Doctors’ Notes


Car Seat Safety (Newborn to 4 Years)

For all of the parents out there confused about the changes in car seat recommendations and what’s appropriate for your child — we’re going to shed some light on things in this week’s Doctor’s Note…

Motor Vehicle Accidents are one of the biggest causes of injuries in children. To prevent these injuries, it’s imperative that your children be properly restrained in a car seat , booster seat, or seat belt at all times.

Pennsylvania law states that all children under the age of 4 need to ride in a federally approved car seat.

Car Seat

Children should ride in a rearward facing car seat placed in the back seat of the vehicle until they reach the seat’s maximum height and weight limit. Studies have shown that children rear-facing are five times less likely to be injured in a car accident, and that using the correct car safety seat or booster seat can help decrease a child’s risk of death or serious injury by over 70 percent.

Remember you must always follow the height and weight guidelines for your specific seat. All seats will have variations in the maximum height and weight restrictions — and those, not a child’s age, are what determine the effectiveness and safety of a particular seat.

Which Seat is Best?

Many of you ask what’s the best car seat to have.  But there is no best or safest seat. The seat that’s best for you is the one that fits in your vehicle and in which your child fits properly.

We recommend that you look at the car seat and choose one that appropriate for your child and for your use.  We don’t recommend that you buy a seat based on price! A higher priced seat may not be safer or easier to use.

Never use a seat that you are unsure of its history.  If you’ve been given a “used seat,” inspect the seat for any damage.  Also look for the manufacturer and model number, then check the manufacturers website or go to for any recall information.  You should not use a seat that was in a previous accident. The American Academy of Pediatrics web site has a list of car seats and features that you may find helpful.

There are 3 different types of seats.

Rear-Facing Only

The first seat is the rear-facing only seat, which in most cases can be used up until 22-35 pounds, depending on manufacturers recommendations.  Advantages to this seat are the relatively small size and carrying handles.  This seat comes with a base that can be anchored in the car.  You can purchase multiple bases and use the same seat in multiple vehicles.  Keep in mind that the carrying handles are great, but that the child and the seat together do get a bit heavy!  (I speak from experience on this fact!)  So before you buy, think “Do I really want to carry a 35-pound child and the seat?!)

Convertible Seat

A Second option is the convertible car seat, which is able to go from rearward to forward facing once the child is old enough based on the manufacturers recommendations. These seats are bulkier and do not have a carrying handle, but their weight and height requirements are higher than the rear-facing-only seats, so they’re ideal for larger children and can be used for a longer period of time.  On average, the maximum weight recommendations for rear facing is 40-45 pounds.

3-in-1 Seat

A third option is the 3-in-1 Seat, which can go from rearward to forward facing and then can be used as a belt positioning booster seat.  As with convertible seats, 3-in-1s have no carrying handle and are much bigger in size, so be sure the seat will fit properly into your vehicle.  Advantages to this seat are also that the height/weight requirements are higher, that they can be used for bigger children, and that they can be used for a longer period of time. These seats can generally be used as belt positioning booster up until 80-100 pounds.

After you’ve chosen your seat, you need to make sure it’s properly installed in the car. All cars made after September 1, 2002 are equipped with the LATCH system (Lower Anchors and tethers for Children).  The lower anchors are used at the base instead of the seat belt, and the upper tethers are used for the forward facing seats.  If you are having trouble, refer to you car manufacturer’s guide for information, or look for a Certified Passenger Seat Technician to assist you.

In the Back Seat

Children should ride in the back seat until age 13, so car seats should be installed in any area of the back seat to get a tight fit. In some cases you may be able to get a proper fit in the middle seat; if not, then install the seat behind either of the front seats. Be sure there is a tight fit. If you can move the seat more than 1 inch side–to- side or front-to-back, it’s not tight enough.  Also make sure the angle is set so that the baby’s head does not fall forward.  In most seats there is an angle indicator, which tells you if the seat is properly installed at the correct angle.

5-Point Harness System

So now you’ve chosen your seat and it’s properly installed in the vehicle.  The next step is to ensure your child is in the seat properly. Until your child graduates to a belt-positioning booster, he or she should be in a 5-point harness system.

In a rearward facing seat, the harness should be at or just below the child’s shoulders. It should be snug, and the harness clip should be at mid-chest level.  Ideally in the winter, it’s best to not dress your children in heavy coats while in the seat.  A better solution is to dress them in lighter clothes and cover them with a blanket. The harness will fit much better. You can buy fleece-lined covers for the infant carriers which will keep the child warm without all the bulky layers. (This is a wonderful thing that someone, somewhere came up with!)

Once your child transitions to a forward-facing seat, the shoulder straps should be at or just above the shoulders, and again the harness should be snug. Once again, avoid the bulky winter coats for the best fit.

A Few Take Home Points

  • Car seat recommendations are just that… Recommendations to keep your child as safe as possible.  There may be exceptions to the recommendations, so always follow the guidelines of you car seat manufacturer.
  • All infants under 24 months should be rear-facing. Recommendations are to continue this position until the child exceeds the recommended height/weight for the seat.
  • Never allow your children to ride in a car without proper restraint!
  • Choose a car seat that works for you, your child, and your vehicles. (Even if you know someone who loved a particular car seat, that seat may not work for your situation.)
  • Never throw away your manufacturers’ recommendations.

With these tips and strategies, you can always keep your children safe!

For information on older children, see my Note on Car Seat Safety for Children 4 and Over.

Dr. Alicia Hartung, a shareholder in the practice, has been a Kids Plus Provider since 2001.