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Harvard Commentaries
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Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Car Safety Seats -- Changes to Make Now

December 16, 2013

By Claire McCarthy M.D.

Boston Children's Hospital

Did you know that three out of four parents do not properly use child restraints in the car?

Motor vehicle crashes are the leading cause of death of children 4 years and older. Child restraint systems can make a big difference — but only if we use them, and use them properly.

In March of 2011, the American Academy of Pediatrics issued new advice to help parents keep their children safe in cars. The changes are based on solid evidence for how best to use child restraint systems. Here are the five recommendations.

  1. All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the maker of the car seat.

    This is going to be a change for families that have turned a child around when she is 12 months old. Research shows that it is safer to keep a child facing backwards, unless she is too big for a rear-facing seat.

  2. All children 2 years or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their car seats, should use a forward-facing car seat with a harness until they have reached the highest weight allowed by the maker of the car seat.

    Once kids get to be preschoolers it can be tempting to take them out of the car seat. Many families — and kids — think a car seat is for babies. But it isn't. It is the safest place for a young child to sit in a car.

  3. All children whose weight or height is above the forward-facing car seat limit should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly — typically when they are 4 feet 9 inches tall and are between 8 and 12 years of age.

    This, too, is going to be a change for many families. This is also an age when kids go on play dates and other people drive them. Look for a booster seat that is easily portable so that you can use it in any car your child rides in.

  4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap-and-shoulder seat belts for the most protection.

    Luckily, most cars come equipped with this kind of seat belt. The lap portion of the belt should fit low across the hips. The shoulder portion should fit across the middle of the shoulder and chest when the child sits with his or her back against the seat. If the belt doesn't fit this way, back to the booster seat!

  5. All children younger than 13 years should be restrained in the rear seats of vehicles for the most protection.

    If they aren't teenagers, they need to be in the back seat.

Visit the National Highway Traffic Safety Administration's website for car seat ratings, instructional videos and lots of other great information about keeping your children safe in and around cars.

One of the children saved could be your child.

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Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.

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