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Car Seat Safety

Chloe Rowe, MD discusses the importance of car seats and how parents can help keep their children safe when riding in automobiles. She shares tips on how to select the best car seat for their child well before they're born.
Car Seat Safety
Chloe Rowe, MD
Chloe Rowe, MD is an Assistant Professor of Clinical Pediatrics, Weill Cornell Medicine and Assistant Attending Pediatrician, NewYork-Presbyterian/Weill Cornell Medical Center.

Melanie Cole: There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kid's Health Cast from Weill Cornell Medicine. I'm Melanie Cole and our topic today is car seat safety. Joining me is Dr. Chloe Rowe. She's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Rowe, it's a pleasure to have you join us again today. Please tell us a little bit about car seats. What's important for parents to know. Are there any new changes and recommendations that we should know about?

Dr. Rowe: Yes. So this is a very important topic. If you think about the fact that one of the most dangerous things a child can do is ride in a car. Motor vehicle crashes are the leading cause of death for children over four years old. Using the correct car seat or booster seat can help reduce the risk of death or serious injury by over 70%. And the biggest change in recent years is the recommendation that children should ride in a rear facing car seat as long as possible. So the American Academy of Pediatrics no longer recommends two years of age as the time when a child changes from a rear to a forward facing seat. So again, that big change is that children should ride in a rear facing seat as long as possible.

Host: For parents to be, when should they start planning and looking for car seats? I remember as a parent, Dr. Rowe, it's a big deal looking, you know, you look at all the different items and there's so many on the market. So when should they start planning and looking for car seats?

Dr. Rowe: We need to be thinking about purchasing a car seat even before the child is born. As you know, parents are not allowed to leave the hospital with their newborn without a car seat. So you really do have to plan ahead. The first car seat a newborn will use is a rear facing infant seat. It's usually has like a convenient handle for carrying and can be snapped in and out of a base that's installed into your car or vehicle. Now this seat can only be used rear facing. So when purchasing, you want to keep in mind that babies will outgrow this seat before their first birthday. So you're not going to need to have this long-term or spend lots and lots of money on that first infant only.

Host: That's really important information for parents to know about that first seat. So how long should a child be kept in a rear facing car seat? When can a child go from rear facing to forward facing? Because I remember feeling a little uncomfortable that they're still facing rear, you know, you want to be able to look at them. You think maybe that they're more uncomfortable, but that's not really the case. And it's so much safer, right?

Dr. Rowe: Correct. And that's really the big change here that we want to highlight. So once your infant or young child outgrows that rear facing infancy, they should continue to ride rear facing in what's often called a convertible seat. So a convertible seat is a seat that can accommodate a larger child and can be positioned either in the rear or forward-facing position. So children should ride rear facing as long as possible up to the limits of their car seat. And this will virtually include all children under two years of age and most children, even up until age four, most of our currently available convertible seats can be used rear facing until at least 40 pounds. So once children outgrow that rear facing seat, then they can be turned to be forward facing in their car seat. They should remain in that position until they reach the seats weight and length limits. Most of our forward facing car seats on the market can accommodate children of up to 60 to 70 pounds.

Host: Well then Dr. Rowe, what are some concerns that parents have told you based on these new recommendations?

Dr. Rowe: So, parents often worry about the child's legs being cramped, especially in a larger or an older child. Who's in the rear facing position. We like to remind them that kids are very flexible and they're usually able to find a comfortable position even in that rear facing position, legs are rarely injured in the rear facing position in a crash. And what's most important really is that the head neck and spinal cord are much better protected in that rear facing position. And I remind parents just kind of jokingly that we can fix broken legs, but a neck or spinal cord injury can be much, much more serious. So that's really our priority and a little more on this. So because of factors like a large head compared to their body size, a high center of gravity, loose ligaments, small children are at much of an increased risk of a spinal injury in a crash. So in a sudden stop, a rear facing seat will cradle the child's entire back and spread out the force of the crash. And this reduces the risk of serious injuries to the neck and spine.

Host: So then continue on for us, Dr. Rowe, what's the next step for when a child gets to face forward then, and possibly even move to a booster seat. Now I was one of those parents that kept my kids in the booster seat, literally till they were 11 and 12 years old, but we're very small. We're not very tall as a family. And so they were kind of horrified, but there was no choice. So tell us what happens after the rear facing seat from the forward facing seat into the booster seat?

Dr. Rowe: Right. So you probably did the right thing, delaying that transition as long as possible is what we recommend, but when your child exceeds the weight and height limits of that forward facing seat, they can then safely ride in a belt positioning booster seat. And remember we mentioned that those forward facing seats can accommodate children of up to 60 to 70 pounds. So staying in that five point harness as long as possible is the safest.

Host: So then what's a booster seat like? And do we use the seat belt and tell us a little bit about the boosters?

