The "best" safety seat is the one that fits your child, fits your car, and fits your family's needs in terms of comfort and convenience, so that you'll use it on every single ride.

A child restraint is a crash tested safety device that is designed for infants and children to protect them in a motor vehicle crash. All approved child restraints meet Federal Motor Vehicle Standard 213. Child restraints are commonly referred to as car seats and booster seats.

Babies have heavy heads and fragile necks. The neck bones are soft, and the ligaments are stretchy. If the baby is facing forward in a frontal crash (the most common and most severe type of crash), the body is held back by the straps, but the head is not. The head is thrust forward, stretching the neck. Older children and adults wearing safety belts may end up with temporary neck injuries. But a baby's neck bones are soft and actually separate during a crash, and the spinal cord can tear. It's like yanking an electrical plug out of a socket by the cord and breaking the wires. In contrast, when a baby rides facing rearward, the whole body--head, neck, and torso--is cradled by the back of the safety seat in a frontal crash. Facing rearward also protects the baby better in other types of crashes, particularly side impacts. In a crash, an infant's spinal cord may stretch if she is riding facing forward, and the baby could die or be paralyzed for life. This is true even for babies who have strong neck muscles and good head control. Do not use an infant-only seat if your baby's weight is over the maximum (20-22 pounds) or if her head is within an inch of the top edge of the seat.  A convertible seat can be used so the baby or toddler can continue to face the rear up to 30 – 35 pounds. (Check the owner’s manual to be sure of the weight range).

Can I put my child in the front of a single cab pickup truck? This question is one that has been resounding on the 888-VMT-SEAT hotline over the last few weeks. Here is what we recommend:

If you have the ability to use another vehicle to transport your child in a back seat; do it. It’s a 53% safer for kids to be in the back seat (see our FAQ titled When can my child sit in the front seat? for more)

If you MUST use the pickup, here’s how to do it safely:

Rear Facing – You MUST turn off the airbag. If you are unable to turn off the airbag, the child may not legally ride in that vehicle. Push the vehicle seat back from the dash as far as you are able, and then install the seat.

Forward Facing – Push the vehicle seat back from the dash as far as possible. Install the car seat. Pickup trucks can have tricky installs. If you have trouble, contact us at 888-VMT-SEAT for help. You can also look up our fitting station list on this website to find a fitting station near you.

Keep your child in a forward facing seat until at least 40 pounds and 40 inches.  Children who are very large may not be ready to move into booster seats at a young age and may need to be harnessed until they mature.  Look for seats that can be harnessed up 50 – 60 – 85 or even 100 pounds.  Labels on the seat and in the instructions will tell you the upper weight limits.

• Never put a rear-facing safety seat in front of a passenger air bag.
• Restrain children in the rear seat, especially if the vehicle has a passenger air bag.
• Check the car’s owner manual and the car set instructions for proper installation of the belts or LATCH
• Strap placement:
  • Rear facing - in the slots at or below the child's shoulders
  • Forward facing –in the slots at or above the child's shoulders
• The harness should be tight enough that the webbing cannot be pinched between your fingers at the shoulder.
• The retainer or chest clip should be at armpit level.
• Use a top tether with forward-facing safety seats, attached to a designated tether anchor. This can reduce the forward-motion of the child's head in a crash by several crucial inches.
• Install the safety seat so that it moves no more than an inch to the front or sideways in the vehicle.
• Put any blankets or coats on top of the harness.

At around 4 years old and 40 pounds and 40 inches a child will be ready for a booster seat.

Place the booster in the back seat of the vehicle equipped with a lap AND a shoulder belt. When your child sits in the booster seat, his/her hips should be flat against the back of the seat and if he is using a high-back booster seat, his/her shoulders must also be flat against the seat back. The lap belt should be across the top of the thighs, at the joint of the legs, and the shoulder belt should fit across the center of the shoulder and the child's chest. If needed, thread the shoulder belt through the "guide" on the side of the seat to move the belt away from the face or throat. To prevent whiplash, it is important that the top of his/her ears is not higher than the booster seat or the vehicle seat back.

