April 2011    After a review of evidence-based recommendations for best practices, The American Academy of Pediatrics has published guidelines to maximize safety to children while traveling in a motor vehicle.  These recommendations include the ages of birth through adolescence.  A summary to the recommendations is contained below.  In addition you may click here  to see the recommendations directly. 

• All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their car safety seat
• All children 2 years of age or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their car safety seat, should use a forward facing car safety seat with a harness for as long as possible, up to the highest weight or height allowed by the manufacturer of their child safety seat
• All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt positioning booster seat until the vehicle lap and shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches and are between 8 and 12 years of age
• When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection
• All children younger than 13 years, should be restrained in the rear seats of vehicles for optimal protection

Dr. Miller Comment:  It is important to understand that each transition to the next level is associated with a lower level of protection.  Therefore, you should delay this transition as long as possible.  When purchasing a child safety seat, we recommend that you choose one with a higher height and weight allowance.  This will allow you to keep your child longer in the rear facing than forward facing car safety seat.   Purchasing a forward facing car safety seat (with a harness) with the highest weight and height limits will allow you to keep your child in this seat longer.  The harness will be safer than a booster seat.  Purchasing a booster seat and keeping your child in one until 4′ 9″ and between 8-12 years, will keep your child safer than moving to a traditional safety belt.  Finally keeping your child in the rear seat until age 13 will optimize safety over using a front seat.   The key is to keep your child in the safer level as long as possible.  While you and your child may look forward to the new transition and while the law may allow transitions at an earlier time, we will all agree that we want to keep our children as safe as the evidence shows us.