Safety and prevention

Infant and child car seats

More infants are seriously injured or die of injuries from car accidents than any other cause after pregnancy-related deaths and SIDS. What is a minor accident for adults can kill or cause brain damage in newborns and small children.

When traveling in a car, your arms are the most dangerous place for your baby. In a low-speed, 30 mph crash, even a tiny 10-pound infant would be ripped from your arms with a force of almost 300 pounds and crushed between your body and the windshield and dashboard.

Properly used car seats and seat belts dramatically increase a child's chance of surviving an accident. Besides being smart, it's the law in all 50 states. Here's what you need to know about choosing and using baby car seats.

What to look for
Shop for a car seat before your child is born; buy only those that have been approved by the U.S. Department of Transportation.

Infants less than 20 pounds
Bucket-style infant seats that recline are manufactured for children up to 20 pounds. They are designed for a baby to face the rear of the car and they must be anchored to the car with a safety belt and the harness must be fastened. This position is important since the back of the seat absorbs most of the impact of a car crash.

Another type of car seat that is economical to use is one that can be used as a rear-facing infant seat and then can be converted to a toddler seat facing forward when the baby has reached at least one year of age and weighs at least 20 pounds (or more depending on model). The American Academy of Pediatrics (AAP) recommends that babies be kept rear-facing until they reach the maximum weight or height allowed by the maker of the car safety seat.

Household infant carriers are not designed to protect an infant in a car.

Infants and children more than 20 pounds
Children who can sit up alone or who weigh 20 to 60 pounds should be buckled into a forward-facing car safety seat. Choose a safety seat or booster seat without a shield. Based on federal motor vehicle safety standards established by the National Highway Traffic Safety Administration (NHTSA), shield boosters have not been certified by their manufacturers for use by children who weigh more than 40 pounds. In a crash, a serious injury may occur to a child by the shield due to ejection and excessive head movement. The AAP does not recommend their use.

Whatever you choose, try it before you buy it. When shopping, take a large doll to the store so you can see how easy it is to put your baby in and take it out of the car seat. And be sure to read all installation and handling instructions before you use it with your baby. There should be diagrams showing exactly how the straps should be arranged.

Children older than 4 and more than 40 pounds
Use a booster seat that allows for the proper use of a regular lap or shoulder belt. Adjust the shoulder belt to fit across the shoulder rather than across the child's face or neck. Use a booster seat for your child until he or she is at least 8 years old, weighs 80 pounds and whose feet can touch the floor.

Put your child in the back seat
Many parents like to put the car seat in the front passenger seat so they can watch their child while driving. Although it's tempting, don't do it. Putting an infant's rear-facing restraint up front puts the baby in the path of the airbag where a serious injury or death could occur if the airbag inflates.

Children under the age of 12 should always sit in the back seat of the car. The back seat is the safest for them whether or not your car has a passenger-side air bag.

Keep it cool
On hot days, cover the car seat with a towel or blanket to help keep metal or plastic parts of the seat cool. Be sure to remove the towel or blanket before strapping in your baby. Never use blankets between the baby and the car seat.

Find a freebie
It's mandatory to have a car seat, but if you can't afford one, you might be able to get a free loaner. Many police departments, hospitals, health agencies and even private businesses have programs that loan out car seats to new parents. Call your local health department or highway patrol to learn about offerings in your area.

Be a good example
Set a good example for your children by always wearing your own seat belt and insisting they buckle up too.

• YNHH Health Library: Installing and Using Child Safety Seats and Booster Seats

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Reviewed: Kirsten A. Bechel, MD
Last revised: June 4, 2007 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.