High-back booster seats have a back that protects your child against whiplash in cars with low seat backs and provide side impact protection. They can be used in cars with or without headrests on the vehicle seats.

No-back or backless booster seats work in the same way as high-back booster seats but no-back booster seats must be used with vehicle seats that have headrests. To protect against whiplash, the headrest should be above your child's ears when he/she is sitting in the booster seat.

Both types of seats are effective at protecting children in car crashes. Remember, the lap and shoulder seat belt must be used with both types of seats.

We need to understand two things before this question can be answered; the statistical danger of the front passenger seat, and bone hardness.

Statistical danger:
The front passenger seat is THE most dangerous position in the car. In Vermont, risk is increased by placing a child in the front passenger seat by 47%. This data was obtained from the Vermont State Police, Child Occupant Safety Report, All Vermont injury or fatal crashes involving occupants 13 years of age or younger, Sally Tarabah, Crash Data Analyst, Vermont State Police, July 21, 2011

Bone hardness:
Babies start off with very soft bones. Due to their fast growth, children’s bones remain soft until they begin to approach their full skeletal growth. This is typically during puberty. At that time, ossification, or hardening of the bones, happens. This hardening of the bones allows for the child to begin to withstand the airbag explosion. Before ossification, children who sit in the front seat during a crash have an unfortunate tendency to break bones and have serious crush injuries, typically to the head and neck. These injuries are not always survivable. As a parallel topic, younger kids tend to play with controls and can easily be out of good belt positioning in the front seat – this also leads to the same type of serious head and neck injury.

Understanding this, and knowing that the front passenger seat is the most dangerous position in the car, the national recommendation for children is to stay in the back seat until they are at least 13, when puberty typically starts. Additionally, there is a national movement to change this recommendation to “when kids learn to drive”.

Try the 5 Step Test with your child. If he or you answer no to any these questions, your child still needs to ride in a booster seat.

1. Does the child sit all the way back against the auto seat?
2. Do the child's knees bend comfortably at the edge of the auto seat?
3. Does the belt cross the shoulder between the neck and arm?
4. Is the lap belt as low as possible, touching the thighs?
5. Can the child stay seated like this for the whole trip?

Vehicle seats and seat belts are designed for adult-sized bodies that are at least 4'9" tall. When you put your child in a seat belt too soon the following can happen:

• The lap belt can ride up above the pelvis (hip bone) onto the abdomen (tummy). When this happens, the internal organs can be damaged in a crash. This is called "seat belt syndrome". In some cases, the spinal cord can be damaged and the child can become paralyzed. This link is a graphic picture of what happens in a crash to a child who graduates to the seat belt too soon. http://sacredjourneys.webs.com/apps/photos/photo?photoid=16778480
• The shoulder belt crosses the face and neck and can bother the child. Because of this, children sometimes place the shoulder belt behind the back or under the arm. This leaves him with no protection for the upper body. In a crash, this can cause broken ribs and internal organ injuries. Both of these scenarios result in spine and head injury.

Booster seats protect against serious injury three and one half times better than seat belts. Booster seats protect against head injury four times better than seat belts.

The price of a booster seat varies, but the retail price typically ranges from $15-$125. You may visit the American Academy of Pediatrics' "2011 Family Shopping Guide to Car Seats" for specifics. The cost of a booster seat is far less than the cost of a visit to the doctor, the emergency room, or a spinal injury

Booster seats can be purchased at most discount chain stores and children's specialty stores. Web sites that specialize in baby products and catalogs also carry booster seats. Vermont Fitting Stations offer seats at a discounted price but you must bring your child with you to make a purchase. For information about Fitting Station locations go here or call 1-888-VMT-SEAT.

There are a number of wider boosters on the market today. Contact us at 888-VMT-SEAT for assistance.

Parents, health care providers and others can learn more about protecting children with special needs by calling 1-888-VMT-SEAT for help. You can also visit www.preventinjury.org for more information.

