In 2017, the American Academy of Pediatrics released the newest car-seat safety recommendations. This is an important review, particularly given one of the leading causes of death among children 0-19 years old is motor vehicle accidents. Appropriate use of car seats and following car safety guidelines helps to keep our children safe.

Infants and toddlers: All infants and toddlers should ride in a rear-facing car seat (either a rear-facing only infant bucket seat or a rear-facing convertible car seat) until they are at least 2 years old or reach the highest weight or height allowed by the car seat manufacturer (those specific limits can be found on the back of each car seat.) Studies show that infants and toddler are five times safer while riding rear facing. Many families are concerned that the legs are “too long.” However, studies show there is no increased risk of leg injury with rear-facing car seats.

Toddlers and preschoolers: Children who have outgrown the rear-facing weight or height limit for their convertible car seat should use a forward-facing car seat with a five-point harness for as long as possible, up to the highest weight or height allowed by the car seat manufacturer. It is best for children to ride in a car seat with a five-point harness until at least until 4 years old, if not longer.

School-aged children: All children who exceed the height or weight limits of the forward-facing, five-point car seat should us a belt-positioning booster seat until the vehicle seat belt fits properly, typically at 4-foot-9, and the children are between 8-12 years old.

Older children: When children are old enough and large enough for the vehicle seatbelt to fit correctly, they should use lap and shoulder seat belts for the best protection. All children should ride in the backseat until they are 13 years old.

An adult seat belt fits correctly when: 1) The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat; 2) The lap belt is low across the upper thighs, not across the abdomen; 3) The child is tall enough to sit against the vehicle seat back with knees bent over the edge of the seat.

Teenagers and beyond: Once 13 years old, teenagers can ride in the front seat of the car while always wearing the lap and shoulder seat belt.

An important car seat safety recommendation to mention while heading into the fall and winter months: infants and toddlers should be dressed in thin layers underneath the buckled harness straps. For additional warmth, wrap a coat or blanket around the child on top of the harness straps. Bulky jackets and snow suits can compress in a car crash causing the car seat straps to be too loose, increasing risk of injury or death.

Each state has different laws regarding car safety that are considered the minimum standards; however, most safety regulators in North Carolina encourage following best practices as outlined in the above AAP recommendations. The North Carolina car safety laws are outlined below.

Infants and toddlers: Legally, a child can face forward as long as he meets the minimum requirements for forward facing specified by the car seat manufacturer (generally 1 year old and 20 pounds)

School-aged children: When a child reaches 8 years old or 80 pounds, a properly fitted seat belt may be used instead of a child restraint or booster seat. Legally, although not recommended, a child may sit in the front seat once 5 years old and weighing at least 40 pound.

All of the above information is printed at healthychildren.org and at buckleupnc.org. More detailed information of car safety recommendations and North Carolina state laws can be found at each of those sites.

Karen Fieselman Stroud, MD, FAAP, is a physician with Washington Pediatrics, 1206 Brown St. and can be reached at 252-946-4134.