Unbelievable coincidence today: I stayed back this morning to finish this post while my family dropped off my son for a birthday party. There are complex carpools happening to get to the party (thank you, Village!) and while sorting it out someone offered my nine year-old a seat in a car — saying it would work out fine but the seat would be without a seat belt.

What? This kid of mine always uses a booster and a seat belt (he’s only 4 foot 7 inches tall). I mean, it’s 2018 and we know seat belts have saved more than 329,715 lives between 1960 and 2012 alone — more than all other vehicle technology combined, including air bags, energy-absorbing steering assemblies, and electronic stability control. I think we take their protective gift for granted. It’s hard for me to stay quiet with the “it will be fine” mentality to one of our riskiest endeavors — riding in the car. That video up there is one of my favorite PSAs of all time…

It’s not just family protection that makes protecting children a challenge. National Highway Traffic Safety Administration (NHTSA) data show that as children get older they are less likely to want to buckle up. For example, in 2016, 262 children 8 to 12 years old were killed in crashes. Nearly half of those who died were not wearing seat belts. But wearing seat belts greatly increases the chance of surviving a crash. AND using car seats, booster seats, and staying in the back of the car until age 13 years make it even safer.

Child safety seats reduce the risk of injury by 71% to 82% and reduce the risk of death by 28% when compared to children of similar age use in seat belts. Booster seats reduce the risk of non-fatal injury in 4 to 8 year-olds by 45% compared with seat belts alone.

This stuff matters. It always sounds so preachy to talk about, and I don’t want it to, but car safety is a place we SHOULD NEVER cut prevention corners. I just don’t know how to look at the world with a, “it’ll be fine” lens. Maybe because I’ve seen so many times, mostly during my medical training, that without proper seat belts and boosters it sometimes isn’t fine. Okay. New recommendations for car seats and seatbelts out this week. Let me get us all up to speed:

Since 2011 I’ve been saying: “2 is the new 1” when it comes to car seats but now it’s more like “4 or 5 years-old may be the new 1.” Babies, toddlers, & preschoolers are safer when in seats that face the rear of the car.

Back in 2011 we got serious, encouraging parents not to turn their newly-minted one year-old forward-facing in the car — the reasons were clear – data confirmed it was much safer for toddlers to remain rear-facing in the car (and in the event of a huge slowdown or car accident as the car comes to a stop, a toddler’s relatively large head and neck are protected better with the entire back, and sides of the seat, restraining them).

That recommendation has recently changed based on re-examination of the data and the ongoing understanding that rear-facing is safer……even longer. We’re borrowing from the Scandinavians here where most children sit rear-facing all through toddlerhood and preschool. Fortunately most “convertible” or car seats designed for toddlers are built to accommodate children rear-facing well past age 2 years. Seats have weight and height guidelines and restrictions on the seat itself, so you can always check the seat and ensure it accommodates your 3 or 4 year-old facing the back.

There is no rush to move children forward-facing — in fact every transition we make as our children grow decreases the protection they get (from infant bucket seat —> convertible 5-point car seat facing back of car —> convertible 5-point car seat facing front of car —-> booster seat in backseat —-> seatbelt in back seat —-> seat belt only in front seat at age 13 years) The new American Academy of Pediatrics guideline eliminates the age-specific milestone to turn a child’s car seat around. Instead, children should ride in rear-facing car seats until they reach the height or weight limit provided by the car seat manufacturer. That might be just before starting pre-K or Kindergarten.

5 New, Clear Recommendations For Protecting Babies and Children In The Car:

  1. Infant/Babies/Toddlers: Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.
  2. Toddlers/Preschool: Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more.
  3. Early School Age: When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.
  4. School Age: 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 optimal protection.
  5. Middle-School & Beyond: All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection. Even if they are as tall as you and as heavy as you, they are safer in back until at least age 13.

Why Is Rear-Facing Better:

This is physics, but it’s simple physics. The worst crashes are when a car hits something from the front. Rear-facing seats protect the child’s head, spread out the force of a crash evenly across the seat, and significantly reduce the risk of injury to the head, neck, and spine. If the car crashes and baby/toddler/preschooler are facing forward their head/neck/spine is whipped forward without any support.

Use the easy “latch and tether” method to securely attach the car seat to the frame of the car whenever possible. If you must attach the seat using a seat belt, make sure the seat belt is tight (i.e. the seat belt has no slack and won’t loosen). You want the car seat to feel very secure and immovable in the car itself.

We know that by using the proper car seat, the risk of death or serious injury is lowered by more than 70%. All children younger than 13 years should be in a vehicle’s back seat. Once children reach the height or weight limit and shift to a forward-facing seat, they should use safety seats with harnesses for as long as possible, often up to 65 pounds. Once children exceed height or weight limits for those seats, they should use a belt-positioning booster seat until the lap and shoulder belts fit properly, often when the child has reached 4 feet 9 inches in height.

Booster Seats Until 4 Feet 9 Inches Tall

  • DO THIS NOW: put a mark on the wall at 4 foot nine inches from the ground. Tell your children to come and ask about getting out of a booster only when they are taller than the mark. The goal is to have the seat belt fit them properly (the booster just boosts them up so it protects them more safely). The seat belt should rest on top of thighs/pelvis, go straight across middle of chest, and cross the middle of their collar bone, avoiding their face and neck. Kids need to be able to sit back in the seat (no slumping over) when riding in the car.
  • The booster seat is critically important because it helps the seat belt (and your child!) stay in position during a crash so that the car can do its job to protect the occupants. Seat belts are only designed for adults and don’t fit properly until a child is around 4 feet 9 inches tall – most kids will reach this height sometime between 9 and 12 years of age. I also like to remind kids that when in a booster they are up higher and can see better out the windows! True…
  • Some parents mistakenly put kids into the seat belt when they aren’t big enough. Dr. Beth Ebel, a Seattle Children’s pediatrician who also researches injury prevention and cares for children at Harborview Medical Center sees these older kids admitted with serious abdominal injuries, spinal fractures, and head injuries because the seat belt doesn’t hold their torso in a crash.
  • Don’t negotiate on car safety. Dr. Ebel and I both keep extra inexpensive booster seats and ask that every kid traveling in our car use one and provide it to others driving our children. Even JUST this week my 4th-grader was complaining about his booster but there’s no negotiating here. He’s not 4 foot 9 yet. And the booster helps position the seatbelt properly.

Hope this all helps amplify your resolve to be awesome at using car seats and seat belts and waiting to turn your babies to face the front long after age 2 years. And also, watch this, a good reminder for us ALL behind a wheel: