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Car Safety Seats for Infants and Children

Each year thousands of young children are killed or injured in car crashes. Proper use of car safety seats can reduce traffic fatalities by at least 80%. All 50 states have passed laws that require children to ride in approved child passenger safety seats. Children should be in rear-facing car seats until their second birthday, because it’s 5 times safer than forward-facing.

You cannot protect a child by holding him or her tightly. In a 30-mile-per-hour crash, the child can be crushed between your body and the dashboard, or ripped from your arms and possibly thrown from the car. Car safety seats also help to control a child's misbehavior, prevent motion sickness, and reduce the number of accidents caused by a child distracting the driver.

What are the types of car safety seats?

Before you buy a car safety seat, look at several different models. Make sure that the car seat will fit in your car and that your seat belts will work with the seat. To be sure that your seat fits properly in your car, contact a children's hospital or local fire department. Many of them can help you install car safety seats correctly.

Remember that with each transition, there is a loss of some safety – so use the restraint to the highest weight and height limits allowed. There are several types of car safety seats:

  • Infant-only seats: These are rear-facing only seats. They can be used from birth until a child weighs approximately 20 pounds (depending on the model). They are small and portable.

    Most of these seats come with a detachable base that you attach to the seat of the car. This allows you to easily snap the car seat in and out of the car without reinstalling the car seat each time. If the base does not attach tightly to your car, apply pressure to the infant seat while tightening the seatbelt. Most children outgrow their infant seat by their first birthday. The top of your baby's head must be at least one inch from the top of the safety seat to protect your infant in a crash.

  • Convertible safety seats: These seats can be used in both rear- and forward-facing positions. The seat needs to stay in the rear-facing position until your child is over 2 years old and has reached the highest weight allowed for the rear-facing position (usually about 30 pounds, but may be more or less depending on the car seat). They can be used in the forward-facing position to a much higher weight limit. Continue using a five point harness to restrain your child for as long as possible, as they are superior to a lap/shoulder belt.
  • Combination seats: These seats are forward-facing seats that can be used after your child has reached the maximum rear-facing weight limit and is at least 2 years old. Your child must wear the 5-point harness until he or she has reached the maximum weight limit. Remember that a five point harness offers superior protection over a lap/shoulder belt. When your child reaches the harness weight limit, you can use this seat as a booster seat by correctly positioning the car's lap/shoulder belt across your child. It can be used as a booster seat to a certain weight limit printed on the seat.
  • Booster seats: These are forward-facing seats that lift the child higher so your car's lap/shoulder belt will fit correctly over the child. A booster seat is for children over 40 pounds. It should be used until the child is 56 inches tall, a height usually reached between 9 and 12 years of age. If your child's seat in your vehicle has no headrest, then you need a high-back booster seat. Placing your child in a seat without a headrest is unsafe.
  • Built-in seats (integrated seats): Some cars and vans come with built-in child safety seats. These may be used by children who are over 2 years of age, weigh at least 30 pounds and meet the weight and height requirements specified by the manufacturer. Check with the maker of the car to find out the height and weight requirements, and to see if there are any recalls.

Keep car seat instructions in a safe spot, such as taped to the back of the seat. Send in the product registration to make sure you are notified of any safety recalls. Check the manufacturer website for updated instructions and videos showing how to install the car seat correctly.

What is LATCH?

Since 2002, most new vehicles and car safety seats have a system called LATCH (Lower Anchors and Tethers for Children). This system may be an easier way to attach safety seats. It lets you attach the car seat without using a seat belt. However, you will need to continue attaching the car safety seat with a seat belt unless your vehicle has the LATCH system. Caution: never use both the vehicle seat belt and the LATCH system at the same time. Check with your car seat and car manufacturer, as lower anchors have weight limits.

What are tethers?

Tether straps are found on forward-facing car seats. A tether strap hooks the top of a car safety seat to a permanent anchor in the car to protect your child from whiplash. Tethers reduce the amount of forward movement of the car seat in a crash. All cars made after September 2000 are required to have tether anchors. Cars made since 1989 can be retro-fitted with tether straps. Most anchors are on the rear window ledge, back of the seat, floor, or ceiling of the car. Check your vehicle owner’s manual for details. Check with your car seat and car manufacturer, as all tethers have weight limits.

Where should the car seat be placed?

All children under the age of 13 should ride in the back seat. It is not as safe for children to ride in the front seat of a car.

