Starting with a baby's very first journey home from the hospital, parents are responsible for ensuring their child's safety during travel. Unintentional injury is the leading cause of death in children and more kids are killed in automobile crashes than in any other type of unintentional injury.
You can protect your kids by following simple safety measures and by teaching some basic rules.
Importance of Child Safety Seats
Using a child safety seat (car seat) is the best protection you can give your child when traveling by car. Every state in the United States requires that an infant or small child be restrained — and with good reason. Child safety seats can reduce the risk of a potentially fatal injury substantially for babies in particular and also for toddlers. But many safety seats are used incorrectly.
When choosing any car seat, following some general guidelines will help ensure your child's safety. The best car seat is not always the most expensive one — it's the one that best fits a child's weight, size, and age, as well as your vehicle.
Once you select a seat, be sure to try it out, keeping in mind that store displays and illustrations might not show the correct usage. It's up to you to learn how to install a car safety seat properly and harness your child for the ride.
If you need help installing your safety seat or would like a technician to check whether you've installed it properly, the federal government has set up child seat inspection stations across the country.
Also, many local health departments, public safety groups, hospitals, law enforcement agencies, and fire departments have technicians or fitting stations to assist parents. (Don't assume that just because you go to one of these locations, their staff will be certified to help you install your seat. Ask if a certified child passenger safety technician is available.)
Guidelines for Choosing a Safety Seat
- Choose a seat with a label that states that it meets or exceeds Federal Motor Vehicle Safety Standard 213.
- Accept a used seat with caution. Never use a seat that's more than 6 years old or one that was in a crash (even if it looks OK, it could be structurally unsound). Avoid seats that are missing parts or are not labeled with the manufacture date and model number (you'll have no way to know about recalls), or do not come with an instruction manual. If you have any doubts about a seat's history, or if it is cracked or shows signs of wear and tear, don't use it.
- If you accept a used seat, call the manufacturer to find out how long they recommend using the seat and if it was ever recalled. Recalls are quite common, and the manufacturer may be able to provide you with a replacement part or new model.
Infant-Only Seats (Birth to 20-22 Pounds)
Infant-only seats fit newborns and smaller infants best, but you will have to buy another seat as your baby outgrows it. Infant-only seats are designed to protect babies from birth until they reach 20 to 22 pounds (about 10 kilograms), sometimes more, depending on the model.
Infant car seats should always be installed to face the rear of the car because in a crash the back of the safety seat cradles head, neck, and torso. Infants should be rear-facing until they are at least 1 year old and at least 20 pounds, though it is recommended that infants stay rear-facing until they reach weight or height limits as prescribed by the manufacturer.
A baby who weighs more than 20 pounds (about 10 kilograms) but has not yet reached 1 year of age should still ride in a rear-facing seat, because the baby's neck is typically not strong enough to support the baby's head in the event of a crash. Follow the height and weight guidelines on the child safety seat, and you will want to keep your child in a seat that faces the rear as long as it's possible and the seat still fits.
Many infant-only safety seats are also very convenient because they're designed to double as carriers, chairs, or rockers when not used in the car. Many models detach right from the base, allowing you to leave the base installed in the car.
Try to limit the amount of time your infant spends in the car seat while you're at home or while the baby is at childcare. Too much time in the car seat may limit your baby's movement and opportunities for stimulation, which help infants develop sensory and motor skills.
How to Install an Infant-Only Seat
Prior to installing your baby's infant-only seat, read the product manual thoroughly. Below are some tips that can help with the installation:
- An infant-only seat should be placed in the back seat, ideally in the middle of the back seat, but most important, in a position where it fits securely.
- Read the owner's manual for your car to find out how to use your car's seat belts with a child safety seat.
- Use your knee to push down on the seat as you tighten the car's seat belt through the belt path. The car seat should not move more than 1 inch (3 centimeters) from side to side or forward and backward at the belt path. If the seat wiggles or moves on the belt path, the belt needs to be tighter.
- Some seat belts may require a special locking clip, which is designed specifically to keep the belt from loosening. Locking clips are available from baby product stores, safety seat manufacturers, and some car dealerships.
- Be sure to check the tightness of the safety seat before each use.
- Never use an infant-only seat in a forward-facing position.
- The car seat should recline at no more than a 45-degree angle.
How to harness your infant:
- Read the entire child safety seat manual.
- Your baby's head should be at least 2 inches (6 centimeters) below the top of the safety seat.
- Infant-only seats are usually designed with a 3-point or 5-point harness. The harness should always be placed in the slots and should always be at or below your baby's shoulders. Most models have a chest clip that holds the harness straps together. Move the clip so the top of it is level with your baby's armpits.
- All harness straps should fit snugly, especially over the shoulder and thigh areas. Straps should always lie flat, never twisted. If you can pinch any harness webbing between your fingers, it's too loose.
