• Many crashes damage only the vehicle. As the driver and passenger are safely restrained by the seat belt, they are not thrown forward or ejected out of the vehicle.
  
• Even at slow speeds, the forces on the body arising from the change in momentum can be severe and result in injury.
• An adult seat belt will not restrain a young child and so will not adequately protect their developing body, particularly their head and neck.

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• Anatomical and physiological differences mean that children are less able to cope with the stress of a collision than adults. For instance:
  
  • Children have a heavier and larger head in proportion to the rest of their body size compared to adults.
    
  • The head accounts for 25% of a baby's total body mass, compared to about 6% in adults.
  • The weaker neck structure of babies and young children, reduces resistance to loads in the neck compared to older children and adults.
  
  

Children have a heavier and larger head in proportion to the rest of their body size compared to adults

• In adults, the iliac crest at the top of the hips hold the belt in position.  A young child's pelvic development is insufficient to keep the lap belt in position.
  
• Young children need crotch straps or a booster seat this is shaped specifically to keep the belt in the correct position.
• For toddlers and older children, a child car seat harness (or the adult seat belt in a booster seat) passes over the shoulder girdle, rib cage and pelvis to distribute the energy across as wide an area as possible over both sides of the body.  A five-point harness ensures the optimal load distribution.

In adults, the iliac crests hold the belt in position; a younger child’s pelvic development is insufficient to keep the lap belt in position

• Two regulations - United Nations (UN) regulations R44 and R129 (the latter also referred to as i-Size) - apply to car seats in the UK.  These currently run side by side.  R44 will, however, be slowly phased out; in the meantime, both regulations meet legal standards.
• The i-Size seats are tested for side impact protection.
• Parents can choose the car seat based on weight (R44) or height (R129 'i-Size').
• Parents need to change the seat before the child exceeds the upper weight or height limit shown on the orange sticker found on the seat.

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i-Size seats are tested for side impact protection

• Rear-facing seats are safer for the neck if there is a frontal collision, which is the most common place of impact, than front-facing seats.
• According to the new European-wide standard for child car seats R129, babies must be placed in a rear-facing baby seat for at least 15 months.  A child between 71 cm and 83 cm tall and over 15 months old can be carried rear- or forward- facing, although it is best to keep children facing the rear for as long as possible.
  
• Most R44 rear-facing seats will be classified as a group 0+ seat and will have a weight limit of 13 kg.  Children in i-Size seats must face the rear for at least 15 months.  In some parts of Europe, especially Scandinavia, children often face the rear until they are 18 kg.
  

Rear-facing seats are safer for the neck if there is a frontal collision

• The child's car seat should be fitted exactly as described in the manufacturer's instructions.  This usually involves using a lap and diagonal seat belt or the vehicle's ISOFIX anchorage points.
  
• ISOFIX is the international standard that defines the attachment points to be manufactured into cars, enabling compliant child safety seats to be quickly and safely secured.
  
• ISOFIX is an alternative to securing the seat with seat belts.  Seats are secured with a single attachment at the top, known as a top tether, and two attachment points between the back of the car seat and the seat cushion. Top tether points became mandatory in all vehicle models in 2013.

ISOFIX seats are secured with a single attachment at the top, known as a top tether (shown above), and two attachment points between the back of the car seat and the seat cushion

• Some ISOFIX seats use a support leg instead of the top tether.  The leg extends to the floor of the vehicle and prevents the seat from tipping forward.
  
• Most cars with underfloor compartments are not suitable for use with a seat that has a support leg.  Parents and carers should always check for compatibility before buying and using an ISOFIX seat.
  
• Midwives and health visitors can suggest that parents contact the car seat or car manufacturer to ensure the seat is compatible with their car.  RoSPA has a compatibility guide on their website.

Some ISOFIX seats use a support leg

• Why should I switch the air bag off?
  
  • Front air bags must be deactivated before fitting a rear-facing car seat in a front seat, which could crush and suffocate a baby.
    
  • i-Size seats have a side protection feature, which should be used on the side of the car seat nearest the car window according to the manufacturer's instructions.
    
  • Side air bags aim to protect the head and are not as powerful as the front ones.  They should not pose a risk to a child in a child seat in the rear.  Indeed, the side air bags could protect the child in their seat.
    

• Until what age should a child travel facing the rear?
  
  • Height-based seats (R129 i-Size seats) must be rear-facing until the child is at least 15 months of age.
  • For weight-based seats, the maximum size depends on the weight limit for the seat - usually 13 kg.
    
  • Some parents choose to keep the child rear-facing for longer in seats that are certified for greater weights.
    

   

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Front air bags must be deactivated before fitting a rear-facing car seat in a front seat

• Can children be left to sleep in a car seat?
  
