TABLE 1

Summary of Best-Practice Recommendations

Best-Practice RecommendationComplementary Information
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All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 y of age or until they reach the highest weight or height allowed by the manufacturer of their CSS.
Infant-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 infant-only seats.
When children using infant-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 35 lb.
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.
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All children 2 y or older, or those younger than 2 y 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 the manufacturer of their CSS.
Several models of convertible and combination CSSs can accommodate children up to 65 or 80 lb when used forward-facing. The lowest maximum weight limit for currently available forward-facing CSSs is 40 lb.
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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 feet 9 inches in height and are between 8 and 12 y of age.
There is a safety advantage for young children to remain in CSSs with a harness for as long as possible before transitioning to booster seats.
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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.
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.
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 or her back against the vehicle seat back. If they do not, then the child is likely too small to use the vehicle seat belt alone and should continue to use a belt-positioning booster seat.
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All children younger than 13 y 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.
  • LATCH indicates lower anchors and tethers for children.