More often than not, we hear about the number of deaths and injuries caused by the misuse of child safety seats. Childcare providers need to become aware of the importance of properly restraining the children in their care. Motor vehicle crashes remain the primary killer of young children and their families.

Consider the following facts:

• Approximately 80 percent of child safety seats on the road today are used incorrectly in one or more ways, according to the National Highway Traffic Safety Administration (NHTSA).
• Of the 600 children under age five who die each year in crashes, 50 percent were not restrained at all, and 26 percent were using adult safety belts.
• When used correctly, child safety seats are 71 percent effective in reducing fatalities among children under age five.
• Children are 30 percent more likely to survive a car crash when they are sitting in the back seat rather than the front.

What issues should childcare providers be aware of and how can they incorporate them into their policies and programs? The following is a listing of some important guidelines developed by the American Academy of Pediatrics (AAP) Committee on Injury and Poison Prevention that childcare providers can use when developing transportation arrangements for facilities, centers, or family care homes.

The guidelines below are not an exclusive course of treatment or an absolute measure of security, as the size and physical make-up of young children varies. Consult a pediatrician with any questions you may have regarding the application of these guidelines to individual children or call the NHTSA Auto Safety Hotline at 800-424-9393 for more information.

Children should face the rear of the vehicle until they are at least 20 pounds AND one year old. Infants who weigh 20 pounds before age one should ride facing the rear in a convertible seat or infant seat approved for higher weights until one year of age.

A rear-facing car safety seat must NEVER be placed in the front passenger seat of any vehicle equipped with a passenger side air bag. Premature and small infants should not be placed in child safety seats with shields, abdominal pads, or arm rests that could come into direct contact with the infant's face and neck during a collision.

In rear-facing car safety seats for infants, shoulder straps must be in the lowest slots until the infant's shoulders are above the slots. The harness should be snug, and the car safety seat retainer clip should be positioned at the midpoint of the infant's chest, not at the abdomen or the neck.

If the vehicle seat slopes so that the infant's head flops forward, the car safety seat should be reclined back at a 45 degree tilt. A firm roll of cloth or newspaper can be wedged under the car safety seat below the infant's feet to achieve this angle.

A convertible child safety seat, which is positioned in a reclining and rear-facing position for a child until one year of age and 20 pounds, and semi-upright and forward-facing for a child older than one year of age who weighs 20-40 pounds, should be used as long as the child fits well. Ears should be below the top of the back of the seat and shoulders should be below the seat strap slots.

A booster seat should be used when the child has outgrown a convertible safety seat but is too small to fit properly in a vehicle safety belt. Children should be in booster seats until they weigh at least 60 pounds.

When the vehicle safety belt fits properly, the lap belt lies low and tight across the child's hips (not the abdomen) and the shoulder belt lies flat across the shoulder, away from the neck and face.

There are two types of booster seats. When a combination lap/shoulder belt is available, a booster seat that can be used with this type of belt is preferable to a booster seat with a small shield, which can be used when only a lap belt is available. A booster seat with a small shield should not be used for a child who weighs less than 40 pounds.

Many new vehicles are equipped with integrated child safety seats designed for children who weigh at least 20 pounds and are at least one year of age. All infants younger than one year of age or who weigh less than 20 pounds should be positioned facing the rear in separate child safety seats.

Instruct parents to read the vehicle owner's manual and child restraint device instructions carefully and to test the car safety seat for a safe, snug fit in the vehicle to avoid potentially life-threatening incompatibility problems between the design of the car safety seat, vehicle seat, and seat belt system.

Advise parents that the rear vehicle seat is the safest place for a child of any age to ride.

Through the Healthy Child Care America campaign, in partnership with the U.S. Department of Health and Human Services Child Care Bureau, the Maternal and Child Health Bureau, and the National Highway Traffic Safety Administration, the American Academy of Pediatrics will help childcare providers understand child passenger safety guidelines and implement child passenger safety procedures for the children in their care by coordinating educational training sessions for childcare providers.

One-and-a-half-day sessions will be held in California, Connecticut, Washington, DC, Florida, Georgia, Illinois, Kansas, Ohio, Oregon, and Washington. For more information, contact the American Academy of Pediatrics at 800/433-9016, ext. 4902. The American Academy of Pediatrics also has appointed pediatricians in each state who can assist in identifying physicians and others active in child passenger safety initiatives. To identify a contact person in your state, or for information on activities of the AAP Committee on Injury Prevention, contact the American Academy of Pediatrics at 800-433-9016, ext 4979.