Every state requires that infants and children ride buckled up. However, state laws do not always require the safest way to transport a child. More children are still killed as passengers in car crashes than from any other type of injury. Using a car safety seat correctly can help prevent injuries to young children, but it is not as easy as you think. Just a little mistake in how the seat is used could cause serious injury to your child.

Which is the "best" car safety seat?

• No one seat is "safest" or "best." The "best" car safety seat is one that fits your child's size and weight, and can be installed correctly in your car.
• Price does not always make a difference. Higher prices can mean added features that may or may not make the seat easier to use.
• When you find a seat you like, try it out! Put your child in the seat and adjust the harnesses and buckles. Make sure it fits in your car.
• Keep in mind that displays or illustrations of seats in stores do not always show them being used correctly.

Types of car safety seats

Infant-only seat

Infant-only seats

• Only can be used rear-facing
• Are used for babies who weigh up to 20 pounds (or more, depending on the model)
• Are small and portable and fit newborns best
• Come with a 3-point harness or a 5-point harness

Infant-only seat features

Detachable base. Several infant-only seat models come with detachable bases. The base attaches to the car and the car safety seat easily snaps into the base. This way, you can carry your baby in and out of the car without needing to re-install the seat. After buckling your baby into the seat, you simply lock

Car seats and shopping carts Do not place a child of any age in a shopping cart. Many infant-only car seats lock into shopping carts. Although infant seats may help prevent falls from shopping carts, injuries can still occur if the cart tips over. The weight of an infant in an infant seat placed high in a shopping cart may make the cart more top-heavy and more likely to tip over. This is true even for shopping carts with built-in infant seats. Thousands of children are hurt every year from falling from shopping carts or from the carts tipping over. Instead, use a backpack, front pack, or stroller while shopping.

the seat into the installed base. Some bases are adjustable to make it easier to correctly recline newborns. These seats also can be used without the base or you can buy additional bases for other cars. However, this feature is only helpful if the base fits tightly into your car. In some cases, the seat may fit better without the base.

Higher weight and height limits. Several infant-only seats are available for use up to 22 pounds, and at least one is available for use up to 35 pounds. Many convertible seats also now have higher weight and height limits in the rear-facing position for heavier or taller babies. Keep in mind that some babies may reach the top height limits of the seat before they reach the top weight limits. If your infant's weight or height exceeds the limits of the seat before a year, use an infant-only seat or a rear-facing convertible seat that has a higher limit.

Harness slots. Infant-only seats that come with more than one harness slot give more room for growing babies. In the rear-facing position, the harness slots usually should be at or below your baby's shoulders. Check the car safety seat manufacturer's instructions to be sure.

Handles. Carrying handles on car safety seats vary greatly in style and ease of use. Check the instructions for how to adjust the handle during travel.

Other features. Angle indicators, built-in angle adjusters, harness adjusters, and head support systems are other features that may make correct installation easier to achieve. See below for a list of infant-only seats.

Convertible seats

• Are bigger and heavier than infant-only seats, but can be used longer and for larger children.
• May not fit newborns as well as some infant-only seats. Make sure that your baby can recline comfortably in the seat. Check the car safety seat manufacturer's instructions to be sure that harnesses can be adjusted properly.
• Are used rear-facing for infants until they have reached at least 1 year of age and weigh at least 20 pounds (or more depending on model). The American Academy of Pediatrics (AAP) recommends that babies be kept in rear-facing seats until they reach the maximum weight allowed, as long as the top of the head is below the top of the seat back.
• Can be used forward-facing for toddlers who are at least 1 year of age and weigh at least 20 pounds and not more than 40 pounds. When your child is older than 1 year of age and has reached the highest weight or height allowed by the seat for use rear-facing, you may turn the seat forward-facing and make the following 3 adjustments:
  • Move the shoulder straps to the slots at or above your child's shoulders (usually the top slots, but check your instructions to make sure).
  • Move the seat into the upright position. (Check the car safety seat manufacturer's instructions for the recline angle allowed when forward-facing.)
  • Route the seat belt through the forward-facing belt path.
• Have the following 3 types of harnesses:
  • 5-point harness - Five straps: 2 at the shoulders, 2 at the hips, 1 at the crotch
  • Overhead shield - A padded tray-like shield that swings down around the child
  • T-shield - A padded T-shaped or triangular shield attached to shoulder straps

Note: If using a convertible seat for a small infant, the best choice for a more secure fit is the 5-point harness. A small baby's face can hit a shield in a crash.