  • Child car seats are not intended to be places for babies to sleep when not travelling.  Parents and carers should move the baby to a Moses basket, crib or cot as soon as possible.

• How can parents and carers check that an ISOFIX seat is correctly installed?
  
  • After checking that the ISOFIX seat is approved for the car, parents and carers should follow the seat manufacturer's instructions.
    
  • Parents and carers can find the ISOFIX anchorage points by checking the car's handbook and by the ISOFIX label on the rear seats.
    
  • The two prongs sticking out of the back or base of the child seat are pushed into the ISOFIX anchorage points in the car seat.
  • The car seat will 'click' or have a visible indicator showing that the child seat has been securely attached.
  • The top tether strap is attached to the third ISOFIX point in the car and not to a head restrautnr or luggage hook.
  • If the child seat has a supporting leg, this should be braced against the floor.

   

The two prongs sticking out of the back or base of the child seat are pushed into the ISOFIX anchorage points in the car seat

• How can parents and carers check that their baby or toddler is correctly harnessed?
  
  • The harness straps should be just below the shoulders for rear-facing seats and just above the shoulders for forward-facing seats.  In addition to ensuring the harness offers the best protection, this position is the most comfortable for the child.
  • The harness should not be twisted as this will absorb less energy and also be uncomfortable.
  • Any chest pads should be level and the straps should be tight against the body.  Parents and carers should only be able to slip two fingers flat between the straps and child's chest or collar bones.
  • Thick clothing, which should be avoided when travelling in car seats, can prevent the harness from fitting properly close to the child's body.

• When should the child move to the next stage of seat?
  • Children should be moved to the next stage seat just before they exceed the upper height or weight.

Car seat design takes the child’s rapid development into account

• How can parents and carers stop children releasing the belts or harnesses?
  
  • RoSPA do not recommend buckle guards that are placed over the seat belt or car seat buckle to prevent children from releasing themselves.  Buckle guards may reduce the effectiveness of the seat belt or harness and could be difficult to undo in an emergency.
    
  • As soon as possible, children should know that their harness keeps them safe and that parents and carers wear a belt.
    
  • Parents and carers could make the process of 'doing up the belt' into a chant or song and should not start the engine until they are sure that the child is secure and that they will not take the child with them if their harness is not done up.
  • Ideally, an adult should sit with the child in the backseat.  If the child releases the harness during the journey, parents and carers should pull over as soon as it is safe to do so.
  • Provided the driver is not distracted, word games, songs, toys or games may reduce the child's temptation to fiddle with the harness through boredom.

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Word games, songs, toys or games may reduce the child’s temptation to fiddle with the harness through boredom

• Should I buy a second-hand car seat?
  • Midwives and health visitors should advise parents and carers against buying second-hand car seats. It is often impossible to tell by visual inspection if a second-hand car seat has been damaged in an accident or by being dropped.
  • Parents and carers should try the seat in their car before they buy it or check that the seat can be returned if unsuitable.
  • Parents and carers should make sure the seat can be fitted exactly to the manufacturer's instructions and is secure.  A seat that wobbles is either wrongly fitted or unsuitable for the car.

• Should I choose a seat that is secured by the car's seat belt or ISOFIX?
  
  • Using ISOFIX reduces the likelihood of incorrect fitting and incompatibility.  A car seat can be securely fixed with seat belts if the manufacturer's instructions are correctly followed.

Correctly fitted ISOFIX seat

• Is it legal to use a booster cushion?
  
  • It is always better to use a high-backed booster seat rather than a booster cushion without a back.  A high-backed booster seat provides more protection around the child's head and neck.
    
  • New regulations regarding the sale and use of booster cushions became effective in March 2017.  Manufacturers are no longer allowed to introduce new models of backless booster seats (booster cushions) for children shorter than 125 cm and weighing less than 22 kg.
    
  • The new regulations apply only to new booster cushions manufactured to the revised legislation.  Booster cushions already in use meet existing safety standards.  Parents who use old booster cushions will not be breaking the law if they continue to use them after the rule changes.
    

A high-backed booster seat provides more protection around the child’s head and neck

• Can car seats from the USA be used in the UK?
  • Child seats from the USA are approved according to the US standard FMVSS 230.  In Europe, child seats must conform to the European safety standards ECE R44/04 or ECE R129.  Parents in the UK should choose car seats that conform to the European standards.

• Can car seats be used on aeroplanes?
  
  • Some car seats are approved for aircraft use.  Parents can check the label on car seats, which will certify suitability for airline use, and should contact the car seat manufacturer.  Some seats, although approved, can be subject to airline regulations and additional accessory kits might be required.  Parents should always check with their airline before travelling.

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Some car seats are approved for aircraft use, but parents should always check with their airline before travelling