by Flavia Fioretti, MD
Keeping your child safe is one of the most important priorities for a parent. Every year, thousands of children are killed or injured in car accidents. Motor vehicle accidents continue to be the leading cause of death for children four years of age and older. Our goal, as pediatricians, is to provide you with enough information to keep your children safe when riding in a car.
Know that using a car seat correctly makes a big difference!
The American Academy of Pediatrics (AAP) published in 2011 a policy statement with evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence:
- Rear-facing car safety seats for infants up to 2 years of age
- Forward-facing car safety seats for children through 4 years of age
- Belt-positioning booster seats for children through 8 years of age and/or 4 feet 9 inches
- Lap-and-shoulder seat belts for all who have outgrown booster seats
- All children younger than 13 years to ride in the rear seats of vehicles
How Can I choose the best and the safest car seat?
With so many different car seats on the market, you may feel overwhelmed choosing an appropriate option. Many factors will influence your choice, for example, your child`s age, size, and your vehicle type.
Always read and follow the manufacturer`s instruction for your car seat.
Types of Rear-Facing Car Seats:
- Rear-facing only seats:
- For infants up to 22-45 pounds, depending on the model
- Should be used only for travel (NOT sleeping, feeding, or any other use outside the vehicle)
- Have carrying handles
- Usually comes with a base that can be left in the car and parents can buy more than one base for additional vehicles
- Convertible seats (used rear facing):
- Can be used rear-facing and then `converted` to forward-facing
- Many have higher limits in rear-facing weights (up to 40-50 pounds) and height than rear-facing only seats, which make them ideal for big babies and toddlers
- Have a 5-point harness that attach at shoulders, hips and between legs
- These should also be used only for travel
- 3-in-1 seats:
- Can be used rear-facing, forward-facing, or as a belt-positioning booster seat
- Do not have the convenience of a carrying handle or separate base
- Ideal for bigger babies and toddlers
Types of Forward-Facing Car Safety Restraints:
- Forward-facing only seats:
- Can be used with a harness for children who weight up to 40-80 pounds (depends on model) or without the harness as a booster (up to 80-120 pounds)
- Convertible seats
- Built-in seats:
- Some vehicles come with built-in seats. Check manual for details.
- DO NOT use before 2 years of age
- Travel vests:
- Can be used by children 20-168 pounds
- Useful for vehicles with lap-only seat belts in rear seats
- For children with special needs
- For children whose weight had exceeded the allowed weight for car seats.
- Booster Seats:
- For children who had outgrown their forward-facing seats.
- To use until the seat belt fits properly (usually when they reach 4 feet 9 inches in height and are 8-12 years old)
- Proper fitting of the Lap-shoulder seat belt:
- Lap belt should be on the on the upper thigh, NOT on the lower belly
- Shoulder belt should be on the shoulder, NOT on the neck
Do premature babies need a special car seat?
The car seat should be appropriate for your baby`s weight. Very small babies usually fit better in rear-facing only seats. Premature babies should be tested while still in the hospital to assure they can seat safely in a semi-recline position. Some babies need to lie flat during long trips. These babies should ride in a car bed that meets Federal Motor Vehicle Safety Standard 213.
AAP Policy Statement – Child Passenger safety (Pediatrics ISSN Numbers: Print, 0031-4005; Online, 1098-4275)