The American Academy of Pediatrics in March 2011 updated their policy statement regarding child passenger safety based on 5 evidence based recommendations to provide better protection for children from birth through adolescence.

Birth to 2 years old

Recommendation #1:

• All infants and toddlers should remain rear-facing until 2 years of age or until they reach the highest weight and height limit for their child restraint (car seat)
• Many infant seats go rear-facing to 30-35 pounds
• Some infants seats only go rear-facing until 22 pounds
• If your child outgrows the infant seat before they are 2 then move them into a convertible seat
• Most convertible seats go rear-facing until at least 35 pounds and some go to 45 pounds.  Convertible seats that go rear-facing to 35 pounds will reach boys and girls that are in the 95^th percentile at 2 years of age
• Rear-facing the harnesses should be at or just below the shoulders
• The retainer clip or chest clip should be at armpit level or across the nipple line
• Make sure you snug the harnesses around the legs first
• The harness should be snug around the child, you should not be able to pinch any excess webbing lengthwise at the top of the shoulders

2 years old – at least 4 years old

Recommendation #2:

• All children 2 years of age or less than 2 who have outgrown their rear-facing seat by either height or weight limit for their child restraint should use a forward facing child restraint with an internal harness until the upper weight or height limit is reached
  • All convertible seats can be used with an internal harness until at least 40 pounds, some seats can go to 50, 65 or 85 pounds with an internal harness  (please check height limits)
  • Combination child restraints are seats that can be used with an internal harness system and then the harness can be removed and then it can be used as a booster seat.  Always check the height and weight limits for the internal harness and for use as a booster seat
  • Forward- facing the harnesses should be at or just above the shoulders
  • The retainer clip or chest clip should be at armpit level or across the nipple line
  • Make sure you snug the harnesses around the legs first
  • The harnesses should be snug around the child, you should not be able to pinch any excess webbing lengthwise at the top of the shoulders

Over 4 years old

Recommendation #3:

• All children whose weight and height are above the  limit for a forward-facing seat should use a belt-positioning booster seat
• The shoulder belt should fit across the center of the chest and the lap belt should stay low on the hips
• Many high- back booster seats have seat back that can be moved up or down depending upon the child’s height
• Many no-back  or high-back booster seats have arm rests, please read the manufacturer’s instruction book for proper placement of seat belts
• Many no-back booster seats have an adjustable shoulder guide which should be used as the shoulder belt should be at or just above the shoulders

8 – 13 years old and older

Recommendation #4:

• When children are old enough and large enough to the use the vehicle seat belts alone, they should ALWAYS use both the lap and shoulder belt
• Many children may be between 8-12 years old before they reach 4’9” and should continue to use a booster seat (best practice)
• The lap belt should fit low on the hips and the shoulder belt should fit across the middle of the child’s shoulder and chest
• The child’s knees should bend at the edge of the seat without slouching
• The child should be able to sit with their back against the back of the vehicle seat and they should be able to sit this way the entire ride
• If a child cannot ride this way, then they are probably too small for the seat belt and should use a booster seat

13 years and older

Recommendation #5:

• All children  younger  than 13 years of age should ride in the back seat for best protection
  • Children should ride in the back seat until they are TEENAGERS!
  • All children should use BOTH the lap and shoulder belt regardless of seating position

Other Guidelines

• Child restraint manufacturer’s state in their instruction book to either use the seat belts or the lower anchors (part of the LATCH system); NOT BOTH.  When using some booster seats you can use the lower anchors and/or top tethers.  YOU MUST READ THE CHILD RESTRAINT MANUFACTURER’S INSTRUCTION BOOK TO DETERMINE IF THIS IS ACCEPTABLE.
• Many vehicle manufacturers will only allow you to use the lower anchors in your vehicle to 40-48 pounds.  You must read your vehicle owner’s manual to find the weight you can use the lower anchors.  Some may refer you to the child restraint manufacturer, if so read your child restraint instruction book.  When in doubt, only use until 40 pounds.
• Always use top tethers for a forward-facing seat in vehicles made after September 1, 2000 (you could have them in your vehicles prior to this) check your vehicles owner’s manual
• Many vehicles only have lower anchors by the doors and you may NOT be able use one from each side to put a child restraint in the middle.  You MUST check your car owner’s manual and if the spacing is more than 11 inches then you must also check your child restraint instruction book (You can always use a seatbelt)
• Tether anchors will be in 3 locations in your vehicle
• If you must place a child in the front seat before they are 13, then place a child that is either in a convertible seat or combination seat w/internal harness in front and move the seat as far away from the dashboard as possible (this child will not be able to move around except for their head)

For more information regarding the child passenger safety, please visit the NHTSA website http://www.nhtsa.gov.  This site will also link to other resources.

Author: Richard A. Falcone, Jr, MD, MPH (November, 2012)