Health Blog

Car Seat Safety

Do you know if you are using your car seat correctly? The American Academy of Pediatrics provides recommendations on the proper use of car seats in regards to a child's height weight, and age.

Car Seat Safety

Do you know if you are using your car seat correctly?  The American Academy of Pediatrics provides recommendations on the proper use of car seats in regards to a child's height weight, and age.  In 2011, the recommendations for Child Passenger  Safety were updated and stated that "All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age or until they reach the weight or height allowed by the manufacturer of their CSS."  This is a change from the previous recommendation that recommended children remain rear-facing only until the age of one.  The current recommendations have been in place since 2011, yet many parents still do not adhere to the updated safety recommendations.

Studies have shown a significant decline in the severity of injuries and number of fatalities in children up to 23 months in rear facing car seats as opposed to forward facing car seats.  In children two years of age and younger, their heads are relatively heavy compared to the total weight of their bodies and their necks and spines are underdeveloped.  As a result, in a car crash with a child in a front facing car seat, the child's head can snap forward with a force that can break their neck, or injure their brain or spinal cord.  In a rear facing car seat, the car seat keeps their head and neck properly aligned throughout the impact of the car crash.  The car seat spreads the force of the impact across their entire body as opposed to just where they would be harnessed in a front facing car seat.

In Sweden, children have been kept in rear facing car seats up to age four since the late 1960's.  Over the past several decades, Sweden has been able to almost eliminate deaths of children ages 0-6 caused by automobile accidents, as opposed to the U.S., where car accidents remain the leading cause of death in children under the age of 13. 

One of the reasons many parents feel the need to transition their child to a forward facing car seat early is that the child lacks the leg room to remain in the rear facing seat once their legs grow long enough to touch the front of the seat.  Parents often fear their child is uncomfortable or is at greater risk of injury for having to bend their legs to fit in the car seat.  However, research shows the facts do not back up these fears.  Children are at a much greater risk of injury to their lower extremities in a front facing car seat than they would be in a rear facing car seat.  As for the comfort of sitting cross legged or with knees bent, children are much more flexible than adults and can sit comfortably in these positions for much longer than an adult could.

Parents often view the transition from a rear facing to a front facing car seat as a milestone in the child's development, much like crawling or walking for the first time.  As much as reaching new milestones becomes a way of life during the child's first year of development, it is important to weigh the safety of the child above the joy of reaching a new milestone.

There are other factors that can also influence parents' decision to turn their child forward facing earlier than recommended.  Many rear facing infant (newborn) car seats have the weight capacity to hold a child until their second birthday, but they will typically exceed the height limit closer to age one.  Car seats that are large enough to keep a child rear facing until age two or three are usually more costly and may be too large to fit in more compact vehicles without having to move the front seats forward.  Parents may be reluctant to shell out extra money for an extra rear facing car seat before transitioning to a front facing car seat and then later to a booster seat.  But as the car seat lady points out "Imagine it's November and your 20-month-old has outgrown all of her winter clothes from last year.  Would you not buy her new clothes because 'it will be warmer in four months'?"

Many reversible car seats will support a child being rear facing until age three or four before being turned around to be front facing.  The child may remain in the car seat until their head is 1" below the top of the car seat and has not yet exceeded the weight limit (due to the way most car seats are manufactured it is much more likely your child will exceed the height limit prior to exceeding the weight limit). 

Once a child has outgrown their front facing car seat (typically around age four, but can be much older if the height and weight limits of the car seat allow, and being a minimum of 40 lbs and 40" tall) the child will then transition to a belt positioning booster seat.  The booster seat does not have a five point harness like a car seat does.  Instead, the booster seat uses the seat belt, both the shoulder and the lap belt, to hold the child and seat in place.  The child must remain in a booster seat until they are 4'9" tall, typically between 8 and 11 years old.  Seat belts with a shoulder harness are designed for adults, so children under 4'9" tall are at greater risk of injury during an accident if they are not in a booster seat.

Children under the age of 13 should not sit in the front seat of a car that has a passenger side airbag due to risk of serious injury or death.  New York State does not have a law banning children under 13 from riding in the front seat, but does state it is unsafe for children under 5 feet tall to sit in the front seat on the NYS DMV website.  NYS does require all children under 16 wear a seatbelt in the backseat of a vehicle, and that all children under 4'9" tall must be in a booster seat.  NYS also requires all children under age four be in a car seat, although it does allow for children over 40lbs who have exceeded the height and weight limit of their car seat to use a booster seat.

For most parents, the safety of their child is their number one priority.  When it comes to car seat safety, the studies show keeping a child rear facing in a car seat as long as possible is the safest way for them to travel in an automobile.  Then once they've outgrown the rear facing seat, using a front facing car seat and booster until your child is at least 4'9" tall, and never in the front seat of a car until age 13.  Following these guidelines will help to ensure your child is traveling as safely as possible next time they ride in a car.


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