Car Seats and Seat Belts and Kids—Oh, My!

boy in car seatBy Y. Katharine Chang, MD, FAAP
Assistant Professor of Pediatrics
Division of General Pediatrics

When I was a young child, I don’t think car safety seats existed. For sure, there weren’t many laws about keeping kids safe in the car. Kids sat or played or fought in the backseat, usually without any restraints, or sat in the front seat, often in their parent’s lap. If you’re of a certain age, I bet you’ve hung out with your siblings, cousins and friends in the way back of a station wagon, in a big jumble of kid arms and legs, while the grown-ups drove and chatted up front.

Nowadays, it’s hard to even imagine driving kids around without dealing with car seats. Sometimes, car seats are frustrating and annoying; often, they’re inconvenient; but, they are always necessary.

Car accidents are the leading cause of death in Americans, ages 5 to 24, and the second leading cause of death in children between 1 and 4. The number of deaths from car accidents has fallen in the past 20 years, probably due to improved child passenger safety. Still, nearly half of the children who die in car accidents are unrestrained. Seat belts are really important, but restraining children with a car seat appropriate for the age and size of the child is much more effective (that is, safer!) than just using a seat belt.

The American Academy of Pediatrics has several recommendations, based on the best available evidence, on how to keep children safe in the car. These recommendations are echoed by other safety organizations, such as the National Highway Traffic Safety Administration (NHTSA) and Safe Kids USA.

  1. Infants and toddlers should ride rear-facing until they outgrow their car seat by weight or by height, or until they are at least 2 years old.
  2. Children who are older than age 2 and/or have outgrown their rear-facing car seat should use a forward-facing car seat with a harness for as long as possible.
  3. Children who have outgrown the weight or height limit of their harnessed seat should use a belt-positioning booster, along with their lap-and-shoulder belt, until the vehicle seat belt fits properly. This typically (but not always) happens when they are about 4’ 9” tall and are between 8 and 12 years of age.
  4. Children who have outgrown their booster seats should always use a lap-and-shoulder belt and not just a lap belt.
  5. Children younger than 13 years should sit in the back seat.

In addition to these recommendations, each state has child restraint laws in place. In New York State, all children under age 16 must be restrained in the car. They need to be in a car seat until they are at least 4 years old. After that, they must be in a “child safety restraint system” (aka booster seat) until they are 8 years old. The state regulations specifically recommend booster seats for children who are 8 years old but less than 4’9” or 100 lbs.  New York State has primary enforcement laws, which means you can get pulled over if the police notice that the children in your car are not restrained appropriately. They do not have to have another reason to stop you.

So, once you know what to do, how do you get it done? Unfortunately, there are so many different types, brands, and styles of car seats out there that the poor parents who are trying to keep their kids safe are left confused and overwhelmed! Once you figure out which car seat to get, then you have to figure out how to install it in your car and how to place your child in it correctly! There are lots of recommendations and advice for that too, but they are beyond the scope of this article.

The bottom line: The best car seat is the one that (1) fits the child, (2) fits in the vehicle, (3) is used correctly, and (4) is used every time. To help you figure this out, it’s wise to have your car seat inspected. Many police and fire departments have members who are certified child passenger safety technicians. To find one near you, you can go to or call 1-866-SEAT-CHECK.

Every year, over 2000 children die in the car accidents. Nearly 30,000 children are hospitalized for injuries sustained in car accidents. We adults—parents, grandparents, friends, pediatricians—need to do everything we can to lower these numbers and to keep our children safe when we drive them to school, to their activities, to the grocery store, to their doctor’s appointments. Keep them rear-facing for as long as possible, harnessed for as long as possible, in a booster for as long as possible and in the back seat for as long as possible!

Safe travels, everyone!

For more information, including local car seat check events, visit:

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