Air bags are standard equipment in most new cars. They are meant for adults, and have saved many lives. However, they can be very dangerous to infants and children. They have caused death from brain injury. If your car has air bags, take the following precautions:

  • Infants riding in REAR-facing child safety seats should NEVER be placed in the front seat of a car or truck with a passenger-side air bag. They must be in the car's rear seat or they can’t ride in that vehicle.
  • Children in FORWARD-facing child safety seats should also ride in a car's rear seat until 13 years of age.
  • If the vehicle does not have a rear seat, children riding in the front seat should be positioned as far back as possible from the air bag. Move the seat all the way back so that the child is as far as possible from the dashboard. Consider using a five point harness to help keep the child away from the airbag in case of a collision. Some cars come with air bag ON/OFF switches. Turn the air bag off only if your car has no back seat. Always read the vehicle owner’s manual for instructions.
  • Side air bags improve safety for adults in side impact crashes. However, children who are seated near a side air bag may be at risk for serious injury. Read your vehicle owner's manual and your car seat manual to find out how this applies to your vehicle.

If you have more questions about installing your car safety seat, a list of inspection stations where you can go for help is available in both English and Spanish at http://www.seatcheck.org or toll-free at 866-732-8243.

When can my child use a regular seat belt?

Keep your child in a booster seat as long as possible. Your child could be ready for a regular seat belt anywhere between 9 and 12 years old depending on height and weight. Your child should be about 4' 9" tall and at least 60 to 80 pounds to properly fit an adult seat belt. When your child is ready for a regular seat belt, it should cross your child's chest, not the neck or throat. Never put the shoulder belt under both arms or behind the back.

In summary, your child is ready to ride in a car using the lap and shoulder belt when:

  1. The shoulder belt fits snugly across the center of your child’s shoulder.
  2. The lap belt fits low, in contact with your child’s hips and across upper thighs.
  3. Your child’s knees bend over the edge of the seat while sitting as far back as possible without slouching.

What are the safety standards?

The American Academy of Pediatrics (AAP) publishes a list of infant/child safety seats that have met the Federal Motor Vehicle Standards. The list is updated yearly. To visit the AAP website:

American Academy of Pediatrics (AAP)
http://www.healthychildren.org/english/safety-prevention/on-the-go/Pages/default.aspx

Each state has its own seat belt laws and safety standards. Although all states require that children are buckled in, not all states require that children travel in the safest way possible. Using a car safety seat correctly is very important. Follow the safety seat instructions and make sure you are keeping your child as safe as possible.

Tips for Using a Car Seat Properly

If used consistently and properly, your child's car seat can be a lifesaver. Your attitude toward safety belts and car seats is important. If you treat buckling up as a necessary, automatic routine, your child will follow your lead and also accept car seats and seat belts. It’s never too early to teach your child about respecting the rules of the road.

To keep your child safe and happy, follow these guidelines adapted from the American Academy of Pediatrics:

  • Always use the safety seat. Use the safety seat on the first ride home from the hospital, and continue using it for every ride.
  • Everyone buckles up. Allow NO exceptions for older kids and adults. If adults ride unprotected, the child quickly decides that safety is just kid stuff.
  • Give frequent praise for appropriate behavior in the car.
  • Remember that a bored child can become disruptive. Keep a supply of favorite soft toys on hand. Use food as a last resort, because they contribute to the unhealthy habit of snacking and overeating. They can also pose a choking hazard.
  • NEVER let a fussy child out of the car seat or safety belt while the car is in motion. If your child needs a break, STOP the car. Responding to complaints by allowing your child to ride unprotected is a disastrous decision that will make it harder to keep him or her in the seat on the next ride.
  • Parents should never take off their seat belt to reach into the back seat to attend to a child while the car is in motion. Too many parents have been seriously injured when their car was struck during those few seconds. Any unrestrained occupant poses a hazard to other people riding in the vehicle, including children.
  • Some infants begin crying at 4 or 5 months (possibly from separation anxiety) when placed in their rear-facing car seats. Try distracting them with music and toys. Also give them practice time in the car seat at home. Use it for pleasant activities such as playing and eating.
  • If a child tries to get out of the seat, stop the car and firmly but calmly explain that you won't start the car until he or she is again buckled in the car seat.
  • Booster seats must be used with a lap and shoulder belt.
  • When your child travels in another person's car (such as a baby sitter's or grandparent's car), insist that the driver also use the safety seat and wear their seatbelt.
  • For long-distance trips, plan for frequent stops and try to stop before your child becomes restless. Cuddle a young child. Let an older child snack and run around for 10 to 15 minutes.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Pediatric Advisor 2015.2 published by RelayHealth.
Last modified: 2013-08-02
Last reviewed: 2014-06-10
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 Barton D. Schmitt, MD FAAP. All rights reserved.
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