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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 in children of all races from 1 to 14 years of age. In fact, about one of every three American children between 5 and 15 years old still rides in a car completely unrestrained. This puts millions of children at risk of injury and death. Even when car seats are used, some studies show that 80% of the 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. Be sure you and your child are buckled 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. Use a booster seat for a child who weighs at least 40 pounds, but is still too small to fit properly in a vehicle seat belt (usually until the child is at least 8 years old or over 4-feet, 9-inches tall.
  6. Never put a blanket around (over) a child BEFORE fastening the straps of the car seat.
  7. Never drive with any small children who are not sitting in a properly installed car seat. Every child (and adult) in your car should be secured in a car seat or vehicle seat belt, no matter how short a ride.
Types Of Car Safety Seats

Children, as they grow, should progress through three types of child safety seats before using the seat belt alone: from rear-facing seats (during infancy) to forward-facing seats (when the child is at least 1 year old and 20 pounds) to booster seats (when the child outgrows forward-facing seat).

Forward-facing seats. These seats are designed to be used in the forward-facing position only and are certified for use with children 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 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 to 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 is at least 8 years old or over 4-feet, 9-inches tall.

Combination seats. These seats can be used for several years, first as a forward-facing seat and later, as a booster seat. 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.

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.

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.

Last updated March 11, 2008