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Clinical Reference Systems: Pediatric Advisor 10.0

Car Safety Seats

The major killer and crippler of children in the United States is motor vehicle crashes. Approximately 700 children under the age of 5 years are killed each year, and about 60,000 are injured. Proper use of car safety seats can reduce traffic fatalities by at least 80%. All 50 states have passed laws that require children to ride in approved child passenger safety seats.

A parent cannot protect a child by holding him or her tightly. In a 30-mile-per-hour crash, the child will either be crushed between the parent's body and the dashboard or ripped from the parent's arms and possibly thrown from the car. Car safety seats also help to control a child's misbehavior, prevent motion sickness, and reduce the number of accidents caused by a child distracting the driver.


  1. Government safety standards

    Since January 1981, all manufacturers of child safety seats have been required to meet stringent government safety standards, including crash-testing. The American Academy of Pediatrics publishes a list of infant/child safety seats that is updated yearly. To obtain this list, write to:

    American Academy of Pediatrics
    Division of Public Education
    PO Box 927
    Elk Grove Village, Illinois 60007

  2. Types of car safety seats

    There are three types of car safety seats:

    • Infant safety seats are installed in a rear-facing position only and can be used from birth until a child weighs approximately 20 pounds.
    • Convertible safety seats can be used in both rear-and forward-facing positions.
    • Booster safety seats are forward-facing.

    Before you buy a car safety seat, look at several different models. Make sure that the car seat will fit in your car and that your seat belts will work with the seat.

  3. Matching car safety seats with your child's weight
    • Birth to 20 pounds: Use an infant safety seat until your child is over 20 pounds and able to sit up by himself. Keep your child facing backward as long as possible, because it protects him from neck injuries.
    • Over 20 pounds: Use a convertible car seat in the forward-facing position. Keep it rear-facing if the child is less than 1 year of age.
    • Over 40 pounds and over 40 inches tall: Use a booster safety seat. A booster seat is needed when your child has outgrown the convertible safety seat but is too small to fit properly into the regular seat belt. This will also help your child see out the window.
    • Over 60 pounds: Use the regular car seat (without a booster seat) and with a lap belt low across the thighs. When your child is also over 4 feet (48 inches) tall, add a shoulder strap. Using a shoulder strap before your child is 4 feet tall can cause neck injuries. If the shoulder strap runs across the neck (rather than the shoulder) your child needs to stay in a booster seat. Never put the shoulder belt under both arms.

  4. Air bags and installation of car seats

    Air bags are standard equipment in most new cars. They have saved many lives. However, they are very hazardous to infants in REAR-facing child safety seats and have caused death from brain injury. If your car has air bags, take the following precautions:

    • Infants riding in REAR-facing child safety seats should NEVER be placed in the front seat of a car or truck with a passenger-side air bag. They must be in the car's rear seat or not ride in that vehicle.
    • Children in FORWARD-facing child safety seats should also ride in a car's rear seat. If the vehicle does not have a rear seat, children riding in the front seat should be positioned as far back as possible from the air bag. Move the seat all the way back so that the child is as far as possible from the dashboard.
    • Whenever possible and at any age, put the safety seat in the back seat of the car, which is much safer than the front seat.


If used consistently and properly, your child's car seat can be a lifesaver. Your attitude toward safety belts and car seats is especially important. If you treat buckling up as a necessary, automatic routine, your child will follow your lead and also accept car seats and seat belts. To keep your child safe and happy, follow these guidelines:

  • Always use the safety seat. Use the safety seat on the first ride home from the hospital, and continue using it for every ride.
  • Everyone buckles up! Allow NO exceptions for older kids and adults. If adults ride unprotected, the child quickly decides that safety is just kid stuff.
  • Give frequent praise for appropriate behavior in the car.
  • Remember that a bored child can become disruptive. Keep a supply of favorite soft toys and munchies on hand.
  • NEVER let a fussy child out of the car seat or safety belt while the car is in motion. If your child needs a break, STOP the car. Responding to complaints by allowing your child to ride unprotected is a disastrous decision that will make it harder to keep him or her in the seat on the next ride.
  • If a child tries to get out of the seat, stop the car and firmly but calmly explain that you won't start the car until he or she is again buckled in the car seat.
  • Make a vinyl seat pad more comfortable in hot weather by covering it with a cloth pad or towel.
  • When your child travels in another person's car (such as a baby sitter's or grandparent's car), insist that the driver also use the safety seat.
  • For long-distance trips, plan for frequent stops and try to stop before your child becomes restless. Cuddle a young child. Let an older child snack and run around for 10 to 15 minutes.

(Originally adapted from the American Academy of Pediatrics with permission, 1986)

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems