Infant-only seats

• Small and have carrying handles (sometimes come as part of a stroller system).
• Have a built-in harness that covers the child's upper torso.
• Can only be used for infants from birth up to 20 to 30 pounds, depending on model.
• Many come with a detachable base, which can be left in the car. The seat clicks into and out of the base, which means you don't have to install it each time you use it.
  

Convertible seats (used rear-facing)

• Are used rear-facing for infants from birth to at least 1 year of age and at least 20 to 22 pounds. Can also be used forward-facing by older children.
• Have higher rear-facing weight limits than infant-only seats. These are ideal for bigger babies.
• Have the following 3 types of harnesses:
  

  - 5-point harness - 5 points of attachment: 2 at the shoulders, 2 at the hips, 1 at the crotch
  - Overhead shield - A padded tray-like shield that swings down over the child
  - T-shield - A padded t-shaped or triangle-shaped shield attached to the shoulder straps
  

Features to look for in rear-facing seats

• Harness slots. Look for seats that come with more than one harness slot to give your baby room to grow. The harnesses should be in the slots at or below your baby's shoulders.
• Adjustable buckles and shields. Many rear facing seats have 2 or more buckle positions for growing babies. Many overhead shields can be adjusted as well.
• Other features. Angle indicators (built-in angle adjusters that help you get the proper recline) and head support systems are other features that can help you install the seat the right way.
  

Forward-facing seat

Forward-facing seats

Once your child is at least 1 year of age and at least 20 pounds, he can ride forward-facing. However, it is best for him to ride rear-facing until he reaches the highest weight or height limit allowed by the car safety seat. There are many types of seats that can be used forward-facing including convertible seats, built in seats, combination forward-facing/booster seats, and travel vests.

Convertible seats (used forward-facing)

As mentioned previously, convertible seats can also be used forward-facing by children who are at least 1 year of age and weigh at least 20 pounds. However, if you have used
your convertible seat rear-facing, you need to make the following 3 adjustments before using it forward-facing:

1. Move the shoulder straps to the slots that are at or above your child's shoulders. On many convertible seats, the top harness slots must be used when the seat is in the forward-facing position. Check the instructions to be sure.
2. Move the seat from the reclined to the upright position if required by the manufacturer of the seat.
3. Make sure the seat belt runs through the forward-facing belt path.

When converting your seat from rear-facing to forward-facing, carefully follow the car safety seat manufacturer's instructions.

Built-in seats

Built-in seats are available in some cars and vans. Weight and height limits vary. Read your vehicle owner's manual or contact the manufacturer for details about how these seats are used.

Combination forward-facing/booster seats
Some car safety seats combine the features of a forward-facing seat and a booster seat. These seats come with harness straps for children who weigh up to 40 to 65 pounds (depending on the model). Once your child reaches the weight or height limit, you can use the seat as a booster by removing the harness and using your vehicle's lap and shoulder seat belts. Keep in mind that when using the harness straps, the seat can be secured with a lap and shoulder belt or a lap-only belt. However, once you remove the harness, you must use a lap and shoulder seat belt. Children must never ride in a booster seat using a lap belt only because serious injury can result.

Travel vests
If your car only has lap belts, a travel vest may be an option. These can also be used for a child who has outgrown his seat with a harness but is not yet ready for a booster seat.

Booster seats

Booster seats do not come with harness straps but are used with the lap and shoulder seat belts in your vehicle, the same way

Belt-positioning booster seat

an adult rides. Your child should stay in a car safety seat with a harness as long as possible before being allowed to ride in a booster seat. You can tell when your child is ready for a booster seat when one of the following is true:

• She reaches the top weight or height allowed for her seat with a harness. (These measurements are listed on labels on the seat and are also included in the instruction booklet that is provided with the car safety seat.)
• Her shoulders are above the harness slots.
• Her ears have reached the top of the seat.

Booster seats are designed to raise your child so that the lap and shoulder seat belts fit properly. This means the lap belt lies low across your child's thighs and the shoulder belt crosses the middle of your child's chest and shoulder. Correct belt fit helps protect the stomach, spine, and head from injury in case of a crash. Both high-back and backless booster seats are available. Booster seats should be used until your child can correctly fit in lap and shoulder seat belts.

Your child is ready to use lap and shoulder seat belts when the belts fit properly.
This means

• The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.
• The lap belt is low and snug across the thighs, not the stomach.
• The child is tall enough to sit against the vehicle seat back with her legs bent without slouching and can stay in this position comfortably throughout the trip.

Remember, seat belts are made for adults. If the seat belt does not fit your child correctly, he should stay in a booster seat until the adult seat belts fit him correctly. This is usually when the child reaches about 4' 9" in height and is between 8 and 12 years of age.

Other points to keep in mind when using seat belts

• Never tuck the shoulder belt under the child's arm or behind the back.
• If there's only a lap belt, make sure it's snug and low on the child's thighs, not across the stomach. Try to get a lap and shoulder belt installed in your car by a dealer.
• Never allow children or anyone else to "share" seat belts. All passengers must have their own car safety seats or seat belts.