- Dress your baby in clothes that keep his or her legs free. This will allow you to buckle the latch crotch strap properly between his or her legs. If it is cold outside, harness your baby first and then cover him or her with a blanket (never cover your baby's head). Never buckle a blanket under or behind the baby.
- If your baby slouches to one side or the other in the seat (common among newborns), place rolled-up cloth diapers or rolled hand towels on each side of his or her shoulders. There are supports specially designed for car seats, but only use them if they came manufactured with your safety seat. Never place any kind of padding or blanket under your baby — this can affect the harness's ability to restrain him or her.
- If your baby's head flops forward (also common among newborns), check the angle of the seat. Use a towel or blanket to tilt the seat back slightly (a 30- to 45-degree angle is best).
Convertible Seats (Birth to 40 Pounds)
Convertible seats are designed to protect kids from birth up to 40 pounds (19 kilograms) or more, depending on the model. Convertible seats are the only type of seats that are placed in different positions depending on a child's age: They face toward the rear until a baby is 20 to 35 pounds (10 to 16 kilograms) and at least 1 year old and can be turned to face forward after that.
However, many of the convertible seats on the market allow a child to remain rear-facing up to 30 to 35 pounds (14 to 16 kilograms). It is recommended that you use the seat rear-facing as long as the instructions allow.
Convertible seats are heavy and not very portable. Yet they can be economical because it may not be necessary to buy a separate infant-only seat. It is also a good option for larger babies who outgrow their infant-only seat before 1 year and still need to be rear facing.
If using a convertible seat, make sure it fits your child correctly — a small child in a large seat may not be the best option. Models with tray shields should not be used for newborns — the shield comes up too high on them, and in a crash, the baby's face could hit the tray.
How to Install a Convertible Seat
An infant or small toddler should be placed in the back seat — preferably in the middle — and must be facing toward the rear of the vehicle until at least 20 pounds (10 kilograms) and at least 1 year old.
- After your child has reached at least 20 pounds (10 kilograms) and at least 1 year of age, the seat may be turned to face forward. (Follow the manufacturer's guidelines for when to turn the seat.)
- Read the owner's manual for your car to find out how to use your car's seat belts or LATCH system with a child safety seat.
- Read the entire child safety seat manual. Be sure to check the recommended angle of recline for the seat when it is forward-facing and rear-facing.
- Use your knee to push down on the seat as you tighten the car's seat belt (may be a lap-only or lap/shoulder) or LATCH attachments belt through the child safety seat's belt path. The seat should not move more than 1 inch (3 centimeters) side to side or forward and backward on the belt path. If the seat wiggles or moves on the belt path, the belt needs to be tighter.
- Some seat belts may require a special locking clip that is designed specifically to keep the belt from loosening. Locking clips are available from baby product stores, safety seat manufacturers, and some car dealerships.
- Be sure to check the tightness of the safety seat before each use.
How to harness your child:
Infants (up to 1 year AND 20 pounds):
- Read the entire child safety seat manual.
- Shoulder straps should be threaded through the lowest harness slots to best protect your baby. They should be at or below your baby's shoulder.
- Convertible seats usually have one of three harness options: the 5-point harness, the tray shield, and the T-shield. The 5-point harness offers the best protection of the three for infants because it can tighten to fit snugly and does not obstruct a baby's head — both of the other harness options can cover a baby's face and are not recommended for infants under 20 pounds (10 kilograms) or 1 year old.
- All straps should fit snugly, especially over the shoulder and thigh areas. Straps should always lie flat, never twisted. If you can pinch any harness webbing between your fingers, it's too loose.
- Dress your baby in clothes that keep the legs free. This will allow you to buckle the latch crotch strap properly between the baby's legs. If it is cold outside, harness your baby first and then cover him or her with a blanket. Never buckle a blanket under the seat straps.
- If your baby slouches to one side or the other in the seat (common among newborns), place rolled-up cloth diapers or rolled hand towels on each side of the shoulders. There are supports specially designed for car seats, but only use them if they came manufactured with your safety seat. Never place any kind of padding or blanket under your baby — this can affect the harness's ability to restrain your little one.
- If your baby's head flops forward (also common among newborns), check the angle of the seat. Use a towel or blanket to tilt the seat back slightly (a 30- to 45-degree angle is best).
Toddlers (older than 1 year AND between 20 to 40 pounds):
- Read the entire child safety seat manual.
- Shoulder straps should be threaded through the top harness slots of a convertible seat or any one of the harness slots in a forward-only facing seat to accommodate your child's new height. They should be at or above your child's shoulder level.
- Convertible seats usually have one of three harness options: the 5-point harness, the T-shield, and the tray shield. If a child's head and neck clear the top of a T-shield or tray shield, all of these harness styles are OK. But for the best protection from head injury, the 5-point harness is recommended.
