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All babies and children will ride in a car at some point in their lives.  It is important for parents to know how to safely transport these little ones from their first ride until they are drivers themselves.  Below is a guide to safely using these restraints and riding in the car for each age group.

Infants and toddlers.  What type of car seat will you need?

The American Academy of Pediatrics recommends that all infants ride in the back seat restrained in a rear-facing car seat.  This will protect your baby’s head, neck and spine if you are in a crash.  It is recommended that baby’s stay rear facing until age 2 to dramatically improve safety.  Don’t worry; even if your child has to bend their legs a bit, they will still be safe. Be careful to read the manufacturer’s height and weight limits because some children will outgrow their rear-facing seat before age 2.  If this is the case, see the section below on forward facing car seats.


Rear facing seats can be carriers that are lifted off of a base, which is installed in the car. The other option is to use a convertible seat, which can be rear facing or forward facing.  Once you have picked a rear-facing seat, it’s time to install it and to do it correctly. You can get help from your local fire or police station as many have certified car seat installers. Rear facing seats should be installed so that the baby is at a 45-degree angle.  It should be installed tightly with very little mobility.  Cars now come equipped with a LATCH (Lower Anchor Tethers for Children) system that serves to anchor a car seat.


The next step is to make sure your baby is in the seat correctly.  It is vital that the straps are right up against your baby with no slack and the retainer clip is at nipple line.  Put blankets over the straps as opposed to under them.   Also, avoid using after-market additions like head rests.


Children over 2 years. When can they switch to a forward facing seat?

This category may include children under 2 who have outgrown their rear facing car seats.

For children who are ready to move to forward facing car seats, look for one that will accommodate your child up to 60+ pounds.  Install the seat using the LATCH system and be sure it is tight without any mobility.  Don’t forget to attach the top tether if available.  Use the 5-point harness system and again have the straps up against your child with the chest buckle right at nipple line.  Follow the manufacturer’s recommendation for when it is time to move the straps to the next slot.


Moving to the booster seat, when is the right time?

My recommendation is to leave young school aged kids in forward facing car seats for as long as they fit (based on manufacture height and weight limits).  Once your child has outgrown the height and weight limit of the seat they can move into a booster seat that is used with the car’s seat belt.  These seats are not tethered to the car and come either with or without a high back.  They should be used for any child under age 8 and up to 12 years who is out of their car seat but below 4 feet 9 inches. Under a height of 4’9″ the seat belt is more likely to sit across the neck as opposed to down on the collar-bone.  This can increase the likelihood of fatal injury in a crash.


When can children move to a seat belt without the booster seat?

Most kids 12 and over are big enough, and mature enough, to sit in the seat with just the seat belt.  Just be sure the shoulder strap rests in the middle of the shoulder and the lap belt is low on the hips.  Furthermore, these kids are safest in the back seat and not in the front.  The AAP recommends keeping kids in the back seat until at least 13 years old.

Keep in mind that it is best to obtain a new car seat as older seats may have been recalled, in a crash or expired.  Car seats expire after 5 years, so check your seat.

 

This article was written by Dr. Jaime Friedman of the Children's Physicians Medical Group (CPMG)

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