What parents should know about the new car seat guidelines

My daughter had just turned 1 when I spent a month working on the trauma service during my Pediatric Emergency Medicine fellowship.  She was not yet 20 pounds so I still had her in a rear-facing car seat.  I asked one of the head trauma surgeons when he would recommend I turn my daughter around so she was facing forward in the car.  His response surprised me.  He said, “If I could, I would ride rear-facing in a 5-point harness.”

Thinking about it some, it makes sense.  If you are in a front end crash, your car comes to a stop and you keep moving forward until you come in contact with your seat belt.  If you are not wearing a seat belt you will stop against the interior of the car, or worse yet something outside of the vehicle.  When children are riding in a rear-facing seat, the force of stopping in a crash is spread out over the whole surface of their back – not just the points where their body contacts the straps.

Now, as a pediatric emergency room physician and a mom of three children under age 7, I am thrilled to see the announcement that the American Academy of Pediatrics has updated their recommendations for child passenger safety.

From the perspective of someone who takes care of children who are brought to the emergency department after car crashes, it is clear the difference selecting the correct restraint for a child can make.  Toddlers who are properly restrained in a car seat with a 5-point harness often fair better than even adult passengers in the car, leaving the emergency department with little more than a scratch.  Unfortunately, I also commonly treat children for serious injuries to their head, spine, or abdomen because they were not yet big enough to fit in the vehicle seat belt that has been designed for an adult.

The release of the new AAP guidelines for child passenger safety gives us the chance to get this important message out to parents: children are safest when they ride in a properly installed child passenger restraint that is right for their size on every trip. By following these recommendations, parents have a chance to reduce a leading cause of death and disability among children in the United States.

The guidelines clearly make 5 best-practice recommendations:

  1. Infants and toddlers should remain rear-facing up to age 2 or the highest weight or height limit of their seat.
  2. Older children should use a forward-facing car seat with a 5-point harness as long as possible until they reach the weight or height limit of their seat.
  3. Children should use a booster seat until they can properly fit in a lap and shoulder belt, which usually occurs when a child has reached 4 feet 9 inches tall.
  4. When children are large enough to use the vehicle seat belt alone, they should always use both the lap and shoulder belts.
  5. Children younger than 13 years old should always ride in a rear seat for optimal protection.

Many parents have concerns about keeping their child rear-facing when their legs bend because they touch the back of the seat.  Remember, babies and toddlers have large heads and neck muscles that are not fully developed.  In a crash, whiplash can cause permanent damage to their brain or spinal cord.  Children’s leg bones rarely break because a child’s feet were touching the back of the seat in a crash.  But broken bones will heal in a way that the brain and spinal cord cannot.

In addition to the importance of using rear-facing car seats correctly, we also encourage people to not rush into using booster seats or seat belts too soon. A close review of our “car seat aged” patients (younger than 8 years old) who were admitted to the hospital due to injuries from a motor vehicle crash revealed that a strong majority were “graduated” to a booster seat or seat belt too soon. Although some booster seats on the market indicate that you can begin to use them starting at 30 pounds – our experience paints a clear picture that this is NOT the best practice. We recommend that kids stay in a 5-point harness until they are at least 40 lbs (but some car seats can be used for children up to 65 pounds or more). Parents should check their child’s car seat for the manufacturer’s height and weight limits and keep in mind that there is some decrease in protection at every transition point. Kids are safest when parents delay these transitions as long as possible while keeping with the seat manufacturer’s instructions.

Installing a car seat can be a challenge but there are resources available to help.  Contact the Mott Buckle Up! program at 734-763-2251 for additional information about child passenger safety and to schedule an appointment for a car seat inspection.

Take the next step:

Michelle Macy MDDr. Michelle Macy is a pediatric emergency physician at the C.S. Mott Children’s Hospital pediatric emergency department.  Dr. Macy and her colleagues in the pediatric ED specialize exclusively in the unique needs of children.



best children's hospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.