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Car Seat Safety Tips

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.