TABLE 1

Summary of Best Practice Recommendations

Best Practice RecommendationComplementary Information
1) Best practice recommendation: infant-only or convertible CSS used rear facingRear-facing-only seats usually have a handle for carrying and can be snapped in and out of a base that is installed in the vehicle. They can only be used rear facing. Convertible CSSs can be used either forward or rear facing and typically have higher rear-facing weight and height limits than rear-facing-only seats.
 All infants and toddlers should ride in a rear-facing CSS as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer.When children using rear-facing-only seats reach the highest weight for their seat, they should continue to ride rear-facing in a convertible seat for as long as possible. Most currently available convertible seats can be used rear facing to at least 40 lb.
2) Best practice recommendation: convertible or combination CSS used forward facingCombination CSSs are seats that can be used forward facing with a harness system and then, when the child exceeds the height or weight limit for the harness, as a booster seat with the harness removed.
 All children who have outgrown the rear-facing weight or height limit for their CSS should use a forward-facing CSS with a harness for as long as possible, up to the highest weight or height allowed by their CSS’s manufacturer.Most models of convertible and combination CSSs can accommodate children up to 65 lb and some up to 70–90 lb when used forward facing. The lowest maximum weight limit for currently available forward-facing car safety seats is 40 lb.
A few vehicle models offer integrated forward-facing seats with a harness system. The vehicle owner’s manual provides instructions for use of integrated seats when they are present. A crash-tested travel vest may be considered for children with special needs or in situations where a traditional CSS cannot be installed correctly.
There is a safety advantage for young children to remain in car safety seats with a harness for as long as possible before transitioning to booster seats.
3) Best practice recommendation: belt-positioning booster seatBooster seats function by positioning the child so that both the lap and shoulder portions of the vehicle seat belt fit properly: the lap portion of the belt should fit low across the hips and pelvis, and the shoulder portion should fit across the middle of the shoulder and chest. They come in both high-back (a seat back that extends up beyond the child’s head) and backless models. A few vehicle models offer integrated booster seats.
 All children whose weight or height is above the forward-facing limit for their CSS should use a belt-positioning booster seat until the vehicle lap and shoulder seat belt fits properly, typically when they have reached 4 ft 9 inches in height and are between 8 and 12 y of age.
4) Best practice recommendation: Lap and shoulder vehicle seat beltThe lap portion of the belt should fit low across the hips and pelvis, and the shoulder portion should fit across the middle of the shoulder and chest when the child sits with his back against the vehicle seat back. If they don’t, the child is likely too small to use the vehicle seat belt alone and should continue to use a belt-positioning booster seat.
 When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection
5) Best practice recommendation: all children <13 years of age should be restrained in the rear seats of vehicles for optimal protectionCSSs should be installed tightly either with the vehicle seat belt or with the LATCH system, if available. LATCH is a system of attaching a CSS to the vehicle that does not use the seat belt. It was designed to ease installation of the CSS. Whether parents use LATCH or the seat belt, they should always ensure a tight installation of the CSS into the vehicle.
 All children <13 y should be restrained in the rear seats of vehicles for optimal protection
  • LATCH, Lower Anchors and Tethers for Children.