According to the National Center for Statistics and Analysis (NCSA), nearly 250,000 children are injured every year in car accidents. Car accidents are also the leading cause of acquired disability (e.g., brain injury, paralysis, etc.) for children nationwide. In the United States, injuries and deaths from car crashes have been dramatically reduced with the use of child safety seats and other restraints. Choosing the proper safety seat or restraint for the age, size, and weight of the child can markedly reduce injuries, deaths, and disability due to car accidents. Much of the information in today’s Health Tip comes from guidelines developed by the American Academy of Pediatrics (AAP) for the selection of 
the most appropriate car safety seat for children.
Infants and toddlers – It is recommended that infants and toddlers ride in rear-facing car seats until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their car safety seat. There are three types of rear-facing car seats appropriate for this age group:
- Infant only seats are used for infants up to 22 to 35 pounds, depending on the model. These are relatively small and usually have carrying handles.
- Convertible seats may be used in a forward or rear-facing position. This allows them to be used for a longer period of the child’s life. Typically, these have a 5-point harness that attaches at the shoulders, at the hips, and between the legs.
- 3-in-1 seats can be used rear-facing, forward-facing, or as a belt-positioning booster. During infancy and the first years of life, they are used in a rear-facing position. These are usually larger than the other two described and don’t come with a carrying handle. Since these can be used as a booster seat, their use extends into late childhood.
Toddlers and preschoolers – When children reach the age of 2 or exceed the recommended weight or height limits for a rear-facing car seat, they should graduate to a forward-facing car safety seat. These are generally used in conjunction with a harness. The five approved car safety restraints that can be used forward-facing are:
- Convertible or 3-in-1 seats – At this stage of the child’s development, these seats are used in forward-facing configuration.
- Forward-facing only – These seats are combined with a harness. Depending on the model, they can be used for children who weight up to 80 pounds.
- Combination seat with harness – These seats can be used forward-facing with a harness for children who weigh up to 40 to 80 pounds. They can then be converted to a booster seat to be used with a seat belt for children up to 100 pounds (depending on the model).
- Built-in seats – Some vehicles come with forward-facing seats built in. Weight and height limits with the seats vary, so reading the owner’s manual is advised.
- Travel vests – These are particularly appropriate in vehicles with lap-type seat belts in the back. They can also be used by children whose weight limit exceeds the limits of a car safety seat.
School-aged children – Booster seats are recommended for older children who have outgrown their forward-facing seat. This is the case when the child reaches the top weight or height allowed for the seat, when the child’s shoulders are above the top harness slots, or when the child’s ears have reached the top of the seat. These seats are designed to raise the child so that the lap and shoulder belts in the car fit properly. Booster seats should be used until your child can correctly fit in lap and shoulder seat belts.
Older children – By the time a child reaches the age of 8 to 12 and is around 4 feet 9 inches, the use of adult-type seat belts without a booster seat becomes appropriate. As with adults, they should always use the combination of lap and shoulder belts. An adult seat belt is considered to fit appropriately when 1) the shoulder belt lies across the middle of the chest and shoulder, not the neck or throat, 2) the lap belt is low and snug across the upper thighs, not the belly, and 3) the child is tall enough to sit against the vehicle seat back without slouching.
Along with selecting the appropriate child seat, it is equally important that it be used correctly. The National Highway Traffic Safety Administration (NHTSA) found that approximately 72% of the 3,500 observed child vehicle safety restraints were being used incorrectly. There have even been reports of improper use of a child’s car safety seat contributing to injury or death. Proper installation and use of child safety seats, on the other hand, can lower the risk of an infant dying in a car crash by 71% and a young child’s risk of dying by 54%.