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Car Seats 101

Car Seats 101

McKenzie Pediatrics


Did you know that 80 to 90% of car seats are installed incorrectly? With road injuries being the leading cause of death in children in the United States, by using a child safety seat parents can reduce the risk of injury and death by 75%! Therefore, proper installation of the car seat is crucial.

In Oregon, car seats must be REAR-FACED until a child’s 2nd birthday. And children must be in a car safety seat (including booster seats) at least until the age of 8 years. Best practice is that a child not sit in the front seat until at least age 12 years.

Rear-facing car seats are for infants ranging from about 5 pounds to up to 22-35 pounds, depending on the seat, and up to 32 inches, again depending on the seat. Most have a base that the seat clicks into, and can be installed with a seat belt or LATCH system. Infant car seats should never be placed in a seat position with an airbag!

Convertible car seats are able to rear or forward face. Typically they are rear-facing up to a maximum of 40 pounds, then forward facing until 60-65 pounds. These car seats can use the seat belt or lower anchors to install, PLUS a top tether.

A relatively new type of car seat is the 3-in-1 car seat, which goes from rear facing to forward-facing, to belt-positioning booster. These are the largest car seat type, and may not be compatible with all cars due to sheer size.

Combination seats are forward-facing to belt-positioning seats. They are used with a 5-point harness until a certain weight or height is met, then the harness can be removed and the seat can be used as a booster seat. Weight limits can vary with combination seats.

Belt-positioning Boosters position the seat belt in the appropriate place, with the shoulder belt positioned over the clavicle and NOT over the neck. The lap belt must contact the hips, and NOT be over the lower abdomen. These car seats MUST be used with BOTH the shoulder and lap belt.

Low-Back Boosters are backless seats that lift the child to be better positioned to have the vehicle’s shoulder/lap belt fit appropriately.

Common questions:

  1. Where should the shoulder straps be?
    1. Rear-facing: at or BELOW the level of the shoulders
    2. Forward-facing: at or ABOVE the level of the shoulders
  2. How tight should the harness be?
    1. Pinch Test: you should NOT be able to pinch excess webbing at the level of the shoulders and hips
  3. How tight should the car seat be?
    1. Once properly installed, the car seat should not move side to side or front to back more than 1 inch at the belt path
  4. Where should the retainer clip fall?
    1. The retainer clip should be at the nipple line or armpit level
  5. Do car seats expire?
    1. All car seats expire, most after 6 years
  6. What is the safest place in the car for a car seat?
    1. The back middle seat is best
    2. But practically speaking, it is the position that allows for the most appropriate and safest install and use every time
  7. What is the recline angle?
    1. Recline angles are especially important for rear-facing car seats
    2. Most car seats have an indicator (like a level) that shows clearly when the recline angle is correct. Others have a line on the side of the car seat that must be parallel to the ground.
  8. How do I adjust the recline angle?
    1. Some car seats have adjustable feet that adjust the angle.
    2. In others, you must use a (cut) pool noodle underneath to attain the correct angle.
  9. What about using used car seats?
    1. If the history of the car seat is unknown, it is not recommended to use
  10. Do I replace the car seat after a car accident?
    1. Yes, if obvious damage to the seat itself, if the car is not driveable after the crash, if air bags deploy, if anyone is injured, or when in doubt.
  11. When do I move my child from rear-facing to forward-facing?
    1. At least 2 years of age by Oregon law
    2. Past 2 years of age, turn the child around if his or her head is less than 1 inch from the top of the seat, and/or if the weight limit of the car seat is reached.
    3. Once they have outgrown the height and weight parameters of the rear-facing seat, transition the child to a forward-facing seat with a 5-point harness.
  12. When I can switch to a booster seat?
    1. Once your child is at least 4 years of age AND 40 pounds
    2. Backed booster seat best until child tall enough (but not 8 years of age yet) to have shoulder/lap restraint fit properly without the use of a belt positioner.
  13. When can my child be out of any type of booster seat?
    1. Once (s)he is at least 8 years of age (by Oregon law)
    2. Once (s)he can sit comfortably with bottom to the back of the seat
    3. Once the knees are naturally bent over the edge of the seat
    4. Once the shoulder belt lays over the clavicle and across the chest, and the lap belt lays across the upper thighs and contacting the hips
  14. What are the most common mistakes made with car seats?
    1. Harness straps are too loose
    2. Retainer clip is too high over the neck or too low over the abdomen
    3. The harness is twisted
    4. The harness is routed through the wrong slots
    5. The harness is frayed or damaged
    6. Non-regulated after-market products are used
    7. The buckle strap is too far from the baby
    8. The baby is wearing bulky clothing
    9. The seat belt is not locked
    10. Using the seat belt and lower anchors together
    11. Incorrect direction for size/age of child
    12. Using the incorrect belt path
    13. Not using the top tether with a forward facing car seat
    14. Car seat is not at the appropriate recline angle
    15. Car seat is too loose (>1 inch of movement)

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