Properly installed and used car seats reduce the risk of fatal injuries by as much as 71 percent for infants, and 54 percent for toddlers.

But national studies show that as many as 90 percent of car seats are not installed or used properly. Because of the variety of cars and car seat designs, car seats can be complicated to install and use.

To make sure your child's car seat is safe, make an appointment with a child passenger safety technician in your area. You can find a technician or inspection station online on the National Highway Traffic Safety Administration's website or by calling your local police department.

• All children ages 12 and younger should ride properly restrained in the back seat at all times. The back seat is the safest place for children whether or not your car has a passenger-side airbag.
• Until they are at least 1 year old AND weigh 20 pounds, infants should ride in rear-facing car seats in the back seat. A child should remain rear-facing longer than this if possible. Check the instructions that come with your car seat for the maximum weight a child should be while the car seat is rear-facing, and follow those guidelines. Because infants do not have good head and neck control, they can be severely injured in a crash if they are seated forward.

Note: Rear-facing car seats should always be in the back seat. Most cars have a passenger-side air bag in the front seat, which can cause severe injury or death if it inflates and strikes the car seat with a child in it.

• Children who weigh more than 20 pounds AND who are 1 year or older may ride in a forward-facing car seat, but the car seat should still be kept in the back seat at all times. Remember to check the weight limit of the seat your toddler is riding in. Many are appropriate for toddlers up to 40 pounds. If your toddler exceeds the maximum weight of the seat, it is recommended that she move to a seat with harness straps rated past 40 pounds, and which can be used as a booster seat after she reaches 4 years of age.
• Children who weigh between 40 and 80 pounds and are shorter than 4'9" (usually between 4 and 8 years old) should sit in booster seats. Seat belts are designed for older children and adults, so a booster seat will help the seat belt fit a younger child more securely and comfortably.
• Your child is ready for a seat belt when:
  • She can sit straight up against the back of the vehicle's seat with knees bent comfortably at the edge of the seat
  • The belt crosses the shoulder between the neck and arm
  • The lap belt is as low as possible touching the thighs
  • She is mature enough to stay seated like this for the whole trip.

• A properly fitting seatbelt should be worn with the lap portion of the belt low and tight across the hips, and with the shoulder portion across the shoulders without cutting across the face or neck.
• Make sure your child never rides with his seat belt's shoulder strap under his arm or behind his back, which could result in serious injuries in the case of a car crash.
• Seat belts that have shoulder belts and lap belts are safest. If your vehicle only has lap belts in the back seat, you may be able to have shoulder straps installed. The National Highway Traffic Safety Administration has a list of manufactures that offer retrofit kits for installing shoulder belts in older cars.
• Set a good example by always wearing your seat belt and making sure all adults in your car wear theirs as well.

• Follow the car seat manufacturer's instructions and motor vehicle owner's manual carefully when securing the car seat into the car and your child into the car seat.
• Replace your child's car seat if it has been in a car crash. Crash forces may have weakened or damaged the seat's protective devices - even if damage is not visible.
• Second-hand car seats are not recommended, since you can't be sure of the history.
• Replace car seats that are more than 6 years old.
• Mail in the registration card that comes with your car seats so you'll hear about potential product recalls. A list of recalled car seats is available at The National Highway Traffic Safety Administration's Child Seat Safety Recall Campaign Listing (http://www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm). You can also call the Auto Safety Hotline at (888) 327-4236.

For more information on child passenger safety, visit the National Highway Traffic Safety Administration (www.nhtsa.dot.gov) online.

Children's Hospital Boston©, 2005. This page may be reproduced for educational purposes. Reprint permission is required for all other uses.