Dr. Rowe: So, a booster seat is the next step after that forward-facing car seat and a booster seat is basically used to help the adult seat belt fit the child properly. So children should stay in a booster seat until they exceed the booster seats, height and weight limits. And until that adult seat belt fits correctly. So typically children are ready to come out of a booster seat when they're at least four feet, nine inches tall. And there are between eight and 12 years old. And generally more like 10 to 12 years old. So your age that you mentioned for your children is right on, and a couple of things to be aware of when you're using the adult seat belt for your child. So that shoulder belt needs to lie in the middle of the chest and shoulder and not hit the child at the neck or the throat. And the lap belt needs to be low and snug across that upper thigh or lower hip area. And it shouldn't be hitting the child in the middle of the belly or abdomen.

Host: So, are those the same recommendations for when a child is no longer in a booster seat? When are they able to ride just in the car using just the seat belt? What's important to know, and what are the criteria to move to that next level?

Dr. Rowe: As you mentioned, they have to be four feet, nine inches tall. And usually that's between age eight and 12 years old, all children under 13 years of age should continue to ride in the backseat with the adult seatbelt.

Host: Well, I'm glad that you brought up the backseat. So when can they start sitting in the front seat? I mean, I still don't like my kids in the front seat and they're older teens. So when can they ride in the front seat? How long can parents put that off?

Dr. Rowe: They can ride in the backseat forever if you choose. But if the child is 13 years or older and they can safely and securely fit in that adult seatbelt, as we mentioned, then they are permitted to ride in the front seat. But that of course is at the parents' discretion.

Host: What about the airbags, Dr. Rowe? Where do they come into play? Because the seatbelt, as you've said is so important, but those airbags come out and they can be pretty tough if you get into an accident, do we worry about that?

Dr. Rowe: We do. And that's why there is an age limit for riding in the front seat. You know, as we discussed with the rear facing younger children have looser ligaments, higher center of gravity and can be injured by an airbag if sitting in the front seat. So we need the child to be 13 years or older and be able to sit comfortably with their back against the back of the seat and the legs appropriately being able to reach the floor.

Host: So, what should families keep in mind when they're selecting a car seat? What car seats should we avoid? Tell us about the risks of using used or expired car seats. And what about buying one at a garage sale? We always see them there.

Dr. Rowe: Yeah. So it's really important not to use a used car seat. If you don't know the history of that particular seat, you don't want to be using a seat that's been in a crash, has been recalled, maybe expired. If you note cracks in the frame, or there are missing parts really important to check the expiration date of your seat, or use six years from the date of manufacturer, if there is no expiration date listed on the particular seat.

Host: And what about adding things to car seats, Dr. Rowe, like pillows and blankets, snow suits, should parents put a child in the car with their snow clothes on? Tell us a little bit about when we want to add things, to make them more comfortable in our own eyes.

Dr. Rowe: As a general rule, bulky clothing, including winter coats and snowsuits should not be worn underneath the harness of a car seat. So in a crash that fluffy padding immediately flattens out from the force and basically creates an extra potential space under the harness, a child can slip through the straps or be thrown from the seat. So parents often worry that their child will be cold in the winter. So we recommend adding a blanket on top of the harness straps or putting the child's winter coat on backwards over those buckled harness straps, after he or she is buckled into the car seat. And it's important to remember that if the item did not come with the car seat, it has not been crash tested, and it may interfere with the protection provided in a crash. So you never want to use sleeping bag inserts or other accessories that were not specifically designed to be used with your particular car seat.

Host: That's so important. And thank you for that. And we're comparing to find out more to learn about safe car seats and how to properly install them? Cause that's a big thing for new parents. They don't know how to really install them properly.

Dr. Rowe: Yes, that is very important. You can reach out to your local police or fire department, local hospitals, or your pediatrician. There are also lots of good websites,,,, which provide families a lot of good information about car seat safety.

Host: Well then wrap it up for us, Dr. Rowe, with your best advice about selecting a car seat for new parents and parents to be, and why it's so important that they follow these new recommendations and all the great advice that you've given us here today?

Dr. Rowe: So yes, I want you to remember that one of the most dangerous things a child can do is ride in the car. And the most important new recommendation is that children should ride in that rear facing position for as long as possible, in many cases until age four years old. And I think as parents and pediatricians, we're always looking forward to that next step or next milestone for our children. But it's really important to note that with car seats in particular, every transition is associated with some decrease in protection. Therefore parents should be encouraged to delay these transitions for as long as possible.

Host: What important information and that's really what it's about is protecting our children. And thank you so much Dr. Rowe for joining us today and thank you to our listeners. That wraps up today's episode of Kid's Health Cast. Please remember to subscribe, rate, and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates, please follow us on your social channels. I'm Melanie Cole.