|SSM Cardinal Glennon Children's Medical Center|
Starting with a baby's very first journey home from the hospital, parents are responsible for making sure that their kids travel safely. Unintentional injury is the leading cause of death in children, and more kids die in automobile crashes than in any other type of unintentional injury.
You can protect your kids by following simple safety measures and by teaching some basic rules.
Importance of Child Safety Seats
Using a child safety seat (car seat) is the best protection you can give your child when traveling by car. Every state in the United States requires that an infant or small child be restrained — and with good reason. Child safety seats can reduce the risk of a potentially fatal injury substantially for babies in particular and also for toddlers. But many safety seats are used incorrectly.
When choosing a car seat, keep some important guidelines in mind. The best car seat is not always the most expensive one — it's the one that best fits a child's weight, size, and age, as well as your vehicle.
Once you select a seat, be sure to try it out, keeping in mind that store displays and illustrations might not show the correct usage. It's up to you to learn how to install a car safety seat properly and harness your child for the ride.
If you need help installing your safety seat or would like a technician to check whether you've installed it properly, the federal government has set up child seat inspection stations across the country.
Also, many local health departments, public safety groups, hospitals, law enforcement agencies, and fire departments have technicians or fitting stations to help parents. (If you go to one of these, be sure to ask for a certified child passenger safety technician to assist you.)
Guidelines for Choosing a Safety Seat
Infant-Only Seats (Birth to 22-35 Pounds)
Infant-only seats fit newborns and smaller infants best, but you will have to buy another seat as your baby outgrows it. Infant-only seats are designed to protect babies from birth until they reach up to 35 pounds (about 16 kilograms), depending on the model.
Infant car seats should always be installed to face the rear of the car because in a crash the back of the safety seat cradles the baby's head, neck, and torso. The American Academy of Pediatrics (AAP) recommends that infants and toddlers ride in a rear-facing seat until they are 2 years old or until they have reached the maximum weight and height limits recommended by the manufacturer.
Many parents have been turning the safety seat around to face the front when their child reaches a weight of 20 pounds (9 kilograms) or 12 months of age, as previous recommendations gave that age and weight as a minimum for front-facing car seats.
Yet recent studies show that a child under age 2 is 75% less likely to die or have a serious injury when in a rear-facing seat. That's because at this age, a child's neck usually isn't strong enough to support the head in the event of a crash.
So it's essential to follow the height and weight guidelines on the child safety seat and keep your child in a seat that faces the rear as long as it's possible and the seat still fits.
Infant-only safety seats are convenient because they're designed to double as carriers, chairs, or rockers when not used in the car. Many models detach right from the base, allowing you to leave the base installed in the car.
Try to limit the amount of time your infant spends in the car seat while you're at home or while the baby is at childcare. Too much time in a car seat can limit a baby's movement and opportunities for stimulation, which are important for developing sensory and motor skills.
How to Install an Infant-Only Seat
Prior to installing your baby's infant-only seat, read the product manual thoroughly. These tips can help with the installation:
How to harness your infant:
Convertible Seats (Birth to 80 Pounds)
Convertible seats are designed to protect kids from birth up to at least 40 pounds (18 kilograms) facing backward, and up to 65 pounds (30 kilograms) or even 80 pounds (36 kilograms) facing forward, depending on the model.
Convertible seats are the only type of seats that are placed in different positions depending on a child's age: They face toward the rear until a baby is ready to face forward, when they can be turned around and "converted" to a forward-facing seat.
Weight ranges vary on convertible car seats, so it is important to consider a child's height and weight before buying one. Convertible seats are heavy and not very portable. Yet they can be economical because it may not be necessary to buy a separate infant-only seat. It's also a good option for larger babies who outgrow their infant-only seat and still need to be rear facing.
If using a convertible seat, make sure it fits your child correctly — a small child in a large seat may not be the best option. Models with tray shields should not be used for newborns — the shield comes up too high on them, and in a crash the baby's face could hit the tray.
How to Install a Convertible Seat
Harnessing infants and toddlers:
Forward-Facing Only Seats (20-80 pounds)
Forward-facing car seats are designed to protect children from 20 to 80 pounds (about 10 to 36 kilograms) or more, depending on the model.
All kids 2 years or older, or those younger than 2 years who have outgrown the rear-facing height or weight limit for their car seat, should use a forward-facing car seat with a full harness for as long as possible. They should only switch to a booster seat that relies on the car's adult seatbelts when they exceed the height and weight limit for their forward-facing car seat.
Combination car seats are also available that allow you to remove the harness to switch from forward-facing child safety seat to belt-positioning booster seat. Review the forward-facing convertible seat for toddlers information mentioned earlier in this article regarding proper installation of forward-facing car seats and harnessing your child.
