|Orthopaedics and Neurosurgery International
6A Napier Road
#02-42 Gleneagles Hospital Annex Block
Singapore, 258500 SGP
This article is also available in Spanish:.
According to the Centers for Disease Control and Prevention (CDC), motor vehicle crashes are the leading cause of death among children.
In 2010, an average of almost 2 children (age 12 and under in a passenger car) were killed and 325 injured each day in car crashes, according to the National Highway Traffic Safety Administration (NHTSA).
Data from NHTSA indicates that approximately half of these deaths can be prevented by using a car seat or booster seat that correctly fits the height, weight, and age of the child.
There are many different types of car seats and booster seats available. This article provides parents and caregivers with general guidelines to follow when selecting children's safety seats.
- Children younger than 12 years should always ride in the back seat. A child sitting in the front seat is at a much higher risk for injury or death in a crash — from both the force of impact and the force of the front-seat airbag deployment.
- Read your car seat instruction manual and your vehicle owner's manual carefully. Keep the manuals in your car at all times.
- Do not transfer your child to the next safety seat stage too early (for example, from a rear-facing seat to a forward-facing seat). Keep your child in each car seat stage until he or she outgrows the seat manufacturer's height and weight limits.
- Always wear a safety belt yourself to set a good example for your child.
The type of safety seat you need depends on the size and weight of your child, as well as your vehicle's safety equipment. Before you select a car seat, be sure to refer to your car's owner manual for helpful information on safety equipment features.
Birth to 2 Years
A rear-facing child safety seat offers maximum protection and should be used for most babies until they are at least 2 years old.
A rear-facing infant car seat typically has a base that is installed in the back seat, allowing your baby to stay in the seat for easy transferring in and out of the car. When your baby outgrows the seat manufacturer's height and weight limits - usually around 1 year - switch to a rear-facing seat with higher size accommodations.
Many manufacturers offer convertible safety seats that can be adjusted as a baby grows. Convertible seats can be used in both rear-facing and forward-facing positions. Height and weight limits for most convertible seats can accommodate most babies in the rear-facing position until they are at least 2 years old.
Keep your baby rear-facing as long as possible. Babies older than 2 years that still fit within car seat height and weight limits can stay rear-facing until they outgrow their seats.
2 to 4 Years
Once your child has outgrown the size limits for car seats in the rear-facing position, a forward-facing seat secured in the back seat is the safest option. Never use a seat that is built just for rear-facing in a forward-facing position.
If you have a convertible car seat, follow the manufacturer's instructions to safely convert the seat from rear- to forward-facing. Children should stay in a forward-facing car seat with a harness until they reach the height and weight limits of the seat, which typically occurs around age 4 years.
4 to 8 Years
A booster seat will put your child in position to be safely secured with your car's lap and shoulder seat belts. When your child has outgrown the forward-facing car seat, buckling up in a booster seat in the back seat of your car will provide the most protection.
There are high-back booster seats and backless booster seats. High-back booster seats should be used in vehicles with lower seat backs that do not support a child's head.
Booster seats should be used until your child is tall enough that the car's seat belts fit correctly. This means that the shoulder belt fits across the chest and shoulder, not across the neck or face, and the lap belt crosses at the upper thighs. In most vehicles, children who are 4' 9" tall can be safely secured with standard shoulder and lap belts in the back seat.
Just as important, make sure that the car seat you are using is right for your child's size and installed properly. A research study from NHTSA concluded that three out of four children are at greater risk for injury because of car seats that are used incorrectly.
For comprehensive information on selecting the right car seat for your child, as well as instructions on car seat installation, seat recalls, and additional safety tools, go to the NHTSA micro-website Parents Central at.
Sources: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. US Department of Transportation, National Highway Traffic Safety Administration, Child Car Safety Fact Sheet 04-04-2012.
Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)
The American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, IL 60018