Common questions about car seats "What if my baby is premature?" Use a car safety seat without a shield. Shields often are too high and too far from the body to fit correctly. A small baby's face could hit a shield in a crash. While still in the hospital, your baby should be observed in her car safety seat to make sure the semi-reclined position does not cause low heart rate, low oxygen, or other breathing problems. If your baby needs to lie flat during travel, use a crash-tested car bed. If possible, an adult should ride in the back seat next to your baby to watch him closely. "What if my baby weighs more than 20 pounds but is not 1 year of age yet?" There are now several infant-only and convertible seats that can be used rear-facing for children weighing more than 20 pounds. See the product listing below for specific seats. "What if my child has special health care needs?" Children with special health problems may need other restraint systems. Discuss this with your pediatrician. Easter Seals, Inc offers programs about car seat safety for children with special health care needs in the following states: California, Colorado, Florida, Georgia, Hawaii, Louisiana, Kentucky, New Mexico, Michigan, Missouri, Ohio, Pennsylvania, and West Virginia. More information is available from Easter Seals, Inc at 800/221-6827. For more information and a list of car safety seats available for children with special needs, see the AAP brochure, "Safe Transportation of Children with Special Needs: A Guide for Families." "What if my car has air bags?" Most new cars have air bags. When used with seat belts, air bags work very well to protect older children and adults. However, air bags are very dangerous when used with rear-facing car safety seats. If your car has a passenger air bag, infants in rear-facing seats must ride in the back seat. Even in a low-speed crash, the air bag can inflate, strike the car safety seat, and cause serious brain injury and death. Toddlers who ride in forward-facing car safety seats also are at risk from air bag injuries. All children, even through school age, are safest in the back seat. If you must put an older child in the front seat, slide the vehicle seat back as far as it will go. Make sure your child is buckled and stays in the proper position at all times. This will help prevent the air bag from striking your child. For most families, air bag on/off switches are not necessary. Air bags that are turned off cannot protect other passengers riding in the front seat. Air bag on/off switches only should be used if all of the following are true: Your child has special health care needs. Your pediatrician recommends constant supervision of your child during travel. No other adult is available to ride in the back seat with your child. On/off switches also must be used if you have a vehicle with no back seat or a back seat that is not made for passengers. "What if my car has side air bags?" Side air bags improve safety for adults in side impact crashes. However, children who are seated near a front or rear side air bag can be at risk for serious injury. Refer to your vehicle owner's manual for recommendations that apply to your vehicle. "What if my car only has lap belts in the back seat?" Lap belts work fine with infant-only, convertible, and forward-facing seats. They cannot be used with belt-positioning boosters (which are safest for children who weigh more than 40 pounds and who are not big enough to fit in adult seat belts). If your car only has lap belts, use a forward-facing seat with a harness approved for use to higher weights, or check with your dealer or the manufacturer of your car to see if shoulder harnesses can be installed. Some travel vests can be used with lap belts. Another thing you can do is buy another car with lap/shoulder belts in the back seat. "What if I drive more children than can be buckled safely in the back seat?" Avoid this situation, especially if your car has passenger air bags. However, in an emergency, place the child most likely to sit in the proper forward-facing position in the front seat, with the vehicle seat moved as far back as possible. A child in a forward-facing car seat may be the best choice because a child who is in a booster seat or using a regular seat belt can more easily move out of position and be at greater risk for injuries from the air bag. "What if I lose my instructions to my car safety seat?" Call the manufacturer and ask for a new set of instructions. "What if my car safety seat was in a crash?" A seat that was in a crash may have been weakened and should not be used even if it looks fine. Call the car seat manufacturer if you have questions about the safety of your seat. "Can I use a car safety seat on an airplane?" The Federal Aviation Administration (FAA) and the AAP recommend that children be securely fastened in child safety seats until 4 years of age, then be secured with the airplane seat belts. This will help keep them safe during takeoff and landing, or in case of turbulence. Most infant, convertible, and forward-facing seats are certified to be used on airplanes. Booster seats and travel vests are not. Check the label on your seat and call the airline before you travel to be sure your seat meets current FAA regulations.

Convertible seat features

Adjustable buckles and shields . Many convertible seats have 2 or more buckle positions to give you extra room for a growing child or bulky clothing. Many overhead shields can be adjusted as well.

Higher weight limits. Several convertible seats are now available with higher rear-facing weight limits for bigger babies. For larger babies, look for a seat that can be used rear-facing up to 30 or 35 pounds.

See below for a list of convertible seats.