Built-in or integrated car seats can be found in some vehicles. As with other forward-facing car safety seats, built-in seats are for kids 2 years of age and older. Some convert to belt-positioning booster seats. Weight and height limits will vary so be sure to check your owner's manual.
Booster seats are vehicle safety seats for kids who have outgrown forward-facing or convertible car seats but are still too small to be properly restrained by a vehicle's seatbelts.
Many states have laws requiring booster seats for kids up to 8 years old and 80 pounds (36 kilograms), or 4 feet 9 inches (about 150 centimeters) tall. The AAP states that kids should use a booster seat until the car's lap-and-shoulder belt fits properly, which is typically when they've reached 4 feet 9 inches in height and are between 8 and 12 years old.
Guidelines for Choosing a Booster Seat
Types of Booster Seats
Booster seats come in many styles. Belt-positioning boosters raise kids to a height where they can safely use the car's lap and shoulder belts. They come in high-back or backless models: High-back boosters are recommended when the car has low seat backs, and backless boosters may be used if a child's head is supported up to the top of his or her ears by the vehicle's back seat or head support.
Combination seats can be used with harnesses as forward-facing safety seats or as belt-positioning booster seats when harnesses are removed. Height and weight limits for different combination seats may vary, so it's best to check the owner's manual for guidance.
Shield boosters (with no back and a shield tray in front of the child) were originally designed for cars with lap-only belts, but they do not provide adequate upper-body protection and therefore are no longer recommended.
If your car doesn't have shoulder belts in the back seat, consider having them installed by the dealer. If that's not possible, the AAP recommends keeping kids in a convertible or forward-facing seat with a full harness and a higher weight limit. Another option is a special type of travel vest that uses a tether and the lap belt to hold the child securely in the seat.
How to Install a Booster Seat
How to secure your child's seatbelt:
Kids this age can begin to understand the importance of buckling up and may want to buckle themselves in. Be sure to check their seatbelts and offer praise when they voluntarily put them on.
When Kids Outgrow Booster Seats
Kids can stop using a booster seat when they're big enough to use the vehicle's lap and shoulder belts while sitting with their back against the vehicle's seat back with their knees bent over the edge of the seat without slouching. The lap belt should rest low, on top of the thighs, and the shoulder belt should lie comfortably across the middle of the chest.
Kids should be able to remain in this position throughout the entire trip. This usually happens when a child reaches a height of 4 feet 9 inches (about 150 centimeters) and is between 8 and 12 years old.
Remember, the shoulder strap of the seatbelt should never be fastened behind a child's back or under his or her arm. And you should never buckle two kids (or an adult and a child) under one seatbelt — a crash could cause their heads to collide.
If you frequently carpool or have other kids in your car, it's wise to have an extra booster seat handy, especially if you're unsure about whether a child meets the height requirements. It's always better to be safe than to let a child who isn't tall enough ride with just a seatbelt.
Air Bags and Kids
When combined with safety belts, air bags protect adults and teens from injury during a collision. They have saved lives and prevented many serious injuries. But young children can be injured or even killed if they are riding in the front passenger seat when an air bag opens.
Air bags were designed with adults in mind: They must open with great force (up to 200 miles per hour) to protect an average-sized, 165-pound (75-kilogram) male from injury. While this force is appropriate for adults and bigger kids, it can be dangerous for small kids, possibly resulting in head and neck injuries.
Protect kids from air-bag injury by following these rules:
The LATCH System
Since September 2002, most new vehicles have safety seat anchorage points and most safety seats have anchor attachments.
One of the problems with installing safety seats properly has been incompatibility between the car seat and the vehicle. The Lower Anchors and Tethers for Children (LATCH) system was devised to make installation easier because it does not require use of the car's seatbelts.
Instead, a tether strap secures the top of the safety seat to an anchorage point either on the rear shelf area, the rear floor, or the back of the rear seat of the car, depending on the vehicle model. Lower anchors secure attachments on the bottom of the safety seat to a point located between the car's seat cushion and seat back.
You should use LATCH only in seating positions recommended by both the vehicle manufacturer and the car seat manufacturer. Never use both the seatbelt and LATCH to install a car seat. Choose whichever method secures the car seat best.
Most forward-facing safety seats made after September 1999 are equipped with top tether straps, and most vehicles made after September 2000 have tether anchors. Since September 2002, most new vehicles also have lower safety seat anchorage points and most safety seats have lower anchor attachments.
If your vehicle or safety seat was purchased after these dates and didn't come with tethers or anchors, call the manufacturer.
Rules for the Car and School Bus
Most kids spend time in a car or on a school bus every day, and should be taught simple rules for traveling in them to help ensure their safety.
Be sure to explain to your kids that these rules must be followed every time, no matter who is driving or how short the ride may be.
Rules for the Car
Rules for the Bus
Reviewed by: Elana Pearl Ben-Joseph, MD