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Reviewed by the Faculty of Harvard Medical School

Car Seats

Every state requires that infants and small children ride in car seats because car seats do save lives! Yet, car crashes are still the most common cause of death and injury in children. Although car seats are often used, some studies show that 80% of child safety seats are used the wrong way. To make sure your child has the safest ride, follow these rules of car seat safety:

  1. Buckle yourself and your child up for EVERY ride, no matter how short.
  2. Purchase the CORRECT seat for your child, which depends on his age and weight.
  3. Check the list of recalled car seats before buying a used car seat or before borrowing someone else's.
  4. Carefully read all car seat instructions and keep them for future reference.
  5. NEVER put a child in a rear-facing car seat in the front seat if there is a passenger-side air bag. Serious injury or death can occur from the impact of the air bag against the back of the car seat. In fact, the back seat is the safest place for all children, because it is the seat farthest away in a front-end collision, the most common type of accident.
  6. Always put a child who weighs less than 20 pounds or is younger than 1 year in a rear-facing car seat. A child who weighs at least 20 pounds and is at least 1 year old can be moved into a forward-facing car seat.
  7. Use a forward-facing car seat for as long as the child fits well (for example, shoulders below the seat strap slots and ears below the top of the back of the seat).
  8. Use a booster seat for a child who weighs 40 pounds, but is still too small to fit properly in a seat belt.
  9. Never put a blanket around (over) a child BEFORE fastening the straps of the car seat.
  10. Never drive with any small children who are not sitting in a properly installed car seat.
  11. Every child in your car should be secured in a car seat or vehicle seat belt, no matter how short a ride.
  12. Never put your child in his car seat in a shopping-cart basket. The seat could slip out of the basket, injuring your child.

Types Of Car Safety Seats

Infant-only seats. These seats are only used for newborns and infants up to age 1 year or 20 pounds, whichever comes first.

Convertible seats. These seats are bigger and heavier than infant-only seats and can be used for both infants and toddlers. Convertible seats can be used in the rear-facing position for babies who are less than 1 year or weigh less than 20 pounds (or more with most models); and then can be used in the front-facing position for toddlers who are at least 1 year and weigh between 20 and 40 pounds. (NOTE: Babies who weigh more than 20 pounds but are younger than 1 year should continue to ride rear-facing until their first birthday. Babies who are older than 1 year but do not yet weigh 20 pounds should continue to ride rear-facing until they reach 20 pounds.) Although these seats may be used for newborns, some don't fit newborns as well as infant-only seats do. So make sure your baby can fit comfortably in the seat.

Convertible seats typically come with one of three harness types.

  • Five-point harness — A five-point harness has five straps: two at the shoulders, two at the hips and one at the crotch. This is the only harness type that should be used with newborns.
  • T-shield — A padded T-shaped or triangular shield is attached to shoulder straps.
  • Overhead shield — A padded tray-like shield swings down around the child.

When your child is old enough and weighs enough to sit facing forward, move the shoulder straps to the slots above your child's shoulders (usually the top slots, but check your instructions to make sure). In addition, place the seat into the upright position and move the seat belt through the forward-facing belt path.

Forward-facing seats. In contrast to convertible seats, forward-facing seats are designed to be used in the forward-facing position only. These seats are certified for use with babies weighing 20 pounds or more; the child also must be at least 1 year old. The harness straps should be at or above your child's shoulders. Forward-facing seats have several slots into which shoulder straps can be inserted, so choose the slots above and as close as possible to your child's shoulders. The chest clip should be positioned across the chest at armpit level to keep the harness straps in place.

Integrated (built-in) seats. Many vehicles, particularly station wagons, sports utility vehicles and minivans, already have built-in forward-facing child safety seats for children who are older than 1 year and weigh at least 20 pounds. Although these built-in seats eliminate the installation problems associated with separate car seats, their weight and height limits vary. Check with your vehicle's manufacturer for details about the built-in seats currently available with your car.

Booster seats. Once your child weighs at least 40 pounds and his ears have reached the top of his car seat, he or she is ready for one of the types of booster seat described below:

  • Belt-positioning booster seats use lap/shoulder belts, which raise your child so the lap and shoulder belts fit properly. This type of booster seat is preferred because it helps protect your child's upper body and head. Both high-back and backless models are available.
  • Shield booster seats are used with lap belts, but are not approved for children who weigh less than 40 pounds because they may be thrown (ejected) from the booster seat if there is a rollover crash. This type of booster seat does not provide enough upper-body protection, so only use it when lap/shoulder belts are not available.

NOTE: Do not attach belt-positioning devices to a booster seat. Shield boosters should only be used without their shields because such devices may pull the lap belt up onto the child's stomach, causing severe injuries in a crash. There also are no federal safety standards for such devices, so the National Highway Transportation Safety Administration does not recommend their use.

Your child should use a booster seat until the car's seat belt fits properly, which is usually not until he or she is at least 8 years old or over 4 feet 9 inches tall.

Combination seats. Forward-facing combination seats can be used after your child is 1 year old and 20 pounds until he outgrows a booster seat. So, like the convertible seats, they can be used for several years. You should remove the harness when your child weighs about 30 to 40 pounds and is at least 3 to 4 years old, according to the manufacturer's instructions, and instead use the seat as a belt-positioning booster seat with the vehicle's lap and shoulder belt.

When used as a forward-facing seat, the harness straps should be at or above your child's shoulders. Forward-facing seats have several shoulder strap slots, so choose the slots closest to (but always above) your child's shoulders. The chest clip should be positioned across your child's chest at armpit level to keep harness straps in place and snug.

Your Child's Safety Is Most Important

More safety guidelines from the American Academy of Pediatrics and the National Highway Transportation Safety Administration when buying a car seat include:

  • Higher prices don't necessarily mean better quality.
  • Test the seat out in the store. Put your child in it and try out all the belts and buckles. Make sure it's easy to use and fits in your car.
  • Remember that the seats displayed in the stores may not be positioned correctly.
  • Some seats come with a tether strap that is attached to the car seat and bolted to the window ledge or floor of the car. If your seat requires or recommends a tether strap, be sure to install it according to the manufacturer's instructions.

Once you have selected the appropriate car seat for your child, it must be properly installed. Watch our short video about car seat installation and then carefully follow the manufacturer's instructions for installing your specific car seat. If you are not sure that you have done this correctly, you can get a free car seat inspection and receive training in proper car seat installation by visiting the National Highway and Traffic Safety Administration to find a certified child-safety seat inspection station near you.

View our videos about choosing and installing a car seat.

Last updated February 13, 2007


   
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