Car crashes are the most frequent cause of injury and injury-related death in children. Infant and child car seats have reduced these injuries by 45% since 1997. However, these seats are only effective if they are used properly.
There are two main categories of seats: rear-facing and forward-facing. Other categories include convertible, combination, 3-in-1, and booster seats.
The American Academy of Pediatrics (AAP) recommends that babies be kept in rear-facing seats for as long as possible:
Rear-facing infant seats may come with removable bases. In seats with removable bases, the base stays in the car so you do not need to install it each time you put your baby in the car. Here are some tips for rear-facing infant seats:
Your child can ride in a forward-facing seat after they have reached 2 years or older, or have reached the highest height and weight allowed by the manufacturer of the rear-facing seat. Here are some additional recommendations:
Convertible seats can be used as both rear-facing and forward-facing seats, depending on the baby’s height and weight. They are bigger than rear-facing infant seats and can be used longer. Follow the AAP's recommendations for keeping babies rear-facing as long as possible. If your child is riding in a convertible seat, they can be turned to face forward after meeting the AAP's guidelines. Check the seat's instructions to see if the recline angle of the seat needs to be adjusted.
3-in-1 seats can be used as rear-facing, forward-facing or as a booster seat. This allows longer use of the seat as your child grows. They do not have a carrying handle or separate base, but are good because they may have a higher weight for rear-facing children (up to 40-45 pounds or 18-21 kg).
Since they are bigger, just make sure that it fits in the vehicle properly.
Combination seats have a harness that can be removed to allow the seat to function as a booster. Combination seats cannot be used rear-facing. They can be used with a harness for children who weigh up to 40-80 pounds (18-36 kg). The booster can be used without a harness for children who weigh up to 80-120 pounds (36-54.5 kg). If your child is using the seat without a harness, follow the recommendations for booster seats.
These are designed to allow your child to use the vehicle’s lap and shoulder belts. Your child should continue to use a car safety seat with a harness as long as possible before switching to a booster seat.
Follow the AAP recommendations for booster seats:
Continue to place your child in the booster seat until he is large enough to fit correctly into an adult seat belt. This is usually when he is about 4 feet 9 inches (1.45 meters) tall and is 8-12 years old.
Keep in mind that price does not indicate the a certain car seat is best or safest. The safest is the one that works best for your child. Here are some things to look for when you are shopping for a car seat.
When you are done with the installation, send the registration card to the manufacturer after purchase. That way, you will be notified if there are problems or recalls.
Second-hand seats are an option if you do not need a new one. Do not use a seat if you do not know the seat's history. Do not use a seat that:
LATCH, which stands for Lower Anchors and Tethers for Children, has been designed to make child safety seat attachment easier. Lower anchors can be used to secure the seat instead of using the seat belt. A top tether strap is attached to the back of a child safety seat. It is important to use the top tether with any forward-facing seat. As of September 2002, all new vehicles and safety seats have lower anchors and attachments.
Unfortunately a significant percentage of car seats are improperly installed.
To ensure your child’s safety, do the following:
Your local police or fire station may have a program that offers a check on car seats to make sure they are properly installed. Check with your local officials.
NHTSA has a list of certified CPS technicians who can help you with any questions you may have about the proper installation and use of child safety and booster seats. A list by state or ZIP code is available on the NHTSA website . There are also inspection stations where you can get instruction on proper installation. The list is available in English and Spanish at http://www.seatcheck.org .
National Highway Traffic Safety Administration
Canada Safety Council
American Academy of Pediatrics Updates Recommendation on Car Seats. American Academy of Pediatrics website. Available at: http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Recommendation-on-Car-Seats.aspx. Updated March 21, 2011. Accessed November 13, 2014.
Anticipatory guidance (pediatric preventive care). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 24, 2014. Accessed November 12, 2014.
Car Safety Seats: Information for Families for 2012. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Information-for-Families.aspx. Updated February 21, 2014. Accessed November 13, 2014.
Last reviewed November 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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