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Reviewed by the Faculty of Harvard Medical School

Car Seats: The Rules Of The Road

Here is one of the first tests of parenting: Before you and your new baby can be discharged from the hospital, you must have a car seat that is the right size for your baby and is placed correctly in the car. It sounds simple, but it can be more complicated than you imagine. Every state requires that infants and small children ride in car seats. Yet, car crashes are the most common cause of death and injury in children, because, although a car seat was used, it often is used incorrectly. In fact, some studies show that 80 percent of child safety seats are used the wrong way. So what can you do to ensure your child has the safest ride?

The Rules Of Car-Seat Safety

  1. Buckle yourself and your child up for every ride, no matter how short.
  2. Purchase the appropriate 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 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 only. 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 or over a child before fastening the straps of the car seat.
  10. Never drive with small children for whom you do not have a properly installed car seat. Every child in your car should be secured in a car seat or vehicle seat belt, no matter how short the ride.

Types Of Car Safety Seats

Infant-only seats. These seats, used for newborns and infants who weigh up to 20 to 22 pounds, depending on the model, are always rear-facing and should be used only in the back seat. (A child who weighs 20 pounds before he reaches 1 year of age still should ride rear-facing, but in a convertible seat approved for use at higher weights.) Infant-only seats typically come with a three- or five-point harness (that is, the seats usually have three or five straps). These harness straps should be at or below your infant's shoulders and pulled snug. The chest clip (the device on the harness straps that's used to position the straps properly) should be at the infant's armpit level to keep the straps in place.

If necessary, put a rolled towel around the baby's head and neck for support. If the car seat slopes so the baby's head flops forward, recline the car seat back at a 45-degree tilt (according to manufacturer's instructions). Don't put bulky clothing on the baby or any extra cushioning under or behind the baby, which may cause slack in the harness straps during a crash. If additional padding is needed, use only the padding that comes with your child safety seat.

Convertible seats. Bigger and heavier than infant-only seats, these seats may be used in the rear-facing position until the baby is 1 year and weighs 20 pounds (or more with most models); then the seats can be used in the front-facing position for toddlers who are at least 1 year and between 20 and 40 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 recline comfortably in the seat.

Convertible seats typically come with one of three harness types, but only the five-point harness is recommended for newborns:

  • Five-point harness — A five-point harness has five straps: two at the shoulders, two at the hips and one at the crotch.
  • T-shield — A padded T-shaped or triangular shield is attached to shoulder straps.
  • Overhead shield — A padded, traylike shield swings down around the child.

T-shields and overhead shields are not recommended for newborns. The shield comes up too high on the newborn and may make it difficult to properly adjust the harness. For a newborn, always choose a convertible seat with a five-point harness, which offers a more secure fit.

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). Also place the seat into the upright position and move the seat belt through the forward-facing belt path.

Forward-facing seats. These are designed to be used in the forward-facing position only. These seats are certified for use for 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. These days, many vehicles, particularly station wagons, sports utility vehicles and minivans, have integrated forward-facing child safety seats that can be used for children older than 1 year who also weigh at least 20 pounds. These built-in seats eliminate the installation challenges associated with separate car seats. However, 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 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 helps protect your child's upper body and head. Both high-back and backless models are available.
  • Shield booster seats are designed to be used with lap belts. However, this type does not provide enough upper-body protection, so only use shield booster seats when lap/shoulder belts are not available. More important, this type of booster seat is not approved for children who don't weigh at least 40 pounds because they can be thrown (ejected) from the booster seat if there is a rollover crash.

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

Do not ever put your baby in his car seat in a shopping-cart basket. The seat could slip out of the basket, injuring your child. Other car-seat safety guidelines, from the American Academy of Pediatrics and the National Highway Transportation Safety Administration, include:

  • Test the seat in the store. Put your child in it and try all the belts and buckles. Make sure it's easy to use and will fit in your car.
  • Remember that the seats displayed in the stores may not be positioned correctly.
  • Install tether straps according to the manufacturer's instructions if your seat requires or recommends a tether strap. Tether straps are attached to the car seat and bolted to the window ledge or floor of the car
  • Don't equate price with quality. More expensive doesn't necessarily mean better quality.

Still not sure if you've got your car seat installed properly? You can get a free inspection and receive training in the proper way to install a car seat by visiting the National Highway and Traffic Safety Administration to find a certified child-safety seat inspection station near you.

Last updated March 11, 2008