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Car seat safety
By Children's Hospital Boston's Injury Prevention Program

Motor vehicle crashes are the leading cause of death for children ages 2 to 12 in the United States. But car seats and booster seats—when used and installed correctly—can significantly reduce the risk of injury and death.

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. Unfortunately, national studies show that as many as 90 percent of car seats are not installed or used correctly.

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 (NHTSA) Web site (www.nhtsa.dot.gov) or by calling your local police department.

Guidelines for car seat safety:
Children ages 12 and younger should ride properly restrained in the back seat, which is the safest place for children.

• 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. Follow the guidelines that come with your car seat for the maximum weight a child should be while the car seat is rear-facing. 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 are 1 year or older and weigh more than 20 pounds 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 feet 9 inches (usually between 4 and 8 years old) should sit in a booster seat secured with a lap and shoulder belt. 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.

Other car seat safety tips

• 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 six 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 NHTSA's Child Seat Safety Recall Campaign Listing (www-odi.nhtsa.dot.gov/cars/problems/ recalls/childseat.cfm). You can also call the Auto Safety Hotline at (888) 327-4236.

Seat belt safety tips

• A properly fitting seat belt 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 the seat belt's shoulder strap under her arm or behind her 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 NHTSA has a list of manufacturers 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.

This article was adapted from content provided by Children's Hospital Boston to the Health and Parenting sections of Yahoo! For more pediatric health information from Children's, visit http://health.yahoo.com/centers/parenting, and select "Parenting Advice" under Parenting Tips.