Child car seats; Infant car seats; Car seats

Automobile accidents are one of the major causes of injury and death in children. In the United States, the law requires car seats for children under 40 pounds. For children over 40 pounds, specific laws vary by state.

Have a spouse or friend bring a car seat with you to the hospital when the child is born. You will need a car seat to bring the baby home from the hospital.

BUYING A CHILD SAFETY SEAT

It is best to use a new car seat. Used car seats often lack instructions and may have cracks or other problems that make the seat unsafe. For example, it may have been damaged during a car accident.

All car seats have expiration dates somewhere on them, usually on the bottom of the seat. Do not use a car seat past its expiration date, as the plastic may no longer be strong enough to support your child safely.

The "best" seat for you depends on your:

• Child's age
• Child's weight and height
• Car

The seat must fit your child's size and be able to be properly installed into your car. A more expensive seat is not necessarily the safest nor easiest to use. All car seats sold in the United States must meet government safety standards.

Make sure you fill out and return the registration card that comes with a new car seat. This way, the manufacturer will contact you if the seat is recalled because of a safety problem or other defect. If you do not have a card, call the company that made the car seat and ask for one.

There are several different types of child safety seats:

• Rear-facing seats
• Forward-facing seats
• Booster seats
• Car beds
• Built-in car seats

REAR-FACING SEATS

A rear-facing seat is one in which the infant faces the back of the car. Always install a rear-facing seat in the back seat of your car. This is the safest position for an infant. NEVER place a rear-facing seat in the front seat of a vehicle with passenger airbags.

There are two types of rear-facing seats:

• Infant-only rear-facing seats
• Convertible seats

Infant-only rear-facing seats are for babies up to about 22 to 30 pounds, depending on the specific car seat. You will need a new seat when your child gets bigger. Infant-only seats have handles that allow you to move the seat from the car to the house or other locations. Some have a base that you can leave installed in the car, so you can just click the car seat into place each time you use it.

Convertible seats are for bigger infants and toddlers under age 1 -- up to about 30-35 pounds, depending on the specific seat. The seat can be used as a rear-facing seats for younger children, and switched to a forward-facing seat on the child's first birthday if the child weighs at least 20 pounds. However, experts recommend keeping the child in a rear-facing position until he or she outgrows the weight or height allowed by the safety seat.

FORWARD-FACING ONLY SEATS

A forward-facing only seat is one in which the child sits facing the front of the car. The seat should be installed in the back seat of your vehicle. Most forward-facing only seats are for children between 20 to 40 pounds.

A combination forward-facing booster seat may be used for children between 40 to 65 pounds, depending on the specific seat. You can remove the seat's safety straps (harness) and use the booster alone, so that the car's lap and seat belts correctly fit the child.

BOOSTER SEAT

A booster seat raises your child up so that the car's lap and shoulder belts fit correctly. The lap belt should fall across the upper thighs. The shoulder belt should go across the middle of the shoulder and chest.

A booster seat is used for older children up to about 80 pounds. Some states have passed laws requiring booster seats for children up to age 8 or 80 pounds. Check your state's law.

CAR BEDS

These seats, also called flat car seats, are for premature or other special-needs babies. The American Academy of Pediatrics recommends that a health care provider looks at how your preterm baby fits and breathes in a car seat before leaving the hospital.

BUILT-IN SEATS

Some cars and vans have built-in car seats. Weight and height limits vary. You can get more details of these seats by reading the vehicle's owner's guide or calling the specific car manufacturer.

INSTALLING A CHILD SAFETY SEAT

It is important to use child car seats properly. Studies show that most people do NOT properly install car seats. The seat must fit snugly and be positioned at the proper angle. Many people install a car seat far too loosely, even though they think the seat is tight. The seat should be snug and not move more than 1 inch forward or sideways.

Follow the manufacturer's instructions for the installation and use of your specific car seat. Also, read your car owner's manual to determine the safest place to install a car seat in your car. If the instructions are unclear, call the company that made the car seat.

Contact your local police or first station for help installing your specific seat. Many have free programs to show you how to do this. To find a certified child passenger safety technician in your area go to www.seatcheck.org.

Child safety seats come with safety straps, called harnesses, which secure the child into position. Your safety seat may have a 3-point or 5-point harness system.

• A 3-point harness system has two straps at the shoulder and one between the legs.
• A 5-point system has two straps at the shoulder, two at the hips, and one between the legs.

The seat is secured into your vehicle using either car's seat belts or the LATCH system.

LATCH stands for lower anchors and tethers for children -- it is designed to make car seat installation easier. A child safety seat that comes with LATCH attaches to anchors in the back seat where the cushions meet and a strap called a tether, which connects the top of the safety seat to the car's frame. The car's seat belts are not used. All child safety seats and vehicles made after September 1, 2002 come with LATCH.

For more information on how to install child safety seats, see the National Highway Traffic Safety Administration web site at www.nhtsa.dot.gov. The NHTSA website also provides a list of all child safety seats recalled since 1990.

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

Committee on Injury and Poison Prevention; American Academy of Pediatrics. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics. 2002;109:550-3.

Biagioli F. Proper use of child safety seats. Am Fam Physician. 2002;65:2085-90.

US National Highway Traffic Safety Administration. Misuse of child restraints. Washington, DC. US Department of Transportation, National Highway Traffic Safety Administration; 2004. DOT HS 809 671.