- All straps should fit snugly, especially over the shoulder and thigh areas. Straps should always lie flat, never twisted. If you can pinch any harness webbing between your fingers, it's too loose.
- Dress your child in clothes that keep the legs free. This will allow you to buckle the crotch strap properly between your child's legs. If it is cold outside, harness your child first and then cover him or her with a blanket. Never buckle a blanket under the seat straps.
- Be sure to readjust harness straps as your child grows. Heavy clothing (such as a puffy winter coat) should always be placed over your child after being harnessed in the seat. (A tip: After your child is harnessed in the seat, slip his or her coat on backward for warmth.)
Forward-Facing Only Seats (20-40 pounds)
Forward-facing car seats are designed to protect children from 20 to 40 pounds (about 10 to 20 kilograms) or more, depending on the model. If you used an infant-only car seat, you can switch to a forward-facing model when your child is at least 1 year old and at least 20 pounds. Kids should stay in a car seat with full harness until they are at least 4 years old before switching to a booster seat.
Combination car seats are also available that allow you to remove the harness to switch from forward- facing child safety seat to belt-positioning booster seat. Refer to the forward-facing convertible seat for toddlers information to review proper installation of forward-facing car seats and how to harness your child.
Built-in or integrated car seats can be found in some vehicles. As with other forward-facing car safety seats, built-in seats are for kids 1 year of age and older and at least 20 pounds. Some convert to belt-positioning booster seats. Weight and height limits will vary so be sure to check your owner's manual.
Booster Seats (40-80 Pounds)
When your child reaches the maximum weight allowed for the car seat or your child's ears have reached the top of the car seat, you'll need to switch to a booster seat. Booster seats are designed for kids who have outgrown forward-facing or convertible safety seats but are still too small to be properly restrained by the vehicle's seat belts. Many states have passed laws requiring booster seats for kids up to 8 years old and 80 pounds (37 kilograms), or 4 feet 9 inches (about 150 centimeters) tall.
Booster seats come in many styles. Belt-positioning boosters raise kids to a height where they can safely use the car's lap and shoulder belts. They come in high-back or backless models: High-back boosters are recommended when the car has low seat backs, and backless boosters may be used if a child's head is supported up to the top of his or her ears by the vehicle's back seat or head support.
Combination seats can be used with harnesses as a forward-facing safety seat up to about 40 pounds (19 kilograms) or as a belt-positioning booster seat when harnesses are removed when the child weighs more than 40 pounds (19 kilograms).
Shield boosters (with no back and a shield tray in front of the child) are designed for cars with lap-only belts, but they do not provide adequate upper-body protection. If your car doesn't have shoulder belts in the back seat, consider having them installed by the dealer.
If that's not possible, the American Academy of Pediatrics (AAP) recommends keeping any child older than 1 year and between 20 and 40 pounds (10 and 19 kilograms) in a convertible or forward-facing seat. Kids who weigh more than 40 pounds (19 kilograms) should never use shield boosters unless the shield is removed and the seat is used as a belt-positioning seat with the vehicle's lap and shoulder belts.
How to Install a Booster Seat
Prior to installing booster seat, read the product manual thoroughly.
- Booster seats should be placed forward-facing in the back seat, ideally in the middle of the back seat where there is a lap and shoulder belt.
- Read the owner's manual for your car to find out how to use your car's seat belts with a child safety seat.
- Be sure to check the tightness of the safety seat before each use.
How to secure your child's seat belt:
- Read the entire booster seat manual.
- Make sure the lap belt is low and tight across your child's hips.
- The shoulder belt should lay flat and snug across your child's shoulder and stay clear of his or her neck or face.
- Shoulder and lap belts should always lie flat, never twisted.
Kids this age can begin to understand the importance of buckling up and may want to buckle themselves in. Be sure to check their seat belts and offer praise when they voluntarily put on their belts.
Using a Seat Belt Without a Booster
Kids can stop using a booster seat when they're big enough to use the vehicle's lap and shoulder belts while sitting with their back against the vehicle's seat back and their knees bent over the edge of the seat without slouching. The lap belt should rest low, on top of the thighs, and the shoulder belt should lie comfortably across the middle of the chest.
Kids should be able to remain in this position throughout the entire trip. This usually happens when a child reaches a height of 4 feet-9 inches (about 150 centimeters).
Remember, the shoulder strap of the seat belt should never be fastened behind a child's back or under his or her arm. And you should never buckle two kids (or an adult and a child) under one seat belt — a crash could cause their heads to collide.
Air Bags and Kids
When combined with safety belts, air bags protect adults and teens from injury during a collision. They have saved lives and prevented many serious injuries. But infants and children can be injured or even killed if they are riding in the front passenger seat when an air bag opens.
