Child car seats

Automobile accidents are one of the major causes of injury and death in children. To keep children safer while driving, it is important to use child car seats properly. Car seats are required by law for children under 40 pounds.

Studies show that most people do NOT have their car seats installed properly. The confusion is understandable -- there are different car seats for different heights, weights, and ages of children, and different installation procedures depending on the type and age of your car. Follow the manufacturer's instructions carefully. In addition, police and fire-station inspection services can help you identify and correct installation problems, free of charge.

Here are the most critical points:

• The safest position for an infant seat is rear facing in the car's back seat. NEVER put a baby or child car seat, facing forward or backward, in the front seat of a car that has airbags. If the airbag deploys, it can injure or kill the child.
• With most models, the rear-facing infant seat is used AT LEAST until the child reaches 20 pounds and 1 year of age. At that point, a forward-facing seat can be used. This may require a new car seat -- it depends on the model.
• As children get older and bigger (usually 40 pounds and over), they should use a booster seat. With a booster seat, the child is restrained by the car's seat belt, but the booster raises the child high enough to make sure the car's seat belt is positioned properly over the shoulder.
• When the child reaches about 80 pounds, he or she can ride on the regular seat of the car, using the car's seat belt.

Some models of infant seats are convertible -- they can be used at different stages. However, as your child grows up, you will need to buy at least two car seats, since no model covers the range from newborn all the way up to 80 pounds.

There are flat car seats, called car beds, for premature and other special-needs babies, which help them get enough oxygen. The American Academy of Pediatrics recommends that all preterm babies be observed in a car seat for fit and breathing stability before discharge from the hospital.

ADDITIONAL GUIDELINES

• Many people install a car seat far too loosely, even though they think the seat is tight. While the seat does not have to be completely immobile, re-read the instructions to see how much "give" is safe.
• Many seats are also installed at an improper angle. If the instructions are unclear, call the seat manufacturer.
• 5-point harnesses are generally considered safer than 3-point harnesses. With 5-point harnesses, make sure the upper retainer clip is at the child's armpit level -- not too close to the child's neck or too low over the child's belly.
• Read your car owner's manual to determine the safest place to install a car seat in YOUR car. Beware of airbag locations. Avoid placing a child car seat in the front passenger seat of a car, and NEVER do so if the car has an airbag.
• Follow the exact instructions for the installation and use of your specific car seat. Recommendations change somewhat depending on the model and type of seat.
• Some states have passed laws requiring that children up to age 8 or 80 pounds be put in booster seats.
• It is best to use a new car seat. Avoid used car seats -- these may lack instructions, be out-of-date, or have cracks or other problems. All car seats have expiration dates stamped into the plastic or onto an adhesive sticker. This information is usually found on the bottom of the seat. Do not use a car seat past its expiration date, as the plastic may no longer be able to withstand the force of an accident well enough to protect your child.
• For more information, call your car seat manufacturer, car manufacturer, or the State Highway Safety Office.

Finally, remember to wear a seat belt when you are pregnant, before the baby is even born. Position the lap belt as low as possible, beneath your belly.

The National Traffic Safety Board. Child Passenger Safety. Available at: http://www.ntsb.gov/Surface/highway/childseat.htm#safetyseats. Accessed June 24, 2005.

American Academy of Pediatrics. Car Safety Seats: A Guide for Families 2005. Available at: http://www.aap.org/family/carseatguide.htm. Accessed June 27, 2005.

Quintana EC. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. Ann Emerg Med. 2004; 43(4): 544.