Combination seats

• Cannot be used rear-facing.
• Are only for children who are at least 1 year of age and weigh at least 20 pounds.
• Have an internal harness system for children who weigh 40 pounds or less.
• Convert to belt-positioning boosters (by removing the harnesses) for children who weigh more than 40 pounds. This allows the seat to be used longer.

See below for a list of combination seats.

Forward-facing seats/restraints

• Cannot be used rear-facing
• Are only for children who are at least 1 year of age and weigh at least 20 pounds
• Can be used with lap only belt or lap/shoulder belt

See below for a list of forward-facing seats/restraints.

Booster seats

High-backed belt- positioning booster

When your child reaches the top weight allowed for his car safety seat or his ears have reached the top of his car safety seat, your child needs a booster seat. Booster seats should be used until your child can correctly use a lap/shoulder seat belt (see below for information on using seat belts). Following are 2 types of booster seats:

• Belt-positioning boosters are used with lap/shoulder belts. The booster raises your child so that the lap/shoulder belt fits properly. This helps -protect your child's upper body and head. Both high-backed and backless models are available.
• Shield boosters: Based on Federal Motor Vehicle Safety Standards established by the National Highway Transportation Safety Administration (NHTSA), shield boosters have not been certified by their manufacturers for use by children who weigh more than 40 pounds. For these children, or for children who are too heavy or too tall to fit in a seat with a full harness, the shield may be removed and the seat used with a lap/shoulder belt as a belt-positioning booster.

Children who weigh 40 pounds or less are best protected in a seat with a full harness. Significant injuries have occurred to children in shield boosters in crashes due to ejection, excessive head movement, and shield contact. Although boosters with shields may meet current Federal Motor Vehicle Safety Standards for use by children who weigh 30-40 pounds, on the basis of current published peer-reviewed data, the AAP does not recommend their use. Children should remain in a convertible, forward-facing, or combination seat with a full harness until they reach the top weight or height allowed by the seat.

See below for a list of booster seats.

Travel vests

A travel vest may be an option if your car has only lap belts.

See below for a list of travel vests.

Built-in seats (integrated seats)

Built-in seats are available in some cars and vans. They may be used for children who are at least 1 year of age and weigh at least 20 pounds. Built-in seats eliminate installation problems. However, weight and height limits vary. Check with vehicle manufacturers for details about built-in seats that are currently available.

Basics of car safety seat use

• Always use a car safety seat, starting with your baby's first ride home from the hospital. Help your child form a lifelong habit of buckling up.
• Read the car safety seat manufacturer's instructions and always keep them with the car safety seat.
• Read your vehicle owner's manual for important information on how to install the car safety seat correctly in your vehicle.
• The safest place for all children to ride is in the back seat.
• Never place a child in a rear-facing car safety seat in the front seat of a vehicle that has a passenger airbag.
• The harness system holds your child in the car safety seat and the seat belt or an anchor system holds the seat in the car. Attach both snugly to protect your child.

Using car safety seats correctly

Read the car safety seat manufacturer's instructions and the child restraint section of your vehicle owner's manual carefully to be sure you are installing and using the car safety seat correctly. When you install the seat in your car, check the following:

Is your child buckled into the car safety seat correctly?

• Be sure to use the correct harness slots for the child.
• Keep the harnesses snug. Place the plastic harness clip, if provided, at armpit level to hold shoulder straps in place.
• Make sure the straps lie flat and are not twisted.
• Dress your baby in clothes that allow the straps to go between the legs. Adjust the straps to allow for the thickness of your child's clothes, making sure that the harness still holds the child securely.
• In cold weather, tuck blankets around your baby after adjusting the harness straps snugly.
• To keep your newborn from slouching, pad the sides of the seat and between the crotch with rolled up diapers or receiving blankets.

Is the car safety seat buckled into your vehicle correctly?

• Place the seat facing the correct direction for the size and age of your child. Route the seat belt through the correct path on the car safety seat (check your instructions to make sure) and pull it tight. Before each trip, check to make sure the car safety seat is installed tightly enough by pulling on the car safety seat where the seat belt passes through. It should not move easily side to side or toward the front of the car.
• If your infant's head flops forward, the seat may not be reclined enough. Tilt the seat back until it is reclined as close as possible to a 45-degree angle (according to manufacturer's instructions). Your seat may have a built-in recline adjuster for this purpose. If not, you may wedge firm padding, such as a rolled towel, under the front of the base of the seat.
• Check the seat belt buckle. Make sure it does not lie just at the point where the belt bends around the car safety seat. If it does, you will not be able to get the belt tight enough. If you cannot get the belt tight, check the car safety seat and vehicle manufacturers' instructions for recommendations. You may need to use another set of belts in the car that can be tightened properly.
• Many lap/shoulder belts allow passengers to move freely even when they are buckled. Read your car owner's manual to see if your seat belts can be locked into position or if you will need to use a locking clip. Locking clips come with all new car safety seats (some have them built in). Read your instructions for information on how to use the locking clip.
• Some lap belts need a special, heavy-duty locking clip, available from the vehicle manufacturer. Check your car owner's manual for more information.

