Infant and child car seats


Child car seats


As many of us know, accidents are one of the major causes of injury and death in children. To keep children safer while driving, it is important to use child car seats properly. Car seats are required by law for children under 40 pounds. Unfortunately, studies show that most people do NOT have their car seats installed properly. The confusion is understandable - there are different car seats for different heights, weights, and ages of children.

Follow the manufacturer’s instructions carefully. In addition, police inspection services can help you identify installation problems.

Here are the most critical points:

  • The safest position for an infant seat is rear facing in the car’s back seat.  
  • In most models, the infant seat is used AT LEAST until the child reaches 20 pounds and 1 year of age. At that point, a forward-facing seat can be used. This may require a new car seat - it depends on the model.  
  • As children get older and bigger (usually 40 pounds and over), they should use a booster seat. With a booster seat, the child is restrained by the car’s seat belt, but the booster raises the child high enough to make sure the car’s seat belt is positioned properly over the shoulder.  
  • The final stage is moving to a regular adult car seat once the child reaches about 80 pounds.

Some models are convertible seats that can be used at different stages. However, as your child grows up, you will need to buy at least two car seats, since no model covers the range from newborn all the way up to 80 lbs.

There are flat car seats for preterm babies to help them get enough oxygen. The American Academy of Pediatrics recommends that all preterm babies be observed in a car seat for fit and breathing stability before discharge from the hospital.


  • Many people install a car seat far too loosely, even though they think the seat is tight. While the seat does not have to be completely immobile, re-read the instructions to see how much “give” is safe.  
  • Many seats are also installed at an improper angle. If the instructions are unclear, call the seat manufacturer.  
  • 5-point harnesses are generally considered safer than 3-point harnesses. With 5-point harnesses, make sure the upper retainer clip is armpit level - not too close to the child’s neck.  
  • Read your car owner’s manual to determine the safest place to install a car seat in YOUR car. Beware of airbag locations. Avoid placing child car seats in the front passenger location of a car, especially if it has an airbag.  
  • Follow the exact instructions for the installation and use of your specific car seat. Recommendations change somewhat depending on the model and type of seat.  
  • Some states have passed laws requiring that children up to 8 years old or 80 pounds be put in booster seats.  
  • It is best to use a new car seat. Avoid used car seats - these may lack instructions, be out-of-date, or have cracks or other problems.  
  • For more information call your car seat manufacturer, car manufacturer, or the State Highway Safety Office. A more extensive car safety seat guide can be found at

Finally, remember to wear a seat belt when you are pregnant, before the baby is even born. Position the lap belt as low as possible under your abdomen and unborn child.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.