Motor vehicle accidents are the leading cause of death and injury for children
in the United States, yet a recent survey found that most parents do not
have children in the proper car seat. Car seat laws can vary from state
to state, but the American Academy of Pediatrics has based its car seat
guidelines on the available evidence to date. Here is a quick guide to
car seat safety for parents, grandparents and caregivers to ensure children
are well-protected and safe:
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Infants: Infants should be in a rear facing car seat that fits their height and
weight. All infant car seats are rear facing only. Straps should be at
or below the level of the shoulders and the chest clip should be over
the sternum. It is easiest to place your fingers just at the infant’s
armpits and position the clip at the same level. Infants should be transitioned
to a convertible rear facing car seat when they outgrow their infant seat.
Most will outgrow the infant seat by length instead of weight which is
usually when they are 9-12 months old. The maximum length and weight for
the seat is provided in the instruction manual, as well as on the side
of the car seat itself. Placing the infant seat in the middle of the rear
seat is the safest location.
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Transition to forward facing: Children should remain rear facing as long as possible. Toddlers are less
likely to be seriously injured in a crash when secured in a rear facing
car seat due to superior head and neck support. Only transition your child
to the forward facing position when they reach the maximum rear facing
weight limit which is generally between 35-45 pounds, depending on the
car seat model as per the manufacturer.
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Forward facing: Children should remain in a five-point harness until they are about to
exceed the height/weight limits set by the car seat manufacturer. Usually
you can tell it’s time if the straps are at the highest position
and the top of the shoulder straps start to dip below the level of the
child’s shoulders. Children often will fall asleep when riding in
the car and the five-point harness will hold them more securely than a booster.
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Booster seat: Children should transition to a belt positioning booster seat, and remain
in one until they are between the ages of 8-12 years
AND 4 feet 9 inches tall (57 inches). As children approach this height, the
need for a booster can depend on the type of vehicle and the design of
the rear seats, as some cars have middle rear seats that are higher than
the side passenger seats. To know if your child still needs a booster,
you must be able to satisfy the following conditions:
- With the child seated without a booster and their backs against the back
of the seat, their knees should bend easily over the edge of the seat.
- The shoulder belt is positioned between the neck and shoulder, not touching the neck.
- The lap belt is comfortably across the hips, touching the thighs.
- The child can easily remain in this position throughout the car ride.
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Car seat installation: Always read the car seat manual prior to installation. Most people install
car seats incorrectly. Consider having the installed car seat inspected
by a professional. A great resource to find inspection sites can be found at:
https://www.nhtsa.gov/equipment/car-seats-and-booster-seats#install-inspection
Nichole Matlick, M.D., and
Kristine Brown, M.D., are pediatricians with
Hoag Medical Group.