The #1 killer and crippler of children in the United States is motor vehicle crashes. More than 600 children under the age of 5 years are killed each year, and about 270,000 are injured. Proper use of car safety seats can reduce traffic fatalities by at least 80%. All 50 states have passed laws that require children to ride in approved child passenger safety seats.

A parent cannot protect a child by holding him or her tightly. In a 30-mile-per-hour crash, the child will either be crushed between the parent's body and the dashboard or ripped from the parent's arms and possibly thrown from the car. Car safety seats also help to control a child's misbehavior, prevent motion sickness, and reduce the number of accidents caused by a child distracting the driver.

What are the types of car safety seats?

Before you buy a car safety seat, look at several different models. Make sure that the car seat will fit in your car and that your seat belts will work with the seat. There are several types of car safety seats:

• Infant-only seats: These are rear-facing only seats. They can be used from birth until a child weighs approximately 20 pounds (depending on the model). They are small and portable.
• Some of these seats come with a detachable base. You attach the base to the seat of the car. This allows you to easily snap the car seat in and out of the car without reinstalling the car seat each time. If the base does not attach tightly to your car, it is better to attach the seat each time and not use the base.
• Convertible safety seats: These seats can be used in both rear- and forward-facing positions. The seat needs to stay in the rear-facing position until your child is over 1 year old and has reached the highest weight allowed for the rear-facing position (usually about 30 pounds, but may be more or less depending on the car seat). They can then be used in the forward-facing position until the child has reached 40 pounds.
• Combination seats: These seats are forward-facing seats that can be used after you child has reached 20 pounds and is at least 1 year old. Your child must wear the 5-point harness until he or she has reached 40 pounds. When you child is over 40 pounds, you can use this seat as a booster seat by correctly positioning the car's lap/shoulder belt across your child. It can be used as a booster seat until your child is about 80 pounds (depending on the model).
• Booster seats: These are forward-facing seats that lift the child higher so your car's lap/shoulder belt will fit correctly over the child. A booster seat is for children over 40 pounds and can be used until the child is 80 pounds (or more depending on the model).
• Travel vests: Travel vests are used if you only have lap belts in your car. They vary in weight ranges depending on the model, but are typically used for children at least 2 years old and up to 100 pounds. The lap belt fits through a backrest or loops and the shoulder straps come over your child and buckle.
• Built-in seats (integrated seats): Some cars and vans come with built-in child safety seats. These may be used by children who are over 1 year of age and weigh at least 20 pounds. Weight and height requirements vary depending on the car manufacturer. Check with the maker of the car to find out the specific height and weight requirements.

What is LATCH?

Staring in 2002, most new vehicles and car safety seats will have a new system called LATCH (Lower Anchors and Tethers for Children). This system may be an easier way to attach safety seats. It allows you to attach the car seat without using a seat belt. However, you will need to continue attaching the car safety seat with a seat belt unless you have both a new car seat and a new car with the LATCH system.

What are tethers?

Tether straps are found on most new forward-facing car seats. A tether strap hooks the top of a car safety seat to a permanent anchor in the car to provide extra protection. Tethers reduce the amount of forward movement of the car seat in a crash. Check your car to see if it has an anchor. Cars made since September 2000 are required to have tether anchors. Cars made since 1989 can be retro-fitted with tether straps. Most anchors are on the rear window ledge, back of the seat, floor, or ceiling of the car. There are tether kits available for older car seats. Check with your car seat and car manufacturer.

Where should the car seat be placed?

Whenever possible and at any age, put the safety seat in the back seat of the car, which is much safer than the front seat.

Air bags are standard equipment in most new cars. They have saved many lives. However, they are very hazardous to infants in REAR-facing child safety seats and have caused death from brain injury. If your car has air bags, take the following precautions:

• Infants riding in REAR-facing child safety seats should NEVER be placed in the front seat of a car or truck with a passenger-side air bag. They must be in the car's rear seat or not ride in that vehicle.
• Children in FORWARD-facing child safety seats should also ride in a car's rear seat until 12 years of age.
• If the vehicle does not have a rear seat, children riding in the front seat should be positioned as far back as possible from the air bag. Move the seat all the way back so that the child is as far as possible from the dashboard. Some cars come with air bag ON/OFF switches. Turn the air bag off only if your car has no back seat.

When can my child use a regular seat belt?

Keep your child in a booster seat as long as possible. Your child could be ready for a regular seat belt anywhere between 8 and 12 years old depending on height and weight. Your child should be about 4' 9" tall and at least 60 to 80 pounds to properly fit an adult seat belt. When your child is ready for a regular seat belt, use a lap belt low across the thighs. If your child is using a shoulder belt, it should cross your child's chest, not the neck or throat. Never put the shoulder belt under both arms or behind the back.

What are the safety standards?

Since January 1981, all manufacturers of child safety seats have been required to meet stringent federal government safety standards, including crash-testing. The American Academy of Pediatrics (AAP) publishes a list of infant/child safety seats that have met the Federal Motor Vehicle Standards. The list is updated yearly. To get this list, write to the AAP or visit their website:

American Academy of Pediatrics (AAP)
Division of Public Education
PO Box 927
Elk Grove Village, Illinois 60007

Each state has its own seat belt laws and safety standards. Although all states require that children are buckled in, not all states require that children travel in the safest way possible. Using a car safety seat correctly is very important. Follow the safety seat instructions and make sure you are keeping your child as safe as possible.

Tips for Using a Car Seat Properly

If used consistently and properly, your child's car seat can be a lifesaver. Your attitude toward safety belts and car seats is especially important. If you treat buckling up as a necessary, automatic routine, your child will follow your lead and also accept car seats and seat belts. To keep your child safe and happy, follow these guidelines:

• Always use the safety seat. Use the safety seat on the first ride home from the hospital, and continue using it for every ride.
• Everyone buckles up. Allow NO exceptions for older kids and adults. If adults ride unprotected, the child quickly decides that safety is just kid stuff.
• Give frequent praise for appropriate behavior in the car.
• Remember that a bored child can become disruptive. Keep a supply of favorite soft toys and munchies on hand.
• NEVER let a fussy child out of the car seat or safety belt while the car is in motion. If your child needs a break, STOP the car. Responding to complaints by allowing your child to ride unprotected is a disastrous decision that will make it harder to keep him or her in the seat on the next ride.
• If a child tries to get out of the seat, stop the car and firmly but calmly explain that you won't start the car until he or she is again buckled in the car seat.
• Booster seats must be used with a lap/shoulder belt.
• When your child travels in another person's car (such as a baby sitter's or grandparent's car), insist that the driver also use the safety seat.
• For long-distance trips, plan for frequent stops and try to stop before your child becomes restless. Cuddle a young child. Let an older child snack and run around for 10 to 15 minutes.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.