Updated AAP car seat policy: Is your child a safe passenger?

Claire McCarthy, MD

Here’s a frightening statistic: according to the National Highway Traffic Safety Administration, 3 out of 4 parents do not properly use child restraints.

Some of the mistakes happen because parents don’t understand how to use the car seat properly. I’ve struggled myself trying to figure out the instructions on a seat! Some of the mistakes happen because people don’t know which seat to use, and how, and until when.  And some of the mistakes happen because we get lazy—the harness is good enough, we think, even though it is a little loose. Or, darn, we left the booster seat in the other car, Junior is getting tall anyway, let’s just use the seatbelt.

Motor vehicle crashes are the leading cause of death for children 4 years and older. Car safety seats prevent injuries—and save lives. But they aren’t going to do this if they aren’t used, and used properly.

Today, the American Academy of Pediatrics is issuing a policy statement on child passenger safety, in the hope of making it clear what parents and caregivers need to do to keep children safe in cars.

There are five recommendations:

They may hate it, but kids under 2 need to ride facing the rear of a car

1. Infants and toddlers should ride in a rear-facing seat until they are 2 years old—or until they reach the maximum height or weight for their rear-facing seat. Because of their body mechanics, they are safer this way.  I know little kids like facing forward, but they have their whole lives ahead of them to ride that way; keep them turned around for now.

2. All children who are 2, or who are younger than 2 but have outgrown their rear-facing seat, should use a forward-facing car seat for as long as possible.  They shouldn’t come out until they have reached the maximum height or weight allowed by the manufacturer of the seat. This will probably be somewhere around age 5. There will be preschoolers who grump at this, but the car seat is the safest place for them.

Depending on size, booster seats may be needed in addition to seat belts for children

3. When kids outgrow the forward-facing car seat, they should use a booster seat until the lap-and-shoulder belt fits them properly. The lap part should fit low across the hips, and the shoulder part should fit across the middle of the shoulder and chest when the child sits back against the seat. This usually happens when kids are around 4 feet 9 inches tall, and between 8 to 12 years. There will be grumping about this, too, especially if your child is shorter than his or her friends, but hold firm. This is also an age where kids go on playdates and are in carpools; advanced planning may be required to be sure your child always has a booster seat when he needs it.

4. When kids outgrow the booster seat, they should always use lap-and-shoulder seat belts. Luckily, most cars come equipped with these, but older models may not, especially in the middle back seat.

5. Any child younger than 13 years should be in the back seat. They will want to sit in front before then. Just say no.

The website of the National Highway Traffic Safety Administration has some great instructional videos, as well as ease-of-use ratings for car seats and lots of other great information about how to keep your children safe in and around cars. You can also find out where to go in your neighborhood to get personal help in installing your carseat (or to find out if you did it right).

So do it right—and don’t give in to laziness or grumpiness. Your child’s life may depend on it.

For more on car seat safety, click here for an NPR piece on the subject, featuring Lois Lee, MD, of Children’s Emergency Department Injury Prevention Program

4 thoughts on “Updated AAP car seat policy: Is your child a safe passenger?

  1. My carseats say they are safe rear-facing up to 45 pounds. As a Mom to 3 preschoolers weighing 34, 33 & 32 pounds at the ages of 5, 5 & almost 4, is the recommendation that I turn all their carseats backward until they are 7?? In the world of a preemie, my kids weights may be under their carseat limits when they begin driving…

    1. Indeed, the recommendation does sound confusing. You can face forward at two. It’s just that if you have a really huge under 2yo who cannot fit in a rear-facing seat safely, you can face them forward. Does that make sense?

      Does sound, though, like your kids are going to be in a car seat of some kind for a while…

      1. Yes. They’ll be in car seats until junior high, likely! I always wonder with my kids, who have trachs, if rear-facing isn’t really the only option for a car seat having any useful safety effect. Are there any recommendations specific to children with these types of medical devices?

  2. When they go to booster seats, which one is best – the $25 Cosco one or the $250 magnesium frame Euro one? Is there any difference? How about the low vs high back booster seat vs convertible? Fortunately for us, our twins are now going on 4yrs old, so the rear/forward revision happened too late for us to have them spinning around, as it were.

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