What is LATCH?

A new car safety seat attachment system has been developed to make car safety seats easier to use and safer. The system is called LATCH, which stands for Lower Anchors and Tethers for Children. This new anchor system will make correct installation much easier because you will no longer need to use seat belts to secure the car safety seat. Starting in model year 2002, most new vehicles and new safety seats will be equipped with these lower anchors and attachments. However, unless both the vehicle and the car safety seat have this new anchor system, seat belts will still be needed to secure the car safety seat.

Why are tethers important?

Most new car safety seats that can be used facing forward come with top tethers. A tether is a strap that hooks the top of the car safety seat to a special permanent anchor in the vehicle. Most anchors are located on the rear window ledge, the back of the vehicle seat, or the floor or ceiling of the vehicle. Tethers give extra protection by keeping the car safety seat from being thrown forward in a crash.

Tether kits are available for most older car safety seats. Check with the car safety seat manufacturer to find out how to get a top tether for your seat. Be sure to install it according to instructions. The tether strap may help make some seats that are difficult to install fit more tightly.

All new cars, minivans, and light trucks have been required to have upper tether anchors for securing the tops of car safety seats since September 2000.

Is your child ready for a regular seat belt?

Keep your child in a car safety seat for as long as possible. When your child is big enough, make sure the seat belts in your vehicle fit your child correctly. The shoulder belt should lie across the chest, not the neck or throat. The lap belt must be low and snug across the thighs, not the stomach. The child should sit against the vehicle seat back with her feet hanging down when the legs are bent at the knee. Seat belts are made for adults. If the seat belt does not fit your child correctly, she should stay in a booster seat until the belt fits. This is usually when the child reaches about 4' 9" in height and is between 8-12 years of age.

Other points to keep in mind when using seat belts include the following:

• Never tuck the shoulder belt under the child's arm or behind the child's back.
• If only a lap belt is available, make sure it is snug and low on the child's thighs, not across the stomach. Try to get a lap/shoulder belt installed in your car.

There are a number of add-on products on the market that claim to solve the problem of poorly fitting seat belts. However, these products may actually interfere with proper lap and shoulder belt fit by causing the lap belt to ride too high on the abdomen and making the shoulder belt too loose. Until the NHTSA develops standards for these products, the AAP recommends they not be used.

Are you using a second-hand seat? Double-check everything!

A new car safety seat is best. However, if you must get a used seat, shop very carefully. Keep the following points in mind:

Do not use a car safety seat that

• Is too old. Look on the label for the date it was made. If it is more than 10 years old, it should not be used. Some manufacturers recommend that seats only be used for 5-6 years. Check with the manufacturer to find out when the company recommends getting a new seat.
• Was in a crash. It may have been weakened and should not be used, even if it looks fine. Do not use a seat if you do not know its full history.
• Does not have a label with the date of manufacture and seat name or model number. Without these, you cannot check on recalls.
• Does not come with instructions. You need them to know how to use the car safety seat. Do not rely on the former owner's directions. Get a copy of the instruction manual from the manufacturer before you use the seat.
• Has any cracks in the frame of the seat.
• Is missing parts. Used seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.

ALWAYS READ AND FOLLOW MANUFACTURER'S INSTRUCTIONS If you do not have the car safety seat manufacturer's instructions, write or call the company's consumer relations department, identifying the model number, name of seat, and date of manufacture. The manufacturer's address and phone number may be on the label on the seat. All products listed below meet Federal Motor Vehicle Safety Standard 213 as of the date of publication. There may be car safety seats available that are not listed on this page. The following information is current as of the date of publication. Before purchasing a car safety seat, check the manufacturer's instructions for important safety information about proper fitting and use.

Manufacturers names are boldfaced.

Although the American Academy of Pediatrics (AAP) is not a testing or standard setting organization, this guide sets forth the Academy's recommendations based upon the peer reviewed literature available at the time of its publication and sets forth some of the factors that parents should consider before selecting and using a car safety seat. The appearance of the name American Academy of Pediatrics (AAP) does not constitute a guarantee or endorsement of the products listed or the claims made. Prices are approximate and may vary. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

? 2002 - American Academy of Pediatrics