seat Safety
Car crashes are the most frequent cause of injury and injury-related death in children. Infant and child car seats were developed to help reduce these injuries. However, serious injuries can occur if car seats are not properly used.
Choosing a Child Car Seat
Follow these steps to make sure you select the right child seat for your child.
You should choose a seat that:
- Fits your child’s size and weight
- Can be installed easily and correctly in your vehicle
- You do not have to buy the most expensive seat. Cost often relates to added features. It does not necessarily make the seat easier to use.
- Try out the seat before purchasing. Make sure it fits your child’s size and weight. 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.
- Make sure you send the registration card to the manufacturer after purchase. That way, you will be notified if there are problems or recalls.
Do not use a seat that:
- Is too old. Contact the manufacturer for the company recommendation on how long the seat can be used. (Look on the label for the date when it was made.)
- Is lacking a manufacturer date and model number. (You should be able to check for recalls.)
- Does not have an instruction manual. (You can probably get a copy from the manufacturer.)
- Has cracks in the frame or seat, or is missing parts.
- Was in a car crash, even if it looks fine.
- 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 (NHTSA) website.
- Is a shield booster, which have caused major injuries.
Types of Child Car Seats
Rear-facing Infants Seats
Rear-facing infant seats come with or without removable bases. In seats with a removable base, the base stays in the car so you don’t need to install it each time you put your baby in the car. Here are some tips on using rear-facing infants seats:
- Use for babies from birth who weigh up to 20 pounds (sometimes up to 35 pounds, depending on the model). All infants should use a rear-facing seat until they have reached at least 1 year of age.
- The seat must face rearward only and recline at a 45° angle.
- Harness slots should be at or below your baby’s shoulders. Getting a seat with more than one set of slots, as well as adjustable buckles and shields, gives room for your baby to grow.
- Harness chest clips should be at armpit level.
- The baby’s head should stay at least 2 inches below the top of the child seat. If the baby is tall, not yet 20 pounds, and less than 1 year of age, move the baby into a convertible seat, which is rear-facing.
Convertible seats are bigger than rear-facing infant seats and can be used longer. They can be used rear-facing or forward-facing, depending on the baby’s age and weight.
Rear-facing Convertible Seats
The American Academy of Pediatrics recommends that babies be kept in rear-facing seats for as long as possible. Here are some additional recommendations:
- Use for babies up to at least 1 year of age and weighing up to at least 20 pounds. Some models are built for heavier babies (up to 30-35 pounds).
- Harness straps should be at or below the baby’s shoulders.
- Harness chest clips should be at baby’s armpit level.
Forward-facing Convertible Seats
Here are the guidelines for forwarding-facing seats:
- Use for children who are between 20-40 pounds, and over 1 year of age.
- Harness straps should be at or above child’s shoulders. Use top harness slots of safety seat.
- Change the seat to the upright from the reclining position, if required.
- The seat belt should go through the forward-facing belt path.
Forward-facing Only Seats
When you child is at least one year old, you may switch to a forward-facing seat.
- Use for children who are at least 1 year of age and weigh between 20-40 pounds (up to 60 pounds with some new models).
- Harness straps should be at or above child’s shoulders.
- Harness chest clip should be at armpit level.
- These seats cannot be used rear-facing.
Combination Forward Facing/Booster Seats
If you choose a combination seat, here is what you need to know.
- Use for children who are at least 1 year of age and weigh at least 20 pounds.
- Depending on the model, the harness straps on these seats can be used for children up to 40-65 pounds.
- Use belt-positioning boosters for children who have reached the weight limit for the harness (see manufacturer’s directions). The vehicle’s lap and shoulder belts should be used and the harness removed. Children must never use a booster seat using a lap belt only since they may be seriously injured should a collision occur.
- These models cannot be used rear-facing.
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. There are several types of booster seats, for example belt-positioning boosters, high-backed boosters with built-in harness, and shield boosters. A booster seat is needed when:
- Your child reaches the highest weight allowed for his or her car seat.
- Or, your child’s ears reach the top of his or her car seat.
- The lap belt should be across your child’s upper thighs and the shoulder belt across the middle of the chest and shoulder.
High-backed Booster With Built-in Harness
When using a high-backed booster, you need to know the following:
- These are recommended for use by children approximately 30-40 pounds, when used with a harness.
- These are used forward-facing only.
- Harness straps should be at or above child’s shoulders.
- Harness chest clip should be at child’s armpit level.
- Remove harness when child reaches 40 pounds.
These seats are used with car seat belts (lap and shoulder). The seat raises the child so that the seat belts fit properly.
The American Academy of Pediatrics recommends against the use of these seats since major injuries have occurred to children who were using them. These seats should be used only if the shield is removed, and the seat is used with a lap and shoulder belt as described above.
The LATCH System
A new system has been designed to make child safety seat attachment easier. The system is called LATCH, which stands for Lower Anchors and Tethers for Children. Most new forward-facing child safety seats require a top tether strap. This adjustable strap is attached to the back of a child safety seat. It has a hook for securing the seat to a tether anchor. The achor is on the rear shelf of the vehicle. In the case of minivans and station wagons, the anchor is on the floor of the back of the rear seat. Since September 2000, all new cars, minivans, and light trucks have had this tether anchor. As of September 2002, all new vehicles and safety seats will have lower anchors and attachments.
Correct Use of the Child Car Seat
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 easily in any direction. If you cannot get the belt tight enough, find another set of belts in the vehicle. Make sure seat belts can be locked into position; check 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. The seat should be tilted back to about a 45° angle.
Information on Child Passenger Safety (CPS) Technicians
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 or toll free at 1-866-SEATCHECK (1-866-732-8243).
American Academy of Pediatrics
National Highway Traffic Safety Administration
Canada Safety Council
Car safety seats: a guide for families 2007. American Academy of Pediatrics website. Available at: http://www.aap.org/family.carseatguide.htm. Accessed on January 24, 2009.
Last reviewed January 2009 by ]]>Janet H. Greenhut, MD, MPH]]>
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.
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