No, two people should never use one vehicle seat belt! In a crash, two people sharing one seat belt will collide violently. Buckling two persons into one seat belt could cause serious injury or even death and it is against the law.

No. Regardless of how these products are labeled, they do not meet any government safety standard. They may help with shoulder belt comfort, but may put too much slack in the shoulder belt or cause the lap belt to ride up over the stomach.

The Vermont Governor's Highway Safety Program has a toll free hotline which answers questions about choosing and using child car seats; car seat recalls, and safety seat technician locations. In Vermont, call 1-888-VMT-SEAT (868-7328) or go here.

A car seat is meant to protect a child during a crash; it is not a seat for inside the house, a crib, or a seat for using in the store.

Car seats are meant to be used in the car, not outside of it. When they are outside, they do not have the same angle as they do in the car. Due to the change in angle, babies can lose their airway and stop breathing.

Other significant dangers include falling out of the cart and head injury. Please visit the following links for more on this:

• Journal of the American Academy of Pediatrics
• Healthy Living - Your Daily Dose
• It's A Parent - The Use and Misuse of Car Seats
• Cincinnati Children's - Change the Outcome

Pediatricians are experts in medicine. They're not experts in car seats. The Child Passenger Safety Technician is an expert in car seats. "A common misperception among health professionals as well as many caregivers is that sitting up will help reduce an infant's reflux (spitting up). According to Dr. Susan Aronson with the Pennsylvania Chapter of the American Academy of Pediatrics, there is a lack of evidence to support this widely held belief, and a recent study actually showed that sitting in an infant seat is worse for reflux than lying flat." 1

Dr. Marilyn Bull, of Riley Hospital for Children in Indiana speaks of putting a child in an infant seat as one of the worst ways to treat reflux. The body mechanics of a child in an infant seat compresses and puts pressure on the GI tract making reflux worse. She suggests sleep wedges to keep the head elevated; these allow the child's body to remain straight and for the abdominal cavity to expand to its full capacity. 2

There is also the airway issue. (See above)

1 Safe Infant Sleep Positioning; Prepared by ND Child Care Resource & Referral Health Consultant Team

2 www.preventinjury.org (This is the website for Dr. Bull's automotive safety program; not a specific reference. The reference is a paraphrase from several lectures on transporting children with special medical needs given in the summer of 2010 in Burlington VT.)

Car seat manufacturers warrant their seat will work as they designed it, with the products they crash tested it with. When you change how a seat works by putting in a bunting or strap cover (adding in a piece that puts something between the baby and the harness), you change the crash dynamics of the seat. A very small change by you can make the car seat work very differently in a crash. The manufacturer only will give you a warrantee if you use it exactly as designed. Adding on stuff voids your warrantee.

Go here for pictures of why.

Companies are allowed to sell products, with great advertising like "crash tested" because it's non-regulated. There are no laws, regulations or rules that address sale and use of these items. None of the relevant Federal Motor Vehicle Safety Standards address add-on products. A person could cut out a round piece of wood, paint it grey and sell it at auction, calling it a rock, saying it passed and exceeded all regulations regarding rocks, because there are none. He would not be breaking any laws, just as these non-regulated product manufacturers are not. It's not illegal to do, so companies sell this stuff – they want to make money.

On the flip side of the coin, the consumer needs to understand what the manufacturer of the seat allows. We live in a free market society. Buyer beware. Using a non-regulated product will void the warrantee of a car seat.

We cannot recommend that you use it. Buntings are non-regulated products and their use changes the harness routing on the car seat. They also put a compressible substance between the baby and the shell of the seat, potentially causing ejection from the seat.

Again, non-regulated products void the warrantee on your car seat.

Go here for a visual on what all of this looks like.

A better solution would be a shower cap or boat cover, which is a non-regulated product that has elastic around the edge and covers the entire top of the car seat –these do not come with the seat, but at least do not interfere with the harness. Blankets are also acceptable, so long as they are not between the baby and the harness. A jacket, put on backwards, after the harness has been fastened is good too.