2018 AAP Recommendations for Car Seat Use
The 2018 recommendation that all children be secured in a rear-facing car seat as long as possible is a significant change that was based on motor vehicle crash data in the United States. This recommendation highlights the need to support a child’s head, neck and spine and the importance of the crash forces being spread across the entire body. Young children have larger heads compared to the rest of their body size and the bones in their spine are still developing. When a vehicle makes a sudden stop or is involved in a crash, a rear-facing car seat will cradle a child’s body and spread out the force of the crash, reducing the risk of injury to the head, neck, and spine.
Summary of Evidence-Based Best Practice Recommendations
- All infants and toddlers should ride in a rear-facing child safety seat until they reach the highest weight or height allowed by their car seat’s manufacturer.
- Children who have outgrown the rear-facing weight or height limit for their child safety seat, should use a forward-facing child safety seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat’s manufacturer.
- All children whose weight or height is above the forward-facing limit for their child 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 in height 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 use a lap and shoulder belt.
- All children younger than 13 should be restrained in the rear seat of the vehicle.