Doctors’ Notes


Car Seat Safety (Over 4 Years)

So for all of you who read the first article on Car Seat Safety, here’s Part 2 to address questions for children over age 4.

For children over the age of 4, Motor Vehicle Accidents are still a major cause of death.  Approximately 5,000 deaths occur each year  due to MVA’s. As a result of these sad statistics, the American Academy of Pediatrics published new car safety guidelines last year.


PA State Law requires:

  • Children ages four (4) and older, but under the age of eight (8), must be buckled into a federally-approved child booster seat, which must be secured to the vehicle by the seat belt system, no matter where they ride in a vehicle (front or back seat). Booster seats must be used in conjunction with lap and shoulder belts.
  • Children ages eight (8) and older, but under age 18 must be buckled in a seat belt, no matter where they ride in the vehicle (front or back seat).Drivers are responsible for securing children in to an approved child passenger restraint system and ensuring children under age 18 are buckled up.

We also recommend that children under age 13 NEVER ride in the front seat.


There are a few ways to determine your child has outgrown the forward facing car seat:

  • They reach the top height/weight recommendations as stated in the manual
  • Their shoulders are above the top harness
  • Their ears have reached the top of the seat.

If your child has met any of these guidelines, it’s time to place in a booster seat.


Booster seats are designed to raise your child so the lap and shoulder belts fit properly across the mid-chest and shoulder and across the top of the upper thighs.  You can purchase high-backed booster seats or backless seats.  In each, case the seat belt is used to anchor the child. Many booster seats have guides that will keep the belt in the proper positions.

A booster seat is generally not fixed in the car using the LATCH system; it usually sits in the seat and is anchored with the child by the seat belt. An exceptions to this is a convertible seat  that is anchored using the LATCH system.  A convertible seat can go from 5-100 pounds, so there will be a 5-point harness; as the child outgrows the forward-facing seat, the seat belt is used instead of the harness.

Advantages to a backless booster seat are that they are less expensive, less cumbersome, and easier to move from one vehicle to another. They should not, however, be used in a vehicle that has no head rests or has low seat backs.

A high-backed booster seat is more expensive and generally can be used as more than just a booster, though it’s heavier, more cumbersome, and so not as easy to move from vehicle to vehicle. High-backed booster seats can be used in cars without headrests or low back seats.

When purchasing any seats, be sure the seat fits properly into your vehicles!


So now that we’ve covered from infant to age 8, or a bit older, what do I need to know about seat belts for my older children?

Children should be restrained in a booster seat until they reach approximately 4’9” tall. They should then be big enough to fit properly in an adult Lap and Shoulder Belt.  Remember that they should still be in the back seat until the age of 13.

A shoulder belt fits appropriately if it lies in the mid-chest and not up to the neck and throat. The shoulder belt should never be tucked under the arm, as this leaves the chest unprotected. The lap belt should fit across the upper thighs. Your child should also be able to sit comfortably with his or her back against the seat and legs bent at the knees. If all of these recommendations are met, your child can be safely restrained in a seat belt, AND you can say goodbye to the car seat and booster seats!


Remember — as parents, car safety starts with us. No matter who your child is travelling with, be sure he or she is appropriately restrained!  And, as adults, we should always wear seat belts properly and set examples for our children.

Safe travels!

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

For information on younger children, see Dr. Hartung’s Note on Car Seat Safety for Infants to 4 Year Olds.