Child safety seats
Child car seats; Infant car seats; Car seats; Car safety seats
A rear-facing car seat position is recommended for a child who is very young. Extreme injury can occur in an accident because of the immaturity of the bones and ligaments in the neck if the child is facing forward. In a frontal crash, a child's head and neck are subjected to great force as the body is strapped in place and the head and neck are pulled away from the body. The head and legs of the child are thrown forward like a rag doll and extreme forces are put on the spinal cord of the child. In a frontal crash, a rear-facing car seat is best, because it cradles the head, neck, and back of the child causing less injury. Therefore, the rear-facing position is recommended for as long as possible for very young children.
Information
Child safety seats are proven to save children's lives in accidents.
In the United States, all states require children to be secured in a car seat or booster seat until they reach certain height or weight requirements. These vary by state. Most children grow big enough to move to a regular seat belt between 8 and 12 years old.
To keep your child safe, keep these tips in mind when using a car safety seat.
- When your child is born, you must have a car seat to bring the baby home from the hospital.
- Always secure your child in a car seat whenever riding in a vehicle. Make sure the harness is fastened snugly.
- Read the car seat manufacturer's instructions for the proper way to use the seat. Read your vehicle owner's manual, too.
- Car seats and booster seats should always be used on the back seat of a vehicle. If there is no back seat, the car seat can be secured on the front passenger seat. This can ONLY be done when there is no front or side air bag, or the air bag has been switched off.
- Even after children are big enough to wear a seat belt, riding in the back seat is safest.
When you are selecting a child safety seat for the first time:
- The seat must fit your child's size and be able to be properly installed in your vehicle.
- It is best to use a new car seat. Used car seats often do not have instructions. They may have cracks or other problems that make the seat unsafe. For example, the seat may have been damaged during a car accident.
- Try the seat before buying it. Install the seat in your vehicle. Put your child in the car seat. Secure the harness and buckle. Check that the seat fits your vehicle and child.
- DO NOT use a car seat past its expiration date. The seat frame may no longer be strong enough to support your child safely. The expiration date is usually on the bottom of the seat.
- DO NOT use a seat that has been recalled. Fill out and send in the registration card that comes with the new car seat. The manufacturer can contact you if the seat is recalled. You can find out about recalls by contacting the manufacturer, or by looking up safety complaints records on your child's safety seat at
www.nhtsa.gov/recalls#car-seats .
The types of child safety seats and restraints include:
- Rear-facing seats
- Forward-facing seats
- Booster seats
- Car beds
- Built-in car seats
- Travel vests
REAR-FACING SEATS
A rear-facing seat is one in which your child faces the back of the vehicle. The seat should be installed in the back seat of your vehicle. The two types of rear-facing seats are the infant-only seat and the convertible seat.
Infant-only rear-facing seats. These seats are for babies who weigh up to 22 to 30 pounds (10 to 13.5 kilograms), depending on the car seat. You will need a new seat when your child gets bigger. Many children grow out of these seats by age 8 to 9 months. Infant-only seats have handles so you can carry the seat to and from the car. Some have a base you can leave installed in the car. This lets you click the car seat into place each time you use it. Follow the manufacturer's instructions on how the seat should be reclined so your baby's head does not shift around while you are driving.
Convertible seats. These seats are to be placed in the rear-facing position and are for infants and toddlers. When your child is older and bigger, the seat can be switched to the forward-facing position. Experts recommend keeping your child rear-facing until at least age 3 and until your child outgrows the weight or height allowed by the seat.
FORWARD-FACING SEATS
A forward-facing seat should be installed on the back seat of your vehicle, although it allows your child to face the front of the car. These seats are used only after your child is too big for a rear-facing seat.
A combination forward-facing booster seat may also be used. For younger children, the booster seat's harness straps should be used. After your child reaches the upper height and weight limit for the harness (based on the seat's instructions), the vehicle's own lap and shoulder belts can be used to keep your child strapped in.
BOOSTER SEATS
A booster seat raises your child up so the vehicle's own lap and shoulder belts fit correctly. The lap belt should fall across your child's upper thighs. The shoulder belt should go across the middle of your child's shoulder and chest.
Use booster seats for older children until they are big enough to fit into a seat belt properly. The lap belt should fit low and tight across the upper thighs, and the shoulder belt should fit snug across the shoulder and chest and not cross the neck or face. A child's legs must be long enough so the feet can be flat on the floor. Most children can wear a seatbelt sometime between ages 8 and 12 years.
CAR BEDS
These seats are also called flat car seats. They are used for premature or other special-needs babies. The American Academy of Pediatrics recommends having a health care provider look at how your preterm baby fits and breathes in a car seat before leaving the hospital.
BUILT-IN SEATS
Some vehicles have built-in car seats. Weight and height limits vary. You can get more details on these seats by reading the vehicle owner's manual or contacting the vehicle manufacturer.
TRAVEL VESTS
Special vests can be worn by older children who have outgrown forward-facing safety seats. The vests can be used instead of booster seats. The vests are used with the vehicle's lap and seat belts. As with car seats, children should be sitting in the back seat when using the vest.
Installing a Child Safety Seat
Use child car seats and restraints properly. Follow the manufacturer's instructions for installing and using your child's car seat. Also, read your vehicle's owner's manual to determine the safest place in your vehicle to install a car seat. If the instructions are unclear, call the car seat manufacturer.
A car seat should be snug and positioned at the proper angle. It should not move more than 1 inch (2.5 centimeters) forward or sideways.
Contact your local police or fire station for help installing your seat. Many have free programs that will show you how to install the seat. To find a certified child passenger safety technician in your area, visit
Child safety seats come with safety straps called harnesses. These secure the child into position. Be sure all harnesses are secured snugly. Double check the buckle to ensure it is fastened.
The seat is secured into your vehicle using either the vehicle's seat belts or the LATCH system. LATCH stands for lower anchors and tethers for children. This system is designed to make car seat installation easier. A child safety seat that comes with a LATCH system attaches to anchors in the back seat where the cushions meet. A strap called a tether connects the top of the safety seat to the vehicle's frame. The vehicle's seat belts are not used. All child safety seats and vehicles made after September 1, 2002 come with LATCH systems.
For more information on how to install child safety seats, visit the National Highway Traffic Safety Administration --
References
Durbin DR, Hoffman BD; Council On Injury, Violence, And Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5). pii: e20182460. PMID: 30166368
Hargarten SW, Frazer T. Injuries and injury prevention. In: Keystone JS, Kozarsky PE, Connor BA, Nothdurft HD, Mendelson M, Leder K, eds. Travel Medicine. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 50.
Marcdante KJ, Kliegman RM, Schuh AM. Injury prevention. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 41.
National Highway Traffic Safety Administration website. Child safety at Parents Central: Car seats.
Version Info
Last reviewed on: 1/24/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
