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Car Seat Safety Guidelines

As a pediatrician, I'm very familiar with the statistics showing that car safety seats save lives. As a grandparent, I'm reminded of the challenges of using a car seat properly every time my grandkids visit. Finding the right car seat for your child is one of the most important, and daunting, tasks parents face. In 2000, 539 children younger than 5 years old died while riding in motor vehicles. Almost half were unrestrained, and many others were restrained improperly. When used correctly, car safety seats can help prevent death and injury to children during crashes. To help parents (and pediatricians) better understand how to use car seats correctly, the American Academy of Pediatrics (AAP) has issued updated recommendations. Here, three steps to car seat safety:

1. Chose a car seat appropriate for a child's age and weight.

Children should ride in a rear-facing infant or convertible car seat until they are at least 2 years of age and have exceeded the weight and height requirements of the seat to decrease the risk of spine injury in the event of a crash. A rule of thumb: The child should remain rear-facing until reaching the maximum weight for the car seat, as long as the top of the head is below the top of the seat back. Forward-facing seats for children over age 2 pounds may be used until the child reaches the seat's weight limit, or the tops of the ears reach the top of the seat back. Premature and small infants should not be placed in car seats that have shields or abdominal pads that could cause harm during an impact.

2. Make sure the car seat is properly installed.

Air bags and car seats don't mix, so never put your child in the front seat. Infants should ride in the rear seat at approximately a 45-degree angle to prevent slumping and breathing problems. If your seat does not allow for an angle adjustment, a firmly rolled towel or newspaper can be wedged under the car seat below your baby's feet so that your baby is in the proper reclining position. Follow the car owner's manual and the car safety seat instructions carefully. When the car seat is installed, test it for proper fit.

3. Make sure your child is correctly placed in the seat.

In rear-facing car seats for infants, shoulder harness straps should usually be placed in the slots at or below the infant's shoulder, and the harness should be snug. The car seat's retainer clip (which holds the harness straps on the shoulders) should always be positioned at the level of the child's armpit, not on the abdomen or in the neck area. For more information, talk with your baby's pediatrician or visit the AAP website at www.aap.org or the National Highway Traffic Safety Administration's website at www.nhtsa.dot.gov. Safe riding to you and your little ones!

Louis Z. Cooper, M.D., is the president of the American Academy of Pediatrics

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