1) Best practice recommendation: infant-only or convertible CSS used rear facing
Rear-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 facing
Combination 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 seat
Booster 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 belt
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 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 protection
CSSs 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.
Explanations of Decision Points and Additional Resources
Does the child have significant health needs?
Children with certain temporary or permanent physical and behavioral conditions such as altered muscle tone, decreased neurologic control, skeletal abnormalities, or airway compromise that may preclude the use of regular CSSs may require specialized restraint systems.
Consult complementary AAP Policy and other resources for best practice recommendations
To locate a child passenger safety technician in your area with special training in special health needs, go to http://cert.safekids.org.
Infants and toddlers have relatively large heads and several structural features of their neck and spine that place them at particularly high risk of head and spine injuries in motor vehicle crashes. Rear-facing CSSs provide optimal support to the head and spine in the event of a crash.
Children who are small for their age may need to be evaluated like younger children. Consult a child passenger safety technician with enhanced training in special needs or other resources for assistance.
Has the child outgrown weight or height limit for seat? Is weight or height less than rear-facing limit for convertible CSS? Is weight or height less than forward-facing limit for convertible combination CSS?
The AAP annually updates information on child restraint systems currently available in the United States (www.healthychildren.org/carseatguide). The weight thresholds provided in the algorithm are considered minimum standards. More recent products have higher weight limits and should be used when possible. In general, children should remain in a child restraint system until they outgrow the weight or height limits for its intended use.
Most children 4–8 years of age are not large enough to fit properly in the vehicle seat belt and will require a CSS or booster seat for optimal restraint. A belt-positioning booster seat positions a child so that the lap and shoulder portions of the seat belt fit properly: the lap portion low across the hips and pelvis and the shoulder portion across the middle of the shoulder and chest.
Most children under 4 ft 9 inches in height will not fit properly in vehicle lap and shoulder seat belts.
Does child fit properly in the vehicle seat belt, usually around 4 ft 9 inches in height?
These 3 questions are an evaluation to determine whether a child is ready to be restrained by the vehicle seat belt without a booster seat. If the answer is “no” to any of these questions, the child should use a booster seat:
1. Is the child tall enough to sit against the vehicle seat back with her knees bent at the edge of the vehicle seat without slouching and stay in this position comfortably throughout the trip?
2. Does the shoulder belt lie across the middle of the chest and shoulder, not against the neck or face?
3. Is the lap belt low across the hips and pelvis?