Air bags were designed with adults in mind: They need to open at up to 200 miles per hour to protect an average-sized, 165-pound (75-kilogram) male from injury. While this force is appropriate for adults and bigger kids, it can be dangerous for smaller passengers, possibly resulting in head and neck injuries.
Protect kids from air bag injury by following these rules:
- All kids 12 years old and younger should always ride in the back seat, and in the middle of the back seat whenever possible. All passengers must have their seat belts buckled.
- Air bags present a serious danger for babies riding in rear-facing car seats. Never place a rear-facing infant seat in the front seat of a car that is equipped with a passenger-side air bag.
- Child safety seats should be placed in the back seat. If you have no choice and must place a child in car seat in the front, push the passenger seat as far back as it will go.
- A law passed in 1995 allows car manufacturers to install a manual cut-off switch that temporarily disables a passenger-side air bag. As recommended by National Highway Traffic Safety Administration, if you must place a child in a car seat in the front seat (that is, if your car is a two-seater or if the car seat will not fit in the back seat) and your car has this cut-off switch, disable the air bag for the duration of the ride. Be sure to switch the air bag back on when you remove the car seat.
The LATCH System
Since September 2002, most new vehicles have safety seat anchorage points and most safety seats have anchor attachments.
One of the problems with installing safety seats properly has been incompatibility between the car seat and the vehicle. The Lower Anchors and Tethers for Children (LATCH) system was devised to make installation easier because it does not require use of the car's seat belts.
Instead, a tether strap secures the top of the safety seat to an anchorage point either on the rear shelf area, the rear floor, or the back of the rear seat of the car, depending on the vehicle model. Lower anchors secure attachments on the bottom of the safety seat to a point located between the car's seat cushion and seat back.
You should use LATCH only in seating positions recommended by both the vehicle manufacturer and the car seat manufacturer. Never use both the seat belt and LATCH to install a car seat. Choose whichever method secures the car seat best.
Most forward-facing safety seats made after September 1999 are equipped with top tether straps, and most vehicles made after September 2000 have tether anchors. Since September 2002, most new vehicles also have lower safety seat anchorage points and most safety seats have lower anchor attachments.
If your vehicle or safety seat was purchased after these dates and didn't come with tethers or anchors, call the manufacturer.
Rules for the Car and School Bus
Most kids spend time in a car or on a school bus every day, and should be taught simple rules for traveling in them to help ensure their safety.
Be sure to explain to your kids that these rules must be followed every time, no matter who is driving or how short the ride may be.
Rules for the Car
A seat belt must be worn during every car trip. It should be fastened before the car is even in motion and should be left on until the end of the trip.
- Use all seat belts. Most cars have lap and shoulder belts that buckle as a unit, but some have two separate belts, one lap and one shoulder. Some have a lap belt only. Teach your child to look for and secure every belt.
- Never share seat belts. It may seem like fun, but two kids should never buckle up as a pair.
- Sit in the back seat. Kids 12 years old and younger should always ride in the back seat. This protects them from possible injury when a passenger-side air bag deploys. Explain that air bags could seriously hurt a small child because they are designed to protect a person with a much bigger body.
- Play it cool. Kids should understand the importance of staying calm and low-key in the back seat. If they are jumping around or yelling, it can distract the driver and put all the passengers at risk.
- Follow the rules in every car. Kids need to follow the rules if they are in a friend's or relative's car, even if other passengers don't follow the rules. If asked to sit in the front seat of someone else's car, your child should politely decline the offer and tell the driver that he or she would prefer to sit in the back seat.
Rules for the Bus
- Wait for the bus away from the street. Kids should get in a line that starts about 6 feet (2 meters) from the curb and goes away from the street rather than down the side.
- Wait for the OK. Kids must wait until the bus driver opens the door and says that it's OK to step on. They should not step into the road even a moment sooner.
- Be careful getting on the bus. This is important for older kids who may carry book bags and backpacks that can get caught in a door or around a seat.
- Wear seat belts if possible. Some school buses are outfitted with seat belts. They should be buckled before the bus leaves and left on until the bus arrives at its destination.
- Play it cool. Make sure kids understand the importance of staying in their seats while the bus is moving. Running or climbing around the bus can distract the driver and be dangerous to other kids.
- Be careful getting off the bus. When exiting the bus, kids should hold onto the handrail and step down slowly. Once off the bus, they must walk in front of it, never behind it.
- Stay in front. When they walk in front of the bus, kids should walk on the sidewalk next to the bus for at least 10 feet (about 3 meters), make sure the bus driver acknowledges them, and then cross the street.
- Don't disappear. A child who drops something while crossing in front of a bus should never bend over to pick it up. This makes the child invisible to the driver. Instead, teach kids to tell the bus driver if they drop something.
Reviewed by: Mary L. Gavin, MD
Date reviewed: July 2008
Originally reviewed by: Janet Brooks
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