A warning about seat belt adjusters

There are products on the market that claim to make seat belts fit better. They attach to the seat belt but are not a part of the original belt. These products may actually interfere with proper lap and shoulder belt fit by causing the lap belt to ride too high on the stomach and making the shoulder belt too loose, and may even damage the seat belt itself. No federal standard ensuring the effectiveness and safety of these after-market products has been developed. In addition, most vehicle and car safety seat manufacturers do not recommend their use. Until the National Highway Traffic Safety Administration develops safety standards for these products, the American Academy of Pediatrics (AAP) recommends they not be used. As long as children are riding in the correct car safety seat for their size and age, they do not need to use any additional devices.

Installing a car safety seat

There are 2 main things to remember when installing a car safety seat.

• Your child must be buckled snugly into the seat.
• The seat must be buckled tightly into your vehicle.

Ask yourself the following questions to make sure both are done correctly. If you are not sure, check the instructions that came with your car safety seat, or contact a certified CPS Technician for help.

Is the child buckled into the car safety seat correctly?

• Are you using the correct harness slots?
• Are the harnesses snug?
• Have you placed the plastic harness clip (if your seat comes with one) at armpit level to hold the shoulder straps in place?
• Do the harness straps lie flat?
• Is your baby dressed in clothes that allow the straps to go between the legs? It's OK to adjust the straps to allow for thicker clothes, but make sure the harness still holds the child snugly. Also, remember to tighten the straps again after the thicker clothes are no longer needed.
• Is anything under your baby? Tuck blankets around your baby after adjusting the harness straps snugly. Never place them under your baby.
• Is your child slouching down or to the side? If so, pad the sides of the seat and between the crotch with rolled up diapers or blankets.
  

Is the car safety seat buckled into the vehicle correctly?

• Is the car safety seat facing the right direction for your child's age and weight?
• Is the seat belt routed through the correct belt path?
• Is the seat belt buckled tight? If you can move the seat more than an inch side to side or toward the front of the car, it's not tight enough.
• Is your rear-facing seat reclined enough? Your infant's head should not flop forward. If it does, tilt the car safety seat back a little. Your car safety seat may have a built-in recline adjuster for this purpose. If not, wedge firm padding, such as a rolled towel, under the base.
• Do you need a locking clip? They come with all new car safety seats. If the seat belts in your car move freely even when buckled, you need a locking clip. If you're not sure, check the manual that came with your car. Locking clips are not needed in most newer vehicles and in vehicles with LATCH. (See "Installation made safer and easier" below for more information.)
• Some lap belts (especially those found in older vehicles) need a special heavy-duty locking clip. These are only available from the vehicle manufacturer. Check the manual that came with your car for more information.
  

Installation made safer and easier

Child passenger safety experts have developed several ways to make car safety seat installation safer and easier, including the following:

• LATCH (Lower Anchors and Tethers for Children) is an attachment system that makes installing a car safety seat easier by eliminating the need to use seat belts to secure the car safety seat. It includes 2 sets of small bars, called anchors, located in the back seat where the cushions meet. Car safety seats that come with LATCH have a set of attachments that fasten to these vehicle anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, come with LATCH. However, unless both your vehicle and the car safety seat have this anchor system, you will still need to use seat belts to secure the car safety seat.
• A tether is a strap that attaches a car safety seat to an anchor located on the rear window ledge, the back of the vehicle seat, or on the floor or ceiling of the vehicle. Tethers give extra protection by keeping the car safety seat and the child's head from moving too far forward in a crash or sudden stop. Tethers should not be confused with LATCH attachments; the tether is a longer strap at the top of the seat and LATCH attachments are located at or near the base of the seat. All new cars, minivans, and light trucks have been required to have tether anchors since September 2000. Most new forward-facing car safety seats and a few rear-facing car safety seats come with tethers. For older car safety seats, tether kits are available. It is highly recommended that tethers be used because they greatly improve the protection of your child in the event of a crash. Check with the car safety seat manufacturer to find out how you can get a tether for your seat if yours does not have one.
• Child Passenger Safety (CPS) Technicians can help you. If you have more questions about installing your car safety seat, a certified CPS Technician may be able to help. A list of certified CPS Technicians is available by state or ZIP code on the National Highway Traffic Safety Administration (NHTSA) Web site at www.nhtsa.dot.gov/people/injury/childps/contacts/. A list of inspection stations- where you can go for help with installation-is available in both English and Spanish at www.seatcheck.org or toll-free at 866/SEATCHECK (866/732-8243). You can also get this information by calling the toll-free NHTSA Auto Safety Hot Line at 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.
  

Common questions about car safety seats

Q: What if my baby is born prematurely?
A: Use a car safety seat without a shield harness. 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. Premature infants should be observed in their car safety seats while still in the hospital
to make sure the reclined position does not cause low heart rate, low oxygen, or 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.

Q: What if my baby weighs more than 20 pounds but is not 1 year old yet?
A: Many babies reach 20 pounds well before their first birthday. However, just because your baby weighs more than 20 pounds does not make him ready to ride forward facing. Look for a convertible seat that can be used rear-facing by children who weigh more than 20 pounds.

Q: What if my child has special health care needs?
A: Children with special health problems may need other restraint systems. Talk about this with your pediatrician. Easter Seals, Inc has car safety seat programs for children with special health care needs. More information is available from Easter Seals, Inc at 800/221-6827. You also can learn more about transporting children with special needs by calling the Automotive Safety Program at 317/274-2977 or by visiting its Web site at www.preventinjury.org. 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.

Q: What if my car has air bags?
A: All new cars come equipped with air bags. When used with seat belts, air bags work very well to protect older children and adults. However, air bags are very dangerous to children riding in rear-facing car safety seats and to child passengers who are not properly positioned. 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 and neck injury and death.

Toddlers who ride in forward-facing car safety seats also are at risk from air bag injuries. All children up to age 13 years 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 properly restrained for his age and size and stays in the proper position at all times. This will help prevent the air bag from striking your child.

Air bag on/off switches are available in the few cases in which an infant must ride in the front seat. Most families don't need to use the air bag on/off switch. 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 heath care needs.
• Your pediatrician recommends constant supervision of your child during travel.
• No other adult can 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.

Q: What if my car has side air bags?
A: Side air bags improve safety for adults in side impact crashes. However, children who are seated near a side air bag may be at risk for serious injury. Read your vehicle owner's manual for recommendations that apply to your vehicle.

Q: What if my car only has lap belts in the back seat?
A: Lap belts work fine with infant-only, convertible, and forward-facing car safety seats. They cannot be used with booster seats, and they are not the safest way to buckle older children. If your car only has lap belts, use a forward-facing car safety seat with a
harness and higher weight limits. Other options are

• Check with a car dealer or the manufacturer of your car to see if shoulder belts can be installed.
• Use a travel vest (some can be used with lap belts).
• Consider buying another car with lap and shoulder belts in the back seat.

Q. What if I drive more children than can be buckled safely in the back seat?
A: Avoid having to drive more children than can be buckled safely in the back seat, especially if your car has passenger air bags. However, if necessary, a child in a forward facing car safety seat with a harness may be the best choice to ride in the front seat. This is because a child who is in a booster seat or using a regular seat belt can easily move out of position and be at greater risk for injuries from the air bag.

Q: Can I use a car safety seat on an airplane?
A: The Federal Aviation Administration (FAA) and the AAP recommend that when flying, children should be securely fastened in car safety seats until 4 years of age, and then should 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 certified to be used on airplanes. Check the label on your car safety seat and call the car safety seat manufacturer before you travel to be sure your seat meets current FAA regulations.

Q: Can I use a car safety seat that was in a crash?
A: If the car safety seat was in a moderate or severe crash, it needs to be replaced. If the crash was minor, the seat does not automatically need to be replaced. A crash is considered minor if all of the following are true:

• The vehicle could be driven away from the crash.
• The vehicle door closest to the car safety seat was not damaged.
• No one in the vehicle was injured.
• The air bags did not go off.
• You can't see any damage to the car safety seat.

If you are unsure, call the manufacturer of the seat. See the resource section for manufacturer names and phone numbers.

Q: What about using a used car safety seat?
A: Avoid using used car safety seats, especially if obtained from a yard sale or secondhand (consignment) shop because there is no way to know the seat's history. Also never use a car safety seat that

• Is too old. Look on the label for the date it was made. Do not use seats that are more than 10 years old. Many manufacturers recommend that car safety seats only be used for 5 to 6 years from the date of manufacture. Check with the manufacturer to find out how long the company recommends using its seat.
• Has any visible cracks in the frame of the seat.
• Does not have a label with the date of manufacture and model number. Without these, you cannot check to see if the seat has been recalled.
• Does not come with instructions. You need them to know how to use the seat. You can get a copy of the instruction manual by contacting the manufacturer.
• Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.
• Is a shield booster. Although shield boosters are still around, the AAP recommends against their use. Major injuries have occurred to children in shield boosters. The only time shield boosters should be used is if the shield is removed and the seat is used with a lap and shoulder belt. (See "Booster seats" on page 8.)
• Was recalled. You can find out by calling the manufacturer or by contacting the following:
  - Auto Safety Hot Line: Toll-free: 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday through Friday.
  - National Highway Traffic Safety Administration (NHTSA) www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm

If the seat has been recalled, be sure to follow the instructions to fix it or to get the parts you need. You also may get a registration card for future recall notices from the hotline.

Always read and follow manufacturer's instructions

If you do not have the manufacturer's instructions for your car safety seat, write or call the company's customer service department. A representative will ask you for the model number, name of seat, and date of manufacture. The manufacturer's address and phone number are on the label on the seat.

All products listed on the following pages meet Federal Motor Vehicle Safety Standard 213 as of the date of publication. There may be car safety seats available that are not listed in this brochure. The following information is current as of the date of publication. Before buying a car safety seat, check the manufacturer's instructions for important safety information about proper fitting and use.

Although the American Academy of Pediatrics (AAP) is not a testing or standard-setting organization, this guide sets forth the AAP recommendations based on 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. Phone numbers and Web site addresses are as current as possible, but may change at any time. 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