Anticipatory Guidance

Car Restraints for Infants and Children


AAP Stance on Car Seat Use - Click Here


According to the CDC, motor vehicle injuries are the leading cause of death for American children. It is the law in all 50 states that children must be in a restraint while riding in a car. Child safety seats can reduce the risk of death by 71% for infants and 54% for toddlers. Most surveys have demonstrated that as many as 95% of restraints are used improperly by caregivers.
Never place more than one child in a single safety belt and if the child is able to undo their belt or get out, the car must stop.  Other individuals who drive your child should be instructed on proper car restraint and seat belt use.

Situations associated with under use of restraints:

  1. Increased number of toddlers unrestrained compared to infants
  2. Riding in trucks
  3. Rural areas compared to suburban and urban 
  4. The driver not using their belt 
  5. The driver is not the child's parent

Installing Car Seats

When installing the car seat, the seat belt of the vehicle must secure the seat.  Also, never use the car seat in the passenger front seat. Some airbags can be deactivated if a child less than 12 years of age must ride in the front seat. Whenever possible, children less than 12 years of age should ride in the back seat. If the child is in the front seat, the seat should be adjusted as far back as possible.
To confirm that the car seat has been properly installed, provides car seat installment inspection and help.

Types of car seats:


Infant Seats- attach to the car by the vehicle safety belt

  1. Designed for infants up to 22 lb.. or when their heads reach the top of the seat.
  2. Should always be installed with the seat facing the rear of the car. The child should face the rear until they are 2 years old
  3. Preferable in the rear seat of the car in the center
  4. Internal harness straps must be used and should be snug
  5. If infant's head flops forward, seat should be inclined to 45 degree tilt or towel may be placed to achieve this angle.

Convertible Seats- can also be used for infants

  1. used for children up to 40 lb. or child's ears are above the back of the seat
  2. After the child weighs 20 lb.and is one year old. may face forward although rear facing is preferred and is safer.
  3. There are two types of harnesses
    1. 5 point with 2 at shoulders, 2 at hips, and 1 at the crotch
    2. Overhead or Tray shield- swings down over the child.

Booster Seats- elevates the child to allow the shoulder belt to fit over the clavicle and center of the chest and the lap belt to go across the hips and thighs.

  1. These are designed for children who have outgrown their convertible seats and are too small for the regular vehicle seat belt. The type that may be used is dependent on the type of seat belts you have in your vehicle.
  2. If there are shoulder-lap belts, a high back booster seat is preferred. 
  3. If there is only a lap belt, a shield type booster seat is preferred.
  4. Should stay in booster until > 4'9" tall and 8-12 years of age.

Regular Seat Belt Use

  1. The shoulder/lap belt may be used when the child is greater than 4'9" tall or 80 pounds This is usually around 10 years of age.
  2. Should ride in back seat until 13 years old.

Premature and Small Babies

  1. Should be tested while still in the hosptital to make sure they can ride safely in a reclined position.  Babies who need to lie flat during travel should ried in a crash-tested car bed.
  2. very small infants who can ride safely in a reclined position usually fit better in an infant-only seat.
  3. If using a convertible seat, choose one without tray shiled harness, abdominal poads, or arm rests.  The baby's face could hit the shield in a crash.


  1. Car Safety Guide. Useful link for families and physicians.
  2. "A Parents Guide to Buying and Using Booster Seats"
  3. CDC Child Passenger Safety : Fact-Sheet. 
  4. Edgeton EA The Dangers of Shield Booster Seats. Pediatrics 2004;113:e153  
  5. Simpson E. et. al. Barriers to Booster Seat Use and Strategies to Increase Their Use.  Pediatrics Vol 110 No 4 October 2002
  6. Bull m, Sheese J. Update for the Pediatrician on Child Passenger Safety: Five Principles for Safer Travel Pediatrics November 2000.
  7. American Academy of Pediatrics Children's Health Topics: Car Safety  Seats an Transportataion Safety: Car Safety Seats: A Guide for Families 2009.