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Can my 1-year-old ride in a forward-facing car seat?
Q: If my child weighs 20 pounds but is not 1-year-old yet, can she ride in a car seat facing forward?
Crystal Olathe
A: There's an old expression, 'The safest place for a child is in his parents' arms.' However, not in the car. In the United States, motor vehicle accidents are the leading cause of death in children over 1 year of age, killing over 2,000 children and injuring over 200,000 each year. Of the children who died, 60% were riding completely unrestrained: not in car seats, boosters, or seat belts.

Fortunately, we've learned that using car seats up to age 4 and booster seats from age 4 to 8 can cut the risk of serious injury and death in half. In addition, having all children up to 12 years of age ride restrained in the back seat better protects them from injuries from front-end collisions and airbags, and reduces their risk of dying in a car crash by one-third. Car seats, boosters, and seat belts are not only the safest way to ride, they're also required by law in many states.

Unfortunately, studies show that only 20% of families use their car seats correctly, and less than 10% use booster seats correctly to achieve the maximum safety for their children. Use the following tips to make sure your child is safely restrained in the car.

Choosing the Right Restraint
Be sure to use the correct restraint for your child's age and size:
  • Infants from birth to 1 year and 20 pounds should ride in a rear-facing infant-appropriate car seat. You may choose an infant-only car seat with a handle to use as a carrier, or a convertible seat that can be used rear-facing in the semi-reclining position for infants.
  • Children from 1 year and 20 pounds to 4 years and 40 pounds should ride in a child car seat. Safety advocates endorse car seats that have a five-point harness system to restrain the child at the shoulders, hips, and groin. Convertible car seats mentioned previously for infants can be readjusted to the sitting position and placed forward-facing for the older child.
  • Children from 4 years and 40 pounds to 8 years and 80 pounds should ride in a booster seat. Booster seats are necessary to position the child so the vehicle seat belt fits properly. Booster seats work best when used with an available combination lap/shoulder belt in the vehicle. If you have a booster with a removable shield, use the booster base with a lap/shoulder belt.
  • Children over 8 years and 80 pounds should ride in a lap/shoulder seat belt. Be sure that they use the shoulder belt properly, not behind their backs or under their arms.

Be careful, because not all car seats fit in all cars. When you're shopping for a car seat, ask the store representative to take the car seat out to your car and demonstrate that it fits properly and can be installed according to the car seat instructions and your car owner's manual. After buying a car seat, be sure to send in your registration card so you'll be notified if your car seat is recalled due to safety problems. You can also check the Auto Safety Hotline (888-DASH-2-DOT) or www.NHTSA.dot.gov to see whether your car seat has been recalled or needs to be repaired. And if your car seat has been in a crash, it may be weakened, so it's safest to get a new one.

Installing the Seat Correctly in Your Car
  • Infant car seats are positioned facing the back of the car. Always put the infant car seat in the back seat. Position the infant seat at a reclining angle, so the baby's head doesn't flop forward.
  • Child car seats and boosters are positioned sitting upright and facing forward. Once children graduate to using vehicle seat belts alone, it's still safest to keep them in the back seat until they're over 12 years old.

For all car seats and boosters, make sure the seat is buckled into the car correctly and your child is buckled into the seat correctly:
  • Strap the car seat into the vehicle seat belt according to the car seat and car manufacturer's instructions. Check whether you need to use a locking clip or tether to keep the car seat secure. Pull the vehicle seat belt as tight as you can.
  • In newer car seats, tethers are available to attach the upper back and the base of the car seat to anchoring mounts behind the seat of the vehicle. These tethers are designed to reduce your child's forward motion in the event of a crash. Car manufacturers factory-installed tether anchors in year 2000 models. Add-on tethers for car seats are made by most car seat manufacturers and are available at stores that sell the seats. If your car doesn't have anchors for the tethers, contact the car manufacturer and ask if a retrofit is available.
  • Once you've secured the car seat, try pulling it forward and side to side—it shouldn't move more than an inch in any direction.
  • Strap your child into the car seat and check the fit of the shoulder harnesses. The shoulder straps typically go through the lowest seat-back slots for infants, and through the highest slots for older children (refer to your car seat's instruction manual). Place the chest clip at armpit level to keep the harness straps on your child's shoulders, not his neck or face. Check their snugness—there should be only one finger's width between the harness and the child's body.
  • Let the experts help you: go to a free, drive-through safety seat check where certified technicians will check your child in her car seat in your car. These safety checks are sponsored by local police and fire departments, health departments, some automobile dealerships, National Highway and Transportation Safety Administration, and National Safe Kids Campaign.

Making Car Rides Safe and Fun
It's natural for children of all ages to occasionally complain about being restrained and to ask to sit up front. Try to be understanding of your children's feelings, but stay calm and insist on safety by positioning your child in the rear seat, and preferably in the center position. Here are some tips to try to make the ride both safe and fun:
  • Give your child advance notice of car trips to help him prepare. Try to leave a little extra time so you're not rushed.
  • Let your child have control of some decisions: whether to take a special toy, book or music tape in the car; what snack to take along; and whether to climb into the car and buckle herself in or let you do it. If your child insists on doing it herself, always double-check to make sure all belts are securely fastened.
  • Make sure he's dressed appropriately for the temperature inside the car—not too overdressed or underdressed.
  • Follow a routine in the car. You may sing a song as you buckle her in, play a game of peek-a-boo, and hand her the toy, book or stuffed animal. You may point out that everyone gets buckled in, even mom and dad. Turn on the children's music or story tape she chooses. Or talk about her day at school, tell stories, play games, and sing songs together.
  • If another child or adult is in the car, seat them together in the rear so they can entertain each other. If the children tend to squabble with each other, try to have separate activities for each.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician