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.
CHOOSING A CAR SEAT
- 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
- 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
- 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
- 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
- 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.
- 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
- 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.
USING A CAR SEAT PROPERLY
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)