Car Safety Seats 2018 Guide
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One of the most important jobs you have as a parent is keeping your child safe when riding in a vehicle. 
Each year, thousands of young children are killed or injured in car crashes. Proper use of car safety seats helps keep children safe. But with so many different seats on the market, many parents find this overwhelming. If you are expectant parents, give yourselves enough time to learn how to properly install the car safety seat in your car before your baby is born to ensure a safe ride home from the hospital. (See If You Need Installation Help.) 
The type of seat your child needs depends on several things, including your child’s age, size, and developmental needs. Read on for more information from the American Academy of Pediatrics (AAP) about choosing the most appropriate car safety seat for your child. (See Car Safety Seats 2018List for a list of seats and manufacturer Web sites.)  
NOTE: The “Types of Car Safety Seats at a Glance” chart is a quick guide on where to start your search. it’s important to continue your research to learn about each seat you use.  
Types of Car Safety Seats at a Glance
Age GroupType of SeatGeneral Guidelines
 

Infants and toddlers

 

Rear-facing–only

 

Rear-facing convertible

All infants and toddlers should ride in a rear-facing seat until they are at least 2 years of age or reach the highest weight or height allowed by their car safety seat manufacturer.
 

Toddlers and preschoolers

 

Forward-facing convertible

 

Forward-facing with harness

Children who have outgrown the rear-facing weight or height limit for their convertible seat should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat manufacturer.
 

School-aged children

BoosterAll children whose weight or height exceeds the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 through 12 years of age. All children younger than 13 years should ride in the back seat.
 

Older children

Seat beltsWhen children are old enough and large enough for the vehicle seat belt to fit them correctly, they should always use lap and shoulder seat belts for the best protection. All children younger than 13 years should ride in the back seat.
 

Installation Information—Seat Belts and LATCH

Car safety seats may be installed with either the vehicle’s seat belt or LATCH (lower anchors and tethers for children) system. LATCH is an attachment system for car safety seats. Lower anchors can be used instead of the seat belt to install the seat, and many parents find them easier to use in some cars. The top tether improves safety provided by the seat and is important to use for all forward-facing seats, even those installed using the vehicle seat belt. Although the seat belt and LATCH systems are equally safe, caregivers may prefer one system instead of the other. Keep in mind that only one system should be used unless the car safety seat and vehicle manufacturer say it is OK to use 2 systems at the same time.  
Vehicles with the LATCH system have lower anchors located in the back seat, where the seat cushions meet. Tether anchors are located behind the seat, either on the panel behind the seat (in sedans) or back of the seat, ceiling, or floor (in most minivans, SUVs, hatchbacks, and pickup trucks). All forward-facing car safety seats have tether attachments that fasten to these anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, are equipped to use LATCH. 
All lower anchors are rated for a maximum weight of 65 pounds (total weight includes car safety seat and child). Parents should check the car safety seat manufacturer’s recommendations for maximum weight a child can be to use lower anchors. New car safety seats have the maximum weight printed on their label. 
NOTE: Seat belts—If you install a car safety seat using your vehicle’s seat belt, you must make sure the seat belt locks to help get a tight fit. In most newer cars, you can lock the seat belt by pulling it all the way out and then allowing it to retract to keep the seat belt tight around the car safety seat. Additionally, many car safety seats have built-in lock-offs to lock the belt without having to lock the seat belt separately as well. Refer to the vehicle owner’s manual for details about how your seat belt locks. 
Middle of the back seat—The safest place to ride for all children younger than 13 years is the back seat. If possible, it may be best to ride in the middle of the back seat. However, it is sometimes difficult to install a car safety seat tightly in the middle if the vehicle seat is narrow or uneven. Also, many vehicles do not have lower anchors for the middle seating position. It is safest to put the car safety seat in a position where you can install it tightly with either the lower anchor system or seat belt; in some cases, this may be on either side of the back seat rather than the middle. A child passenger safety technician (CPST) can help you decide which place is best to install your child’s car safety seat in your vehicle. 

Infants and Toddlers—Rear-Facing Seats

The AAP recommends that all infants ride rear facing starting with their first ride home from the hospital. All infants and toddlers should ride in a rear-facing seat until they are at least 2 years of age or, preferably, until they reach the highest weight or height allowed by their car safety seat manufacturer. When infants outgrow their rear-facing–only seat, a convertible seat installed rear facing is needed. All parents can benefit from getting installation help from a CPST to ensure that their seat is properly installed. (See If You Need Installation Help on page 5.) 

Types of Rear-Facing Seats

Three types of rear-facing seats are available: rear-facing– only, convertible, and 3-in-1. When children reach the highest weight or length allowed by the manufacturer of their rear-facing–only seat, they should continue to ride rear facing in a convertible or 3-in-1 seat. 
  1.  
    1. Rear-facing–only seats
     
    •  
      Are used for infants up to 22 to 40 pounds, depending on the model.
    •  
      Are small and have carrying handles.
    •  
      Usually come with a base that can be left in the car. The seat clicks into and out of the base so you don’t have to install it each time you use it. Parents can buy more than one base for additional vehicles.
    •  
      Should be used only for travel (not sleeping, feeding, or any other use outside the vehicle).
  2.  
    Convertible seats (used rear facing)
     
    •  
      Can be used rear facing and, later, “converted” to forward facing for older children when they outgrow either the weight limit or the length limit, for rear facing. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and they do not come with carrying handles or separate bases and are designed to stay in the car.
    •  
      Many have higher limits in rear-facing weight (up to 40–50 pounds) and height than rear-facing–only seats, which make them ideal for bigger babies and toddlers.
    •  
      Have a 5-point harness that attaches at the shoulders, at the hips, and between the legs.
    •  
      Should be used only for travel (not sleeping, feeding, or any other use outside the vehicle).
  3.  
    3-in-1 seats (used rear facing)
     
    •  
      Can be used rear facing, forward facing, or as a belt-positioning booster. This means the seat may be used longer by your child as your child grows.
    •  
      Are often bigger in size, so it is important to check that they fit in the vehicle while rear facing.
    •  
      Do not have the convenience of a carrying handle or separate base; however, they may have higher limits in rear-facing weight (up to 40–50 pounds) and height than rear-facing–only seats, which make them ideal for bigger babies and toddlers.
 
Figure 1. Car safety seat with LATCH.
 
Figure 1. Car safety seat with LATCH.

Installation Tips for Rear-Facing Seats

Always read the vehicle owner’s manual and the car safety seat manual before installing the seat. 
When using a rear-facing seat, keep the following tips in mind: 
 
Figure 2. Rear-facing–only car safety seat.
 
Figure 2. Rear-facing–only car safety seat.
 
Figure 3. Convertible car safety seat used rear facing.
 
Figure 3. Convertible car safety seat used rear facing.
  •  
    Place the harnesses in your rear-facing seat in slots that are at or below your baby’s shoulders.
  •  
    Ensure that the harness is snug (you cannot pinch any slack between your fingers when testing the harness straps over the child’s shoulders) and that the harness chest clip is placed at the center of the chest, even with your child’s armpits.
  •  
    Make sure the car safety seat is installed tightly in the vehicle with either LATCH or a locked seat belt. If you can move the seat at the belt path more than an inch side to side or front to back, it’s not tight enough.
  •  
    Never place a rear-facing seat in the front seat of a vehicle that has an active front passenger airbag. If the airbag inflates, it will hit the back of the car safety seat, right where your child’s head is, and could cause serious injury or death.
  •  
    If you are using a convertible or 3-in-1 seat in the rear-facing position, make sure the seat belt or lower anchor webbing is routed through the correct belt path. Check the instructions that came with the car safety seat to be sure.
  •  
    Make sure the seat is at the correct angle so your child’s head does not flop forward. Check the instructions to find out the correct angle for your seat and how to adjust the angle if needed. All rear-facing seats have built-in angle indicators or adjusters.
  •  
    Check the car safety seat instructions and vehicle owner’s manual about whether the car safety seat may contact the back of the vehicle seat in front of it.
  •  
    Still having trouble? Check with a certified CPST in your area who can help. If You Need Installation Help for information on how to locate a CPST.

Common Questions

 
Figure 4. Car safety seat with a small cloth between the crotch strap and infant; harness chest clip positioned at the center of the chest, even with the infant’s armpits; and tightly rolled receiving blankets on both sides of the infant.
 
Figure 4. Car safety seat with a small cloth between the crotch strap and infant; harness chest clip positioned at the center of the chest, even with the infant’s armpits; and tightly rolled receiving blankets on both sides of the infant.
Q: What if my child’s feet touch the back of the vehicle seat? 
A: This is a very common concern of parents, but it should cause them no worry. Children can bend their legs easily and will be comfortable in a rear-facing seat. Injuries to the legs are very rare for children facing the rear. 
Q: What do I do if my child slouches down or to the side in the car safety seat? 
A: You can try placing a tightly rolled receiving blanket on both sides of your child. Many manufacturers allow the use of a tightly rolled small diaper or cloth between the crotch strap and your child if necessary to prevent slouching. Do not place padding under or behind your child or use any sort of car safety seat insert unless it came with the seat or was made by the manufacturer for use with that specific seat.  
Q: Why should I dress my child in thinner layers of clothing before strapping him into a car safety seat? 
A: Bulky clothing, including winter coats and snowsuits, can compress in a crash and leave the straps too loose to restrain your child, leading to increased risk of injury. Ideally, dress your baby in thinner layers and wrap a coat or blanket around your baby over the buckled harness straps if needed. 
Q: Do preemies need a special car safety seat? 
A: A car safety seat should be approved for a baby’s weight. Very small babies who can sit safely in a semi-reclined position usually fit better in rear-facing–only seats. Preterm babies should be tested while still in the hospital to make sure they can sit safely in a semi-reclined position. Babies who need to lie flat during travel should ride in a car bed that meets Federal Motor Vehicle Safety Standard 213. They should be tested while in the hospital to make sure they can lie safely in the car bed. 

Toddlers and Preschoolers—Forward-Facing Seats

Always read the vehicle owner’s manual and the car safety seat manual before installing the seat. 
Any child who has outgrown the rear-facing weight or height limit for her convertible seat should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by her car safety seat manufacturer. It is best for children to ride in a seat with a harness as long as possible, at least to 4 years of age. If your child outgrows a seat before reaching 4 years of age, consider using a seat with a harness approved for higher weights and heights. 

Types of Forward-Facing Car Safety Seat Restraints

Four types of car safety seat restraints can be used forward facing. 
  1.  
    Convertible seats—Seats can “convert” from rear facing to forward facing. These include 3-in-1 seats.
  2.  
    Combination seats with harness—Seats can be used forward facing with a harness for children who weigh up to 40 to 90 pounds (depending on the model) or without the harness as a booster (up to 80–120 pounds, depending on the model).
  3.  
    Built-in seats—Some vehicles come with built-in forward-facing seats. Weight and height limits vary. However, do not use built-in seats until your child is at least 2 years of age. Read your vehicle owner’s manual for details about how to use these seats.
  4.  
    Travel vests—Vests can be worn by children between 20 and 168 pounds and can be an option to traditional forward-facing seats. They are useful for when a vehicle has lap-only seat belts in the rear, for children with certain special needs, or for children whose weight has exceeded that allowed by car safety seats. These vests usually require use of a top tether.

Installation Tips for Forward-Facing Seats

Always read the vehicle owner’s manual and the car safety seat manual before installing the seat.  
It is important that the car safety seat is installed tightly in the vehicle and that the harness fits your child snugly. To switch a convertible or 3-in-1 seat from rear facing to forward facing, 
  •  
    Move the shoulder straps to the slots that are at or above your child’s shoulders, or position at or closest to (above or below, based on rear or forward facing) the child’s shoulders. Check the instructions that came with the seat to be sure you are positioning the shoulder straps correctly.
  •  
    You may have to adjust the recline angle of the seat so that it sits more upright in your vehicle. Check the instructions to be sure.
  •  
    If using a seat belt, make sure it runs through the forward-facing belt path (be sure to follow car safety seat instructions) and that the seat belt is locked and tightened.
  •  
    If using the lower anchors, make sure that the weight of your child plus the weight of the seat does not exceed 65 pounds. Most seats now state the maximum child weight to use the anchors in the manual and on the stickers on the side. If the child weighs too much, families must use the seat belt to install.
  •  
    Always use the top tether when you can. A tether is a strap that is attached to the top part of a car safety seat and holds the seat tightly by connecting to an anchor point in your vehicle (often on the seat back or rear shelf; see your vehicle owner’s manual to find where tether anchors are in your vehicle). Tethers give important extra protection by keeping the car safety seat and your child’s head from moving too far forward in a crash or sudden stop. All new cars, minivans, and light trucks are required to have tether anchors as of September 2000. Forward-facing seats come with tether straps. A tether should always be used as long as your child has not reached the top weight limit for the tether anchor. Check the car safety seat instructions and vehicle owner’s manual for information about the top weight limit and locations of tether anchors.

Common Questions

 
Figure 5. Forward-facing car safety seat with a harness.
 
Figure 5. Forward-facing car safety seat with a harness.
Q: What if I drive more children than can be buckled safely in the back seat? 
A: It’s best to avoid this, especially if your vehicle has airbags in the front seat. All children younger than 13 years should ride in the back seat. If absolutely necessary, a child in a forward-facing seat with a harness may be the best choice to ride in front. Just be sure the vehicle seat is moved as far back away from the dashboard (and airbag) as possible.  
Q: What do I need to know if my child will be driven by someone else, such as for child care or school? 
A: If your child is being driven by someone else, make sure 
  •  
    To move the shoulder straps to the slots that are at or above your child’s shoulders, or position at or closest to (above or below, based on rear or forward facing) the child’s shoulders. Check the instructions that came with the seat to be sure you are positioning the shoulder straps correctly.
  •  
    The car safety seat your child will be using fits properly in the vehicle used for transport.
  •  
    The car safety seat being used is appropriate for the age and size of your child.
  •  
    The person in charge of transporting your child knows how to install and use the car safety seat correctly.
Child care programs and schools should have written guidelines for transporting children, including 
  •  
    All drivers must have a valid driver’s license. In some states, school bus drivers need to have a special type of license.
  •  
    Staff to child ratios for transport should meet or exceed those required for the classroom.
  •  
    Every child should be supervised during transport, either by school staff or a parent volunteer, so the driver can focus on driving.
  •  
    School staff, teachers, and drivers should know what to do in an emergency, know how to properly use car safety seats and seat belts, and be aware of other safety requirements.
Q: Should my child ride in a car safety seat on an airplane? 
A: The Federal Aviation Administration (FAA) and the AAP recommend that children less than 40 pounds be securely fastened in certified child restraints when flying. This will help keep them safe during takeoff and landing or in case of turbulence. Most rear-facing, convertible, and forward-facing seats can be used on airplanes, but booster seats and travel vests cannot. 
Read your seat’s instruction manual and look for a label on the car safety seat that says, “This restraint is certified for use in motor vehicles and aircraft.” You can also consider using a restraint made only for use on airplanes and approved by the FAA. Larger children may use the airplane seat belt or continue to use their car safety seat on the airplane as long as it is labeled for use on aircraft and the child has not exceeded the seat’s weight or height limit. Remember that your child will need an appropriate car safety seat to use at your destination. For more information, visit the FAA Web site at https://www.faa.gov/travelers/fly_children or the CARES Airplane Safety Harness for Children Web site at www.kidsflysafe.com. 

School-aged Children—Booster Seats

Booster seats are for older children who have outgrown their forward-facing seats. All children whose weight or height exceeds the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 through 12 years of age. Most children will not fit in most vehicle seat belts without a booster until 10 to 11 years of age. All children younger than 13 years should ride in the back seat. Instructions that come with your car safety seat will tell you the height and weight limits for the seat. As a general guideline, a child has outgrown a forward-facing seat when any of the following situations is true: 
  •  
    He reaches the top weight or height allowed for his seat with a harness. (These limits are listed on the seat and in the instruction manual.)
  •  
    His shoulders are above the top harness slots.
  •  
    The tops of his ears have reached the top of the seat.

Types of Booster Seats

High-back and backless are 2 standard types of booster seats. They do not come with harness straps but are used with lap and shoulder seat belts in your vehicle, the same way an adult rides. They are designed to raise a child up so that lap and shoulder seat belts fit properly over the strongest parts of the child’s body. 
 
Figure 6. Belt-positioning booster seat.
 
Figure 6. Belt-positioning booster seat.
Most booster seats are not secured to the vehicle seat with the seat belt or lower anchor and tether but simply rest on the vehicle seat and are held in place once the seat belt is fastened over a child. However, some models of booster seats can be secured to the vehicle seat and kept in place using the lower anchors or top tether. (Currently, only a few vehicle manufacturers offer built-in booster seats.) 

Installation Tips for Booster Seats

When using a booster seat, always read the vehicle owner’s manual and the car safety seat manual before installing the seat. Booster seats often have a plastic clip or guide to correctly position vehicle lap and shoulder belts. See the booster seat instruction manual for directions on how to use the clip or guide. 
Booster seats must be used with a lap and shoulder belt. When using a booster seat, make sure 
  •  
    The lap belt lies low and snug across your child’s upper thighs.
  •  
    The shoulder belt crosses the middle of your child’s chest and shoulder and is off the neck.
If your booster seat has lower anchors or top-tether attachments, check its manual for installation instructions. 

Common Questions

Q: What if my car has only lap belts in the back seat? 
A: Lap belts work fine with rear-facing–only, convertible, and forward-facing seats that have an internal harness but can never be used with a booster seat. If your car has only lap belts, use a forward-facing seat that has a harness and higher weight limits. You could also 
  •  
    Check to see if shoulder belts can be installed in your vehicle.
  •  
    Use a travel vest (check the manufacturer’s instructions about the use of lap belts only and about the use of lap and shoulder belts).
  •  
    Consider buying another car with lap and shoulder belts in the back seat.
Q: What is the difference between high-back and backless boosters? 
A: Both types of boosters are designed to raise your child so seat belts fit properly, and both will reduce your child’s risk of injury in a crash. High-back boosters should be used in vehicles without headrests or with low seat backs. Many seats that look like high-back boosters are actually combination seats. They come with harnesses that can be used for smaller children and, later, removed for older children. Backless boosters are usually less expensive and are easier to move from one vehicle to another. Backless boosters can be used safely in vehicles with headrests and high seat backs. 

Older Children—Seat Belts

Seat belts are made for adults. Children should stay in a booster seat until adult seat belts fit correctly, typically when children reach about 4 feet 9 inches in height and are 8 through 12 years of age. Most children will not fit in a seat belt alone until 10 to 11 years of age. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for the best protection. All children younger than 13 years should ride in the back seat. 
 
Figure 7. Lap and shoulder seat belt.
 
Figure 7. Lap and shoulder seat belt.

Using a Seat Belt

  1.  
    An adult seat belt fits correctly when
     
    •  
      The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.
    •  
      The lap belt is low and snug across the upper thighs, not the belly.
    •  
      Your child is tall enough to sit against the vehicle seat back with her knees bent over the edge of the seat without slouching and can comfortably stay in this position throughout the trip.
  2.  
    Other points to keep in mind when using seat belts include
     
    •  
      Make sure your child does not tuck the shoulder belt under her arm or behind her back. This leaves the upper body unprotected and adds extra slack to the seat belt system, putting your child at risk of severe injury in a crash or with sudden braking.
    •  
      Never allow anyone to “share” seat belts. All passengers must have their own car safety seats or seat belts.

Common Questions

Q: I’ve seen products that say they can help make the seat belt fit better. Should we get one of these? 
A: No, these products should not be used. They may actually interfere with proper seat belt fit by causing the lap belt to ride too high on the stomach or making the shoulder belt too loose. They can even damage the seat belt. This rule applies to car safety seats too; do not use extra products unless they came with the seat or are specifically approved by the seat manufacturer. These products are not covered by any federal safety standards, and the AAP does not recommend they be used. As long as children are riding in the correct restraint for their size, they should not need to use additional devices. 

Shopping for Car Safety Seats

When shopping for a car safety seat, keep the following tips in mind: 
  •  
    No one seat is the “best” or “safest.” The best seat is the one that fits your child’s size, is correctly installed, fits well in your vehicle, and is used properly every time you drive.
  •  
    Don’t decide by price alone. A higher price does not mean the seat is safer or easier to use.
  •  
    Avoid used seats if you don’t know the seat’s history. Never use a car safety seat that
     
    •  
      Is too old. Look on the label for the date it was made. Check with the manufacturer to find out how long it recommends using the seat.
    •  
      Has any visible cracks on it.
    •  
      Does not have a label with the date of manufacture and model number. Without these, you cannot check to see if the seat has been recalled.
    •  
      Does not come with instructions. You need them to know how to use the seat. Instructions can be found on manufacturer Web sites or by contacting the manufacturer.
    •  
      Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.
    •  
      Was recalled. You can find out by calling the manufacturer or contacting the National Highway Traffic Safety Administration (NHTSA) Vehicle Safety Hotline at 888/327-4236. You can also visit the NHTSA Web site at www.safercar.gov.
  •  
    Do not use seats that have been in a moderate or severe crash. Seats that were in a minor crash may still be safe to use, but some car safety seat manufacturers recommend replacing the seat after any crash, even a minor one. The NHTSA considers a crash minor if all the following situations are true:
     
    •  
      The vehicle could be driven away from the crash.
    •  
      The vehicle door closest to the car safety seat was not damaged.
    •  
      No one in the vehicle was injured.
    •  
      The airbags did not go off.
    •  
      You can’t see any damage to the car safety seat.
If you have specific questions about the car safety seat, contact the manufacturer. 

About Airbags

  •  
    Front airbags are installed in all new cars. When used with seat belts, airbags work well to protect teenagers and adults; however, airbags can be very dangerous to children, particularly those riding in rear-facing seats, and to preschool- and young school-aged children who are not properly restrained. If your vehicle has a front passenger airbag, infants in rear-facing seats must ride in the back seat. Even in a relatively low-speed crash, the airbag can inflate, strike the car safety seat, and cause serious brain injury and death.
     
    Vehicles with no back seat or a back seat that is not made for passengers are not the best choice for traveling with small children; however, the airbag can be turned off in some of these vehicles if the front seat is needed for a child passenger. See your vehicle owner’s manual for more information.
  •  
    Side airbags are available in most new cars. Side airbags improve safety for adults in side-impact crashes. Read your vehicle owner’s manual for more information about the airbags in your vehicle. Read your car safety seat instructions and the vehicle owner’s manual for guidance on placing the seat next to a side airbag.

If You Need Installation Help

If you have questions or need help installing your car safety seat, find a certified child passenger safety technician (CPST). Lists of certified CPSTs and child seat–fitting stations are available on the following Web sites: 
NHTSA Parents and Caregivers 
National Child Passenger Safety Certification 
http://cert.safekids.org (Click on “Find a Tech” or call 877/366-8154.) 
Includes list of CPSTs fluent in Spanish and other languages or with extra training in transportation of children with special needs. 

Important Reminders

  1.  
    Be a good role model. Make sure you always wear your seat belt. This will help your child form a lifelong habit of buckling up.
  2.  
    Make sure that everyone who transports your child uses the correct car safety seat or seat belt on every trip, every time. Being consistent with car safety seat use is good parenting, reduces fussing and complaints, and is safest for your child.
  3.  
    Never leave your child alone in or around cars, and lock your vehicle when not in use. Any of the following situations can happen when a child is left alone in or around a vehicle. A child can
     
    •  
      Die of heatstroke because temperatures can reach deadly levels in minutes.
    •  
      Be strangled by power windows, retracting seat belts, sunroofs, or accessories.
    •  
      Knock the vehicle into gear, setting it into motion.
    •  
      Be backed over when the vehicle backs up.
    •  
      Become trapped in the trunk of the vehicle.
  4.  
    Always read and follow the manufacturer’s instructions for your car safety seat. If you do not have those, write or call the company’s customer service department. They will ask you for the model number, name of seat, and date of manufacture. The manufacturer’s address and phone number are on a label on the seat. Also, be sure to follow the instructions in your vehicle owner’s manual about using car safety seats. Some manufacturers’ instructions may be available on their Web sites.
  5.  
    Remember to fill out and mail in the registration card that comes with the car safety seat. You can also register your seat on the manufacturer’s Web site. It will be important in case the seat is recalled.

Figure 1 adapted from US Department of Transportation, National Highway Traffic Safety Administration. LATCH Makes Child Safety Seat Installation as Easy as 1-2-3. DOT HS publication 809 489. Published March 2011.

Figures 2, 3, 5, 6, and 7 by Anthony Alex LeTourneau.

Figure 4 from Bull MJ, Engle WA; American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, Committee on Fetus and Newborn. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009;123(5);1424–1429.

The appearance of the name American Academy of Pediatrics (AAP) does not constitute a guarantee or endorsement of the products listed or the claims made. The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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GOVERNING USE OF WEBSITE AND MATERIALS

The following terms and conditions are an agreement (the “Agreement”) governing your access and use of the [Pediatric Care Online (PCO)] website (the “Website”) and its content (collectively, the “Materials”). Please read these terms carefully. If you agree to all of the terms of this Agreement please click the “I Agree” button below to indicate your acceptance and you will automatically be taken to the Website. If you do not wish to be bound by these terms, you may not access or use the Materials - in such event you should click the “I Do Not Agree” button below and follow the instructions to obtain a refund of any subscription fees paid by you.

1. Materials. The American Academy of Pediatrics (“AAP”) hosts the Website and related Materials on its servers and makes them available via the Internet to subscribers for non-commercial research and education purposes and for use in providing healthcare services. In consideration of payment of the applicable subscription fee, the AAP is willing to provide access to the Materials to you and, if applicable, your Users (as defined below), subject to all of the following terms. You acknowledge that certain portions or content of the Website or Materials may contain information, materials or content provided by a third party provider or licensor (a “Provider”) and that the liability and obligations of such Providers is limited as provided herein.

2. Access and License.

(a) Subject to the terms of this Agreement, the AAP grants to you a non-exclusive, non-assignable and non-transferable right to access and use the Materials for the purpose of providing healthcare services to your patients (the “License”).

(b) “User” means you and your authorized users for whom a subscription has been activated. For individual enrollment use of the Materials is limited solely to you, and you agree not to permit others to access the Materials using your account. For group enrollment, access to the Materials is limited to you and your authorized Users for whom you have obtained an authorized subscription. You agree not to permit others to access the Materials using your account. You agree to issue passwords or other access information only to authorized Users and use reasonable efforts to ensure that Users do not divulge their passwords and other access information to any third party.

(c) You agree to make all Users aware of, and ensure that all of your Users comply with, all of the terms of this Agreement. You will monitor compliance of your Users with the terms of this Agreement. You acknowledge that you will be held responsible for any access or use of Materials traceable to your Users and/or User ID. You agree to immediately notify us in the event you determine, or have reason to believe, that an unauthorized party has gained access to the Materials and to take all reasonable steps, both to ensure that such activity ceases and to prevent any recurrence.

(d) Under the License, Users are only permitted to:

(i) Access and display the Materials in connection with providing healthcare services.

(ii) Electronically save and print off individual parts or documents of the Materials for personal use in connection with providing healthcare services.

(iii) Distribute the Materials in print or electronic form to other Users for the purposes of providing healthcare services.

