“Dr. Linda, why do we need to use a car seat?”

When used properly, studies on car seat safety show that car seats lower the risk of death in car accidents by 71% in infants and by 54% in children between 1-4 years of age. They also lower the risk of serious injuries by 67%. One of the most important investments you will make in your child’s safety is in car seat safety.

Car seats are so important that hospitals in developed countries will not allow you to take your newborn home unless you have a car seat.

Remember: Car seats are made for transporting your baby in a car or other vehicle and not for use as a place for your baby to sleep. The risk of SIDS (sudden infant death syndrome) is higher in babies who sleep in their car seats rather than in their bed at night and at nap time.

This article is your guide to optimal car seat safety - to keep your little one safe and healthy! It is one of our many practical guides for raising holistic, thriving babies and children.

Choosing the right car seat for your baby is only the first step toward keeping your baby safe in the car.  It is just as important to make sure that the car seat is installed properly and that you use it correctly!

What you need to know when choosing a car seat for your baby/child 

  • Infants and babies less than 2 years old should be in rear-facing car seats.
  • Different types of car seats are safe for different ages.
  • All car seats/booster seats for babies and children under 13 years of age should be in the back seat of the car.
  • Infant car seats are only safe for infants less than 20 pounds(10kg) and can only be used rear facing. They have a base you strap into the car and leave there, and a seat that you can remove from the car. Remember, it is not safe to use the seat as a place for your baby to sleep.
  • You can keep your baby in the infant car seat till he/she has outgrown the maximum height or weight rating of the car seat After this move your baby to a convertible car seat. Make sure the new seat is safe for your baby’s height and weight.
  • Convertible car seats can be used for infants (always note the minimum and the maximum weight and height ratings), older babies, toddlers, and preschoolers.
  • Either type of car seat should be backward facing until your baby is 2 years old after which they can be switched to forward-facing car seats.
  • After your child outgrows the convertible car seat s/he will still need to stay in a “belt-positioning booster seat”, booster seat, for short until the regular seat belt of the car fits properly. A properly fitting seat belt lays halfway across your child’s shoulder and very low on the lap under your child’s tummy and just above the thighs. A loose shoulder strap could hurt your child’s neck in the case of an accident and a loose lap strap could rupture an organ. Kids can usually move out of a booster seat when they are taller than 4 foot 9 inches tall and between 8-12 years old.

Common Car Seat Safety Challenges 

The three most common car seat challenges are :

  • Incorrect car seat for your baby’s age or weight or height.
  • Improper fit in the car.
  • Improper fit of your baby in the seat

How to avoid these challenges

Get the proper car seat for your baby’s age, weight, and height.

  • Check the information on the side of the seat to make sure it is appropriate for your child’s age, weight, and, height.
  • Look at both the minimum and maximum ratings if you have a small baby. If your baby is very small, make sure that the seat is safe down to your baby’s present weight.

Install the Car Seat Correctly

  • Read the manual that comes with the car seat as well as your car manual.
  • Make sure that the seat is safe to use in your car.
  • Install the seat properly in the back seat.
  • The car seat needs to face backward till your baby is at least 2 years old or he outgrows the height and weight limits on the seat.
  • The car seat needs to be strapped in so tightly that you cannot move it more than an inch (1.5cm) from side to side and front to back. If it wiggles more than that amount, it’s not safe.
  • The car seat needs to be at the correct angle in the car so that the baby’s head does not flop forward and close the airway. There is a little level on the side of car seats to help you with this.
  • Here is a great resource for you to watch as you get ready to install your baby’s car seat. https://www.safercar.gov/parents/CarSeats/How-To-Install-Car-Seats.htm?view=full
  • If you’re not sure you’ve installed the car seat properly, many fire and police stations have specially trained people who can check that you have installed the car seat correctly and correct any problems they may find.

Make sure your baby fits snugly and safely in the Car Seat

  • The slots for the shoulder straps should be at your baby’s shoulder level or just below.
  • The harness strap needs to be strapped snugly enough around your baby’s shoulders that you can’t put more than your thumb between baby’s chest and the strap and you can’t pinch any extra strap at the shoulders.
  • Make sure that the chest clip is at the center of your baby’s chest even with the armpits.
  • Do not add anything to the car seat to make it ‘fit better’ that is not approved by the manufacturer.
  • In the winter bulky snowsuits and clothing can actually make the fit of the straps too loose on your baby in case of an accident. Dress your baby in many thin layers rather than one bulky piece of clothing.  If you’re not sure how many layers to use, a good rule of thumb is to dress your baby in one layer more than you have on.

“Dr. Linda, is it safe to buy a used car seat?”

Here is what you need to know when Buying a Used Car Seat:

  • Has the car seat been in an accident? If a car seat has been in a moderate or severe accident it may not be safe to use.
  • Does it have all its original parts? Any parts that are not original to the car seat should not be used or relied on as they are probably not safe.
  • What is the expiration date of the car seat? Plastic may lose strength over time, so you need to make sure the seat is not past its expiration date. Most car seats expire between 6-10 years after they are manufactured. You may find the information on the seat itself or in the manual. If you can’t find it - call the manufacturer or search online using the make and model number.

If you know that the car seat has not been in an accident and that it has all it’s original parts and is not past its expiration date, then it is safe to buy the car seat. If all three of these are not present, you are probably safer to buy a new one or a used one that meets all safety criteria.

“Dr. Linda, my baby is a preemie and he only weighs 5 pounds. What kind of car seat should I get?”

How to Choose a Car Seat for Your Preemie

Choosing the right car seat for car seat safety for a small or preemie baby is very much like choosing one for a bigger baby with a few extra precautions:

  • Make sure you get a car seat rated as safe for babies down to 4 pounds(1.8kg). Check the label on the side of the car seat or read the manual to see the minimum weight rating of the car seat.
  • Make sure that the straps fit baby snugly and securely.  Just like in bigger babies, the slots for the shoulder straps need to be low enough that they are at the level of your baby’s shoulders or right below. This way you know that the straps will be nice and tight on your baby’s shoulders which will hold him/her securely in place in case of an accident. If the straps are too loose baby won’t be safe!
  • It is not safe to use blankets or pillows to ‘fix’ the fit of the straps. Very small babies may slump over to the side and possibly close off their airways. Talk to the hospital staff about using very tightly wrapped receiving blankets on either side of the baby to hold them upright.
  • To secure the car seat in the car only use parts that came from the car seat manufacturer.
  • Bring the car seat to the hospital before discharge to check the fit of your baby and that your baby can tolerate the angle of the car seat
  •  If your preemie can’t tolerate the angle of the car seat or your doctor tells you he/she needs to lie flat during travel, talk to your doctor about using a car bed. Make sure it meets the  Federal Motor Vehicle Safety Standard 213. ( It should say it does in the car bed’s manual).Before leaving the hospital ask the hospital staff to check your baby can lie safely in the car bed.

Remember …

  • Size does matter.
  • Fit matters.
  • Car seats should be backward facing for the first two years.
  • Babies and children need to be in the back seat until they are 13 years old.
  • Never leave your baby alone in the car, even if s/he is in their car seat.
  • Register your baby’s car seat so that you can be informed if there is a safety recall on the seat.

 As always, thank you for visiting…and please leave a comment to share your experiences.

To your holistic health,

Have a happy, healthy day,

Ask Dr. Linda