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| Jerome Gronli, MD |
One of the most important parts of caring for your child is keeping him or her safe while riding in vehicles. Motor vehicle crashes are the leading cause of death for children older than 4. Counting all children and adolescents through 21 years old, there are over 5,000 deaths per year, and for each death, 18 children are hospitalized, and 400 are injured seriously enough to require medical attention. Many of these children are unrestrained or improperly restrained for their age or size. Understanding the car seat recommendations and how to correctly use and install the proper car seat can truly make a big difference in keeping your child safe. With any car seat you use for any age child, make sure to carefully read the instructions to see if your child is the proper size for the car seat, and to see how to correctly install the seat in your car and secure your child into the seat.
Some of the below guidelines may come as a surprise; in 2011 the American Academy of Pediatrics updated the recommendations for car seat safety for children based on new research, making some of the recommended ages for moving to the next stage higher than the previous guidelines. This was done with the goal of keeping children safe. It is important to recognize that while families often look forward to transitioning from one seat to the next as a kind of milestone, each step upwards gives up some degree of protection of your child in the event of a crash. As a general guideline, each transition should be delayed until it is necessary, when your child fully outgrows the recommendation for his or her current stage.
Infants and toddlers � rear-facing
The American Academy of Pediatrics recommends that all infants should ride in rear-facing car seats starting with their first ride home from the hospital until they reach 2 years old, or reach the highest height or weight allowed by their car seat�s manufacturer. This is a change from the previous guideline of 1 year old, as studies have shown that children under 2 are 75% less likely to suffer severe or fatal injuries in a crash if they are facing the rear of the car. Due to babies� relatively large heads and the immature bones of their neck, these areas are vulnerable to injury in a crash. Facing backwards allows the shell of the car seat to support your baby�s entire body in the event of a crash, while forward facing seats may not adequately protect baby�s head, neck, and spine. One common question about this recommendation is whether it matters if the baby�s legs are touching the back of the vehicle seat. The answer is that babies can easily bend their legs and will still be comfortable and safe facing the rear of the car. Leg injuries are very rare for rear-facing children in car crashes, and the primary objective is to protect their heads and necks.
Toddlers and preschoolers � forward facing
All children 2 years of age or older, or those younger than 2 who have outgrown the height and weight limits set for their rear-facing car seat, should sit in a forward-facing car seat with a harness for as long as possible, through the maximum height or weight recommended by their seat�s manufacturer. It is best for a child to remain in a seat with a harness at least through 4 years of age; if your child outgrows his or her forward facing car seat before this age, you should consider using a car seat with a harness approved for higher heights and weights.
School-aged children � booster seats
Booster seats for children who have outgrown the height or weight limit for their forward facing car seat and harness. Car seatbelts are designed for adults, and not children, and the goal of the booster seat is to raise your child up and him or her so that the vehicle seatbelt fits properly, with the shoulder belt crossing the mid-chest and mid-shoulder rather than the neck or face, and the lap belt crossing the upper thighs, rather than the abdomen. This position allows the belt to fit over strong bones, and helps protect your child from injury in case of a crash. The booster seat should be used until the vehicle seat fits properly over the shoulder and thighs; as a general guideline, this is typically when they have reached 4�9�� in height and are between 8 and 12 years of age. Although this sounds late to many parents, it is important that vehicle seat belts fit correctly, because improperly used or positioned seatbelts are more likely to result in serious injuries in the event of a crash.
Older children � seat belts
Once a child is old enough for the vehicle seat belts to fit properly, they may use the seatbelt alone. Deciding whether the vehicle seatbelt fits properly includes checking that the shoulder belt lies across the middle of the chest and shoulder, and does not cross the neck or throat, and that the lap belt lies snugly across the upper thighs, and does not cross over the child�s belly. As is the case for all passengers, children who are old enough should use the seat belt each and every time they are being driven in a car. Your child should be old enough to sit straight against the vehicle seat back, with knees bent and without slouching. You should also make sure that your child does not tuck the shoulder belt under the arm or behind the back; this is dangerous because it leaves the upper body unprotected, and because it allows extra slack into the seat belt system which can cause serious injury. Keep in mind also that children should never share seat belts; all passengers should have their own car seats or seat belts. Children should remain in the back seat at least through 13 years of age.
One basic fact to keep in mind when looking for the proper car seat is that no one seat is the best or safest seat. This consideration applies as well how you should think about cost � the most expensive car seat may not be the best, safest, or easiest to use car seat. The best seat is the one that fits your child�s size, is correctly installed, and is correctly and consistently used each and every time the child is in the vehicle. Do not use seats that have visible cracks or damage, have been recalled (or does not have a label with the model number and date of manufacture, allowing you to check if it has been recalled), do not come with instructions for how to properly install the seat, are missing parts, or have been involved in a moderate or severe crash. A moderate or severe crash includes any in which the vehicle could not be driven away from the crash, the vehicle door closest to the car seat was visibly damaged, any person in the vehicle was injured, the air bags did not go off, or there is visible damage to the car seat.
We hope that this information helps you to determine the best way to keep your child safe while riding in a vehicle. In addition to understanding these recommendations, always remember to be a good role model. Make sure that in addition to having all children in the car properly secured, you and all adults in the car wear seatbelts correctly as well. Seeing you consistently use your seatbelt helps children build good car safety habits long after they outgrow their car seats. Make sure that the guidelines discussed here are used every time your children are in your vehicle, and also any time they are transported by anyone else or in another vehicle. Consistency between trips, vehicles, and caregivers is safest for your child and will help eliminate fussing and complaints. Good luck and travel safely!
For more information on car safety for children, as recommended by the American Academy of Pediatrics, see:
http://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx
http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Recommendation-on-Car-Seats.aspx
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