By: Hayley Scott, MD
Pregnant with my first child and shopping for a car seat, I found myself overwhelmed with aisles and aisles of choices at the local big box stores. The fact that car accidents are the #1 cause of injury and death among American children and youth was prominent in my mind. While most parents spend hours agonizing over paint colors for the nursery, one of the most important decisions to make for a new baby is selecting an appropriate car seat and then correctly installing and using it.
New parents can find themselves confused while determining which seat is right for them. Once you look beyond the branding, advertising, and pressure, it’s not as difficult as it may seem—the right car seat fits the child, fits the vehicle, fits the budget, and gets used correctly 100 percent of the time.
From birth to a minimum of two years old, children should be in car seats that face the back window of the vehicle. Yes, two years old. This rear-facing position offers the most support for a baby or toddler’s fragile head and neck in the event of an accident. You might be wondering: “But won’t his legs be squished?” Legs are actually less likely to be injured rear facing. (Besides, I like to think of my two-year-old son as riding in a big recliner in the car.)
Forward facing harnessed seats are the next step once your child is over two years old and at least 30 pounds, although there is no need to rush into forward facing. Ideally, children should continue to face the rear of the vehicle until the limits of the seat are reached, which could be well over two years old. Any car seat should fit snugly in the vehicle, and you should not be able to pinch any slack in the harness strap over the child’s collar bone. It is imperative to read the manual for installation information. Local agencies even have certified child passenger technicians available to check car seat installations free of charge.
Children are usually ready for a booster seat around the time they start kindergarten or first grade, and are at least four years old, 40 pounds, and able to sit properly for the entire car ride. The seatbelt should fall between the neck and arm, with the lap belt riding low on the hips, not on the tummy. Often times full back boosters provide additional support, and may be required in seating positions without headrests. Children should ride in a booster until their back sits against the vehicle seat with their knees bent at the edge of the vehicle seat. The seat belt should still land in the same place on the child’s shoulder and lap as it did in a booster, and the child should be able to ride in position the entire trip. For most children, this final move to an adult seatbelt happens between 10 and 12 years old, although for smaller kids and in larger vehicles they may be even older. All children 12 and under should continue to ride in the back seat of the car.
Loading and buckling kids may seem like a hassle, but don’t rush progressing through these stages. Every step towards the adult seatbelt is a step down in safety.