According to the American Academy of Pediatrics, motor vehicle accidents are the number one killer of children 4 years of age and older in the United States. The best way to protect your child when riding in a car is to make sure your child is in the right car seat or booster seat and that it’s used in the right way.
Child safety seats reduce the risk of injury by an estimated 71-82 percent and reduce the risk of death by 28 percent. Select a car seat based on your child’s age and size and one that is compatible with your car. Install it or have it installed using the vehicle owner’s manual, checking height and weight limits. If you are uncertain, ask your pediatrician for referrals to experts in your area. Some fire departments and other public health authorities offer car seat installation classes.
- Rear-facing car seat—This is the best seat to use for an infant up through the toddler years. It has a harness and, in a crash, cradles and moves with your child to reduce the stress to the head, neck and spinal cord. There are a couple different types. Infant carriers are seats that can be snapped in and out of a base that is installed in the vehicle. When your baby outgrows that seat, move to a convertible car seat that is still positioned to face the rear until your child exceeds the weight and height limit for that seat.
- Forward-facing car seat—This type of seat has a harness and tether that limits your child’s forward movement during a crash. These car seats accommodate children to at least 40 pounds, but many of them can be used up to 80 pounds.
- Booster seat—This type of seat raises and positions your child so the seat belt fits properly over the stronger parts of your child’s body. A high-back booster seat is recommended if your vehicle has a low seat back in order to support the child’s head.
- Seat belt—This type of restraint should lie across the upper thighs and be snug across the shoulder and chest to restrain the child safely in a crash. It should not rest on the stomach area or across the neck.
Which restraint to use and when
Child passenger restraint requirements vary based on age, weight and height:
- Birth to 2 years—A child under 2 years old should always ride in a rear-facing car seat in the back seat. This may be news to you if this is your second child and your first child was born before the 2011 recommendations were released. The AAP issued a policy statement on child passenger safety in 2011 that lengthened their recommendation to two years instead of 12 months as numerous studies showed added protection in this vulnerable age group.
- 2-4 years—The AAP now recommends that children remain rear-facing as long as possible according to the manufacturer’s guidelines for each seat but until about age four. Once a child outgrows the rear-facing height and weight guidelines for their car seat, they can transition to a five-point harness style forward-facing seat. New five-point harness forward-facing seats can accommodate most children until sixty pounds.
- Older children—Children who have outgrown the weight and height harness strap limits of their forward-facing car seat can move to a belt-positioning booster seat but it must still be in the back seat. This is typically after the age of 4.
- 8-12 years—A child should be kept in a booster seat until big enough, typically 4 feet, 9 inches tall, to fit in a seat belt properly. Proper fit means the lap belt must lie snugly across the hips and pelvis, not the stomach, and the shoulder belt should lie snugly across the middle of the shoulder and chest and not cross the neck or face. All children younger than 13 should sit in the back seat for optimal protection.
Reviewed by Dr. Sara Connolly, February 2019
- Children under two years old should always ride in a rear-facing car seat.
- All children younger than 13 should sit in the back seat.
- Motor vehicle accidents are the number one killer of children 4 years old and younger in the U.S.