Installing and Using Child Safety Seats and Booster Seats
Proper restraints for children riding in motor vehicles depend on the child's age and size. Restraints to keep a child safe in the car include:
The key to keeping your child safe is to use an age-appropriate child restraint that is properly installed and properly used.
Infant and child safety seats come in many shapes and sizes. Some are not compatible with certain vehicles. The best child safety seat for a family is the one that is easy to use for the parents or caregivers, fits in the vehicle's seats, is compatible with the vehicle's seat belts, and is the proper size for the child. The American Academy of Pediatrics has a series of specific recommendations for the use of child safety seats:
Children should face the rear of the vehicle until they are at least 2 years of age to reduce the risk of cervical spine injury in the event of a crash. Infants who outgrow their car safety seat recommended by the manufacturer can use convertible seats but must still be rear-facing.
A rear-facing car safety seat must not be placed in the front passenger seat of any vehicle equipped with a passenger-side front air bag. This practice prevents the risk of death or serious injury from impact of the air bag against the safety seat.
Premature and small infants should not be placed in car safety seats with shields, abdominal pads, or arm rests that could directly contact an infant's face and neck during an impact.
In rear-facing car safety seats for infants, shoulder straps must be in the lowest slots until the infant's shoulders are above the slots. The harness must be snug and the car safety seat's retainer clip should be positioned at the midpoint of the infant's chest, not on the abdomen or in the neck area.
The car safety seat should be reclined halfway back, at a 45-degree tilt. A higher angle should be used when the child is over 6 months. Until engineering modifications can be implemented to prevent this problem, a firm roll of cloth or newspaper can be wedged under the car safety seat below the infant's feet to achieve this angle.
A convertible safety seat, which is positioned reclined and rear-facing for a child until 2 years of age and semi-upright and forward-facing for a child older than 2 years of age who weighs 20 to 40 pounds, should be used as long as the child fits well (this includes ears below the top of the back of the seat and shoulders below the seat strap slots).
A booster seat should be used when the child has outgrown a convertible safety seat, but is too small to fit properly in a vehicle safety belt.
A belt-positioning booster seat that uses a combination lap/shoulder belt, if that type of belt is recommended. A booster seat with a small shield, which can be used when only a lap belt is available, is not recommended by the National Highway Traffic Safety Administration (NHTSA).
The infant safety seat
Infant safety seats are often small and portable seats used for babies up to age 1 and 35 pounds. Infant seats are rear-facing and may come with a three-point or a five-point harness. Some infant seats come with detachable bases that can be left belted into the vehicle so that the parent does not have to install the seat every time. (Some bases also are adjustable to correctly recline the infant.)
The child safety seat
Child safety seats are either convertible seats or forward-facing seats:
Convertible seats can be used for infants up to age 2 in the rear-facing position, and then turned around into the forward-facing position for toddlers. The disadvantage of a convertible seat is that is does not fit a newborn as well as an infant safety seat. When changing from a rear-facing position to a forward-facing position, parents or caregivers should check the seat's manual on how to adjust the shoulder straps appropriately and how to route the seat belt properly.
Forward-facing child safety seats are for children over 2 years of age. Some seats may convert to booster seats for children over 40 pounds.
The booster seat
Booster seats help raise your child so that the vehicle's seat belts fit properly. Booster seats are necessary when a child outgrows his or her child safety seat top weight or height, usually after 40 pounds or age 4. Children do not fit in adult shoulder/lap belts (without a booster seat) until they are 58 inches tall (with a sitting height of 29 inches) and weigh 80 pounds, according to the CDC.
Booster seats should always be placed in the back seat of the vehicle. There are several types of booster seats, including:
High back booster with five-point harness. A booster seat that helps protect the head and neck in back seats that do not have head restraints. The five-point harness can be used up to a weight of 40 pounds, after which the harness can be removed to convert the seat to a belt-positioning booster.
Belt-positioning booster. A booster seat that uses the vehicle's lap and shoulder belts to restrain the child.
Shield booster. A booster seat with a removable shield to convert to a belt-positioning booster seat. Shield booster seats should not be used for those children over 40 pounds.
Checking your car seat
As many as 85 percent of child safety seats are found to be improperly installed and/or used when vehicles are stopped and checked, according to studies from National SAFE KIDS Campaign Car Seat Check Ups. Some of the most common mistakes in installing or using child safety seats include the following:
Safety belt not holding the seat in tightly and/or not in locked mode
Harness straps not snug and/or routed correctly
Harness retainer clip not at armpit level
Locking clip not used correctly
Car seat recalled and not repaired (includes booster seats)
Infants placed rear-facing in front of an active air bag
Children turned forward-facing before reaching 2 years of age
Parents and caregivers should carefully read their vehicle owner's manual and the instructions that come with the child safety seat to ensure proper installation and use of the seat. The NHTSA recommends doing the following quick safety seat assessment:
Is your child riding in the back seat? (The back seat is the safest place in a crash.)
Is your child facing the correct way? (Infants up to age 2 should face the rear.)
Is the child safety seat held tightly in place by the seat belt?
Does the harness buckle snugly around your child?
If your child is between 40 and 80 pounds, is he or she in a booster seat for better seat belt fit?
Does your older child fit properly in the vehicle's seat belts? (The shoulder belt should rest over the shoulder and across the chest, and the lap belt should fit low and tight over the upper thighs. The child should be tall enough to sit with knees bent at the edge of the seat--at least 58 inches tall and 80 pounds.)
Replacing child safety seats and seat belts after a crash
Once a vehicle has been in a severe crash, child safety seats and seat belts should be replaced because they may have become stretched or damaged. All child safety seats are replaced by insurance companies. Always check with your child safety seat manufacturer concerning questions about the safety of your child's seat.
When car seats are recalled
Sometimes child safety seats are recalled for safety reasons. To check if your child safety seat has been recalled, call the seat's manufacturer or the Auto Safety Hot Line at 888-DASH-2-DOT. If the seat has been recalled, you will be instructed on how to repair it, or how to obtain parts to repair it.
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Online Medical Reviewer: Haines, Cynthia, MD
Last Review Date: 01/26/2013
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