(iv) Supply a printed copy of individual documents or parts of the Materials to individual patients of a User on request or on an ad-hoc basis in connection with providing healthcare services, provided that such dissemination does not result in distribution of a substantial or material portion or volume of the Materials to such patient.

(v) Supply print or electronic copies of individual documents from the Materials to governmental authorities for legal or regulatory purposes.

(e) You are responsible for furnishing, at your expense, any computer, networking, telecommunications and other equipment necessary for you or your Users to access the Internet and connect to the Website and Materials.

(f) The AAP shall use commercially reasonable efforts to cause the Website and Materials to be accessible to the Internet twenty-four (24) hours each day except for scheduled maintenance and required repairs, and except for any interruption due to causes beyond the reasonable control of the AAP. The AAP and its Providers do not warrant that access to the Materials or Website will be uninterrupted or error free or that any information, software, or other materials available on or accessible through the Materials or Website is free from viruses, worms, Trojan horses, or other harmful components. THE AAP AND ITS PROVIDERS WILL NOT BE LIABLE FOR DAMAGES OR REFUNDS SHOULD THE WEBSITE OR MATERIALS BECOME TEMPORARILY UNAVAILABLE OR IF ACCESS TO THEM OCCASIONALLY BECOMES SLOW OR INCOMPLETE. In no event shall the AAP or its Providers be liable for downtime, system speed or slow-down caused by the misoperation or failure of the Internet or any other network not under the sole control of the AAP or by any other cause beyond the reasonable control of the AAP or its Providers. The AAP will restore access to the Website and Materials as soon as commercially practicable in the event of an unscheduled interruption or failure thereof.

3. License Restrictions. The License shall be subject to the following restrictions and conditions, and without the separate written approval of the AAP neither you nor any User shall:

(a) Use, or permit any third party to use, the Materials for any purposes other than in connection with providing healthcare services to Users’ patients.

(b) Distribute, publish or make available any part of the Materials (in print or electronic form) to anyone other than Users or Users’ patients except as explicitly permitted herein.

(c) Remove, obscure, or change any copyright notices, author identification, disclaimers or other proprietary legends incorporated in the Materials.

(d) Alter, abridge, adapt or modify the Materials or prepare derivative works based upon the Licensed Materials or incorporate the Materials into other materials, nor permit third parties to do so.

(e) Make the Materials available to the public via the Internet, World Wide Web or other un-secure network (except pursuant to features or functionality specifically built into the Website or Materials to facilitate such access).

(f) Make agreements for access to the Materials with individuals, organizations, vendors, affiliates, or partners, who are not your individual Users.

(g) Use, or allow the use of, the Materials in contravention of any federal, state, local, foreign or other applicable law, or any rules or regulations of regulatory or administrative organizations.

4. Changes to the Materials. The AAP reserves the right at any time, in its discretion, for any reason and without prior notice: (i) to change, suspend or discontinue any aspect of the Materials, including the availability of any feature, database or content; (ii) to limit or restrict user access to certain features available on the Materials; and (iii) to suspend users use of the Materials, temporarily or permanently; provided that in the event any such change materially affects your ability to use the Materials or makes them materially less useful to you, then you may, within thirty (30) days of the change, terminate this Agreement by giving fifteen (15) days written notice to the AAP, and the AAP will refund any unearned portion of your subscription fee. If the AAP gives you notice that it is withdrawing materials because it no longer retains the right to publish them or that it has reasonable grounds to believe they infringe copyright or are defamatory, obscene, unlawful or otherwise objectionable, then you agree promptly after receipt of such notice to take all commercially reasonable efforts to prevent further access to the applicable Materials by Users.

5. Fees. You agree to pay to the AAP the current subscription fee detailed at enrollment or otherwise provided on the Website, including the then-current fee during any renewal term. The AAP reserves the right, without prior notice, to suspend your use of the Materials if owed fees are past due.

6. Term and Termination.

(a) The initial term (“Term”) of this Agreement will be for the period corresponding to the subscription fee that you have paid. The Term will automatically extend for additional renewal periods for which you subsequently pay the then-current subscription fee. This Agreement and your and your Users’ right to access and use the Materials will automatically expire at the end of the Term.

(b) The AAP may terminate this Agreement by giving notice to you if you or one of your Users materially breaches any provision of this Agreement.

(c) Upon termination of the License for any reason, you and your Users shall immediately cease all further use and distribution of the Materials. The following rights and obligations shall survive any termination: (a) any obligation that matured prior to the effective date of the termination or expiration; and (b) Sections 7(b), 8, 9, 10 and 11.

7. Trademarks and Approvals.

(a) You are authorized to use the AAP’s trademarks, logos and brand names (the “AAP Trademarks”) only in connection with reproducing any such AAP Trademarks as incorporated in the Materials. You may not make any other uses of the AAP Trademarks, including uses in promotional and marketing materials, advertising, and web pages, without the AAP’s prior written approval, to be granted in the AAP’s sole discretion. You agree not to distribute, display or publish any such materials without such approval.

(b) You acknowledge that the AAP is the sole and exclusive owner of the AAP Trademarks and that any use by you shall inure solely to the benefit of the AAP. Upon termination of this Agreement for any reason, you agree to cease use of the AAP Trademarks.

