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 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 2 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 they have reached 2 years or older, or have 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 4 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 weigh up to 40-80 pounds (18-36 kg). The booster can be used without a harness for children who weigh 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 hips and pelvis, and fit snugly.
- The shoulder belt should cross the middle of your child's chest and shoulder when they are sitting back.
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.
Last reviewedNovember 2014by Michael Woods, 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.