Things this doctor has been dying to talk about: the New Car Seat Recommendations


I ask teens and young adults the following question: “Is there anything you’ve been dying to talk to a doctor about?”  While the answer is usually a terse “no,” I have been surprised a few times.  Even shocked.  Well, if you asked me the same question but switched out “doctor” for “patient”, the answer would be yes.  There are some things I have been dying to talk about with my patients-namely the new car seat guidelines.  Why?  Appropriate car safety is critical to decrease your kid’s risk of dying or serious injury.

The American Academy of Pediatrics released their updated car seat guidelines this summer with a new recommendation that kids ride rear facing until FORTY POUNDS.  From 1999 to 2008 the number of fatalities in children under age 18 was almost cut in half.   However transportation in cars continues to pose a huge threat to children.  Children under 16 spend almost an hour a day in motor vehicles, making safety measures and appropriate child restraints extremely important.  

Some people are still wrapping their heads around the “new” car seat guidelines from 2011, where we recommended infants between 1 and 2 years old rear face in a convertible car seat.  My oldest son was 18 months at the time, so it was an easy choice. We complied; he’s now in third grade.  I’m always eager for updated safety recommendations in children, considering that for every kid that dies, about 18 kids will be hospitalized and > 400 will receive medical attention for crash related injuries.  

Big take home points in the new guidelines→

These are the recommendations to limit head and neck injuries and crash related injuries in general for children.  Kids should stay in a rear facing convertible car seat until 40 pounds.  Kids then transition to a forward facing car seat around age 4-5 until they outgrow it.  They move to a booster seat until FOUR FOOT NINE which is usually between 8-12 years old.  This helps to position the lap belt on their lap and not across their tummies to decrease risk of internal organ damage. (Note-my almost nine year old has one more inch to go and still rides in a booster. If your child is shorter than 4 foot 9, they should be in a booster.)  Kids under 13 should ride in the backseat.  This is because evidence has shown that kids under 13 are more likely to get injured from air bags and impact when riding in the front seat.

Ask any of my lab partners and premed classmates, and they will tell you that physics was not my favorite class.  But this is an easy physics concept. An object in motion stays in motion. If you are forward facing, on that initial impact your head will continue to whip forward. If rear facing, there is a firm car seat there to support your head from the initial injury.  Sure, there is an increased risk for leg injuries being crunched up.  But we have plenty of talented orthopedic surgeons who can fix long bone injuries with surgery or a cast.  You know what is very hard to fix? Your brain.  Traumatic brain injury is devastating.  Please keep your child’s head and neck safe in the event of crash. It contains everything that makes them who they are.  As a pediatrician, I love anything preventative.  And I am happy to have these updated guidelines to further protect our children.  What’s all the fuss about?  Please keep your children safe as they travel by car. daily.

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