8. Proprietary Rights.

(a) As between you and the AAP, title to and ownership of the Materials and all materials and data provided by the AAP in connection with this Agreement, any materials or other derivative work based on or derived therefrom or improvements thereto, and all copyrights and associated intellectual property rights, will belong to the AAP. To the extent that any such items are not deemed a work-made-for-hire or you otherwise retain rights therein, you agree to and hereby grant, assign and convey to the AAP all of your right, title and interest, if any, in such items and in all patents, copyrights and other intellectual property rights therein. You agree to cooperate fully with the AAP for the purpose of securing, reserving and protecting the AAP’s rights in such items, including executing any documents requested by the AAP. The only rights to the Materials granted to you are the rights to use the Materials in accordance with the License and all rights not specifically granted herein are reserved by the AAP.

(b) You acknowledge and agree that at all times the Materials, including any portion or alteration of the Materials and any derivative work based on the Materials, shall belong to the AAP and may only be used in accordance with the terms of this Agreement.

9. Disclaimer of Warranties.

(a) Although the AAP believes the information in the Materials to be accurate and timely, because of rapid advances in the field of pediatrics medicine and our reliance on information provided by outside sources, the AAP and its Providers make no warranty or guarantee concerning the content of the Materials, including the accuracy or reliability of the content in the Materials, or on other sites to which we link. When clinical matters are discussed, the opinions presented are those of the discussants only. The material discussed in the Materials is not intended to present the only or necessarily the best pediatric method or procedure, but rather presents the approach or opinion of the discussant. You acknowledge that the recommendations and information in the Materials do not indicate an exclusive course of treatment or serve as a standard of medical care. You and your Users assume full responsibility for the appropriate use of medical information contained in the Materials, and you agree to hold the AAP and its Providers harmless from any and all claims or actions arising from you or your Users’ use of the Materials in accordance with Section 10(e).

(b) THE MATERIALS AND WEBSITE AND THE INFORMATION, SOFTWARE, AND OTHER MATERIAL AVAILABLE ON OR ACCESSIBLE THEREFROM ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO REPRESENTATIONS OR WARRANTIES REGARDING TITLE, NONINFRINGEMENT, ACCURACY, TIMELINESS OR COMPLETENESS OF THE INFORMATION CONTAINED IN THE MATERIALS, OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE, ALL OF WHICH THE AAP AND ITS PROVIDERS DISCLAIM. If implied warranties may not be disclaimed under applicable law, then ANY IMPLIED WARRANTIES ARE LIMITED IN DURATION TO A PERIOD OF SIXTY (60) DAYS FROM THE DATE THE MATERIALS ARE FIRST ACCESSED BY YOU. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. This warranty gives you specific legal rights, and you may also have other rights which vary from state to state.

10. Limitation of Liability and Damages.

(a) The AAP shall indemnify, defend and hold you, and your affiliates, and Users harmless from and against any loss, damage, costs, liability and expenses (including reasonable attorney fees) arising out of any legal action taken against such entities claiming that the Materials used as contemplated by this Agreement infringe the U.S. copyright or any other U.S. proprietary or intellectual property rights of any person. The AAP shall have no obligation under this Section for any such claims, actions or losses which are based upon: (i) you or your Users’ use of the Materials in a combination with materials or products not supplied by the AAP which violate the rights of third parties, (ii) the modification of the Materials or the use or distribution of such modified content, or (iii) use of the Materials in a manner other than that permitted herein.

(b) UNDER NO CIRCUMSTANCES SHALL THE AAP OR ITS PROVIDERS BE LIABLE TO YOUR OR ANY AUTHORIZED USER OR OTHER PERSON FOR ANY DIRECT, INDIRECT, CONSEQUENTIAL, INCIDENTAL, SPECIAL EXEMPLARY, PUNITIVE OR OTHER DAMAGES (INCLUDING WITHOUT LIMITATION LOSS OF PROFITS, PERSONAL INJURY/WRONGFUL DEATH OR DAMAGES RESULTING FROM LOST DATA OR BUSINESS INTERRUPTION), ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT OR THE USE OR INABILITY TO USE THE MATERIALS OR WEBSITE, YOUR RELIANCE ON OR USE OF THE INFORMATION PROVIDED IN THE MATERIALS, OR THAT RESULT FROM MISTAKES, OMISSIONS, INTERRUPTIONS, DELETION OF FILES, ERRORS, DEFECTS, DELAYS IN OPERATION OR TRANSMISSION, OR ANY FAILURE OF PERFORMANCE, WHETHER BASED ON WARRANTY, CONTRACT, TORT, OR ANY OTHER LEGAL THEORY, AND REGARDLESS OF WHETHER THE AAP OR ITS PROVIDERS OR AGENTS KNOWS OR HAS REASON TO KNOW OF THE POSSIBILITY OF SUCH DAMAGES.

(c) IN NO EVENT SHALL THE AAP OR ITS PROVIDERS BE LIABLE TO ANY PARTY FOR ANY ADVERSE CONSEQUENCES ARISING FROM INDEPENDENT APPLICATION OF THE CONTENT OF THE MATERIALS TO PARTICULAR CIRCUMSTANCES NOR FOR YOUR OR YOUR USERS’ RELIANCE ON THE WEBSITE OR MATERIALS FOR ANY PURPOSE.

(d) EXCEPT FOR CLAIMS BROUGHT PURSUANT TO SECTION 10(a), THE AAP’S AND ITS PROVIDERS’ LIABILITY (WHETHER IN CONTRACT, TORT, NEGLIGENCE, STRICT LIABILITY IN TORT OR BY STATUTE OR OTHERWISE) TO YOU OR TO ANY THIRD PARTY FOR ANY AND ALL CLAIMS RELATED TO OR ARISING OUT OF THIS AGREEMENT OR THE MATERIALS, SHALL NOT IN THE AGGREGATE EXCEED THE FEES PAID BY YOU HEREUNDER IN THE TWELVE (12) MONTHS PRIOR TO THE OCCURRENCE GIVING RISE TO THE CLAIM.

(e) Except as to those matters for which the AAP is obligated to indemnify you under Section 10(a), you agree to indemnify, defend and hold the AAP and its Providers and agents harmless from and against any loss, damage, costs, liability and expenses (including reasonable attorney fees) arising out of your or your Users’ use of the Materials, including any claim or legal action taken against the AAP or its Providers or agents related to or in any way connected with (i) any use of the Materials by Users or (ii) any failure by you to perform your obligations in relation to this Agreement.

(f) Certain portions of the Website or Materials may contain information or content provided by Mead Johnson & Company for use in connection with the Website as a sponsor of the Website (“Mead Johnson Content”). With the sole exception of Mead Johnson Content, Mead Johnson & Company is not the author of, nor responsible for, the content of the Website or Materials. You agree that Mead Johnson & Company’s liability and obligations are limited as a Provider in accordance with the terms of this Agreement, including Sections 9 and 10 herein.

(g) Certain portions of the Website or Materials may contain medical reference information or database content provided by Lexi-Comp, Inc. for use in connection with the Website (“Lexi-Comp Content”). You agree that Lexi-Comp, Inc.’s liability and obligations are limited as a Provider in accordance with the terms of this Agreement, including Sections 9 and 10 herein. The Lexi-Comp Content is intended to serve the user as a rapidly accessible, concise initial reference resource and not as a complete reference resource. It does not include information concerning every therapeutic agent, laboratory or diagnostic test or procedure available. The Lexi-Comp Content is clinically oriented and is intended to be used only by Users who are: (1) researchers who will not use the information for medical diagnosis or treatment, and (2) physicians and other competent healthcare professionals who will rely on their own discretion and judgment in medical diagnosis and treatment. Neither the AAP nor its Providers directly or indirectly practice medicine or dispense medical services and, as such, assume no liability for data contained in the Lexi-Comp Content. You and your Users assume full responsibility for the appropriate use of medical information contained in the Lexi-Comp Content, and you agree to hold the AAP and its Providers harmless from any and all claims or actions arising from your or your Users’ use of the Lexi-Comp Content.

11. General .

(a) Force Majeure. Except for your obligations hereunder to pay the AAP, neither party shall be responsible for delays or failures in performance resulting from acts or circumstances beyond the control of such party, including, without limitation, acts of God, strikes or other labor disputes, riots, acts of war, malfunction of portions of the Internet or another third party network, governmental regulations promulgated after the effective date of this Agreement, communication line failures, power failures, equipment failures, fires or other disasters, and acts of third parties including hackers and crackers.

(b) Changes to this Agreement. The AAP reserves the right to change or modify this Agreement at any time by presenting you with a new set of terms before you access the Materials. Following your agreement to such modified Agreement, this Agreement shall be of no further effect and the modified agreement shall control. In the event you refuse to agree to any such new agreement, the AAP will, if requested, refund any unearned portion of your subscription fee.

(c) Political Activities. The AAP is a Section 501(c)(3), not-for-profit corporation, and as such, does not participate in any political activities. You are prohibited from participating in political activities while using the Materials or the Website.

(d) Governing Laws and Venue. This Agreement will be governed by the laws of the State of Illinois applicable to contracts made and to be performed in that state. The parties hereby submit to the exclusive jurisdiction of the federal and state courts located in Cook County, Illinois, U.S.A. to resolve disputes related to this Agreement or the Materials.

(e) Waiver and Severability. A waiver of any breach or default under this Agreement shall not constitute a waiver of any other right arising out of any subsequent breach or default. Either party's failure to enforce any term of this Agreement shall not constitute a waiver of any rights to enforce subsequent breaches. If any term of this Agreement is held to be invalid, the parties agree that such invalidity will not affect the remaining terms.

(f) Notice. Any notice required under this Agreement shall be in writing and sent to the other party’s address shown on the Website or provided during enrollment, or such other address as may be provided by each party from time-to-time. Notices shall be effective when received.

(g) Assignment. Neither party may assign this Agreement to any third party without the prior written consent of the other party.

(h) Entire Agreement. This Agreement and any attachments represent the entire agreement between the parties and supersede any previous contemporaneous oral or written agreements, commitments, representations or communications regarding the subject matter of this Agreement. Any modification to this Agreement must be in writing and signed by a duly authorized agent of both parties. Signed facsimile copies of this Agreement, and attachments will legally bind the parties to the same extent as original documents.

(i) Privacy and Compliance with Law. Each party shall comply with all applicable laws and regulations in exercising its rights and performing its obligations hereunder. Collection and use of personal information in connection with the Website is subject to the AAP’s privacy policy posted on such Website. Despite any representations concerning privacy, the AAP reserves the right to disclose without notice to you any information in our possession if required to do so by law or upon a good-faith belief that such action is necessary to comply with the law, to protect or defend our rights or property, or to respond to an emergency situation.

By clicking on the “I AGREE” button below, (1) YOU AGREE TO ALL OF THE TERMS OF THIS AGREEMENT, (2) YOU ARE CONSENTING TO ENTER INTO THIS AGREEMENT IN ELECTRONIC FORM AND (3) YOUR CLICK SHALL CONSTITUTE YOUR ELECTRONIC SIGNATURE ACCEPTING THIS AGREEMENT. Any person accepting this Agreement on behalf of another entity further represents and warrants that such individual is a duly authorized representative, having the power and authority to bind such entity to this Agreement. If you do not wish to be bound by these terms, you may not access or use the Materials - in such event you should click the “I Do Not Agree” button below and follow the instructions to obtain a refund of any subscription fees paid by you.

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