TABLE 2

Explanations of Decision Points and Additional Resources

Embedded ImageChildren with certain temporary or permanent physical and behavioral conditions such as altered muscle tone, decreased neurologic control, skeletal abnormalities, or airway compromise may preclude the use of regular CSSs and may require the use of regular CSSs may require specialized restraint systems.
Embedded ImageThe AAP has issued a policy statement that provides specific guidance on best-practice recommendations for children with special health care needs (www.pediatrics.org/cgi/content/full/pediatrics%3B104/4/988). To locate a child passenger safety technician in your area with special training in special health needs, go to http://cert.safekids.org.
Embedded ImageInfants younger than 2 y 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, and evidence indicates that this benefit extends to children up to 2 y of age or longer.
Children who are 2 y of age or older and small for age may need to be evaluated like children younger than 2 y. Consult a child passenger safety technician with enhanced training in special needs or other resources for assistance.
Embedded ImageThe AAP annually updates information on child restraint systems currently available in the United States (http://aap.org/family/carseatguide.htm). 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.
Embedded ImageMost children 2 to 8 y 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.
Embedded ImageMost children shorter than 4 feet 9 inches in height will not fit properly in vehicle lap-and-shoulder seat belts.
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:
    Is the child tall enough to sit against the vehicle seat back with his or her knees bent at the edge of the vehicle seat without slouching and stay in this position comfortably throughout the trip?
    Does the shoulder belt lie across the middle of the chest and shoulder, not against the neck or face?
    Is the lap belt low and snug across the upper thighs, not the abdomen?