Child Passenger Safety: AAP Updates Best Practice Recommendations
Am Fam Physician. 2019 Apr 15;99(8):525-526.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Infants and toddlers should ride in a rear-facing car safety seat until they reach the highest weight or height allowed by the car seat manufacturer.
• Children who have outgrown the rear-facing weight or height limit for their car seat should use a forward-facing seat with a harness as long as possible.
• When the children have outgrown the forward-facing seat limits for the car seat, they should use a booster seat until the lap and shoulder parts of the seat belt fit correctly.
• All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.
From the AFP Editors
Child safety seats reduce the risk of injury and death when compared with seat belts. There has been an increase in scientific evidence supporting the use of child safety and booster seats. The American Academy of Pediatrics (AAP) has updated best practice recommendations on child passenger safety based on this evidence. There are five evidence-based recommendations to improve safety in passenger vehicles for children from birth through adolescence.
Best Practice Recommendations
INFANT-ONLY OR CONVERTIBLE CAR SEAT USED REAR FACING
Infants and toddlers should ride in a rear-facing car safety seat until they reach the highest weight or height allowed by the car seat manufacturer. They have relatively large heads and several structural neck and spine features that place them at higher risk of head and spine injuries in motor vehicle crashes. Once the highest weight has been reached using the rear-facing seat, they should continue riding rear facing in a convertible seat. Most convertible seats can be used rear-facing up to 40 lb (18 kg) and up to two years of age or longer.
CONVERTIBLE OR COMBINATION CAR SEAT USED FORWARD FACING
Children who have outgrown the rear-facing weight or height limit for their car seat should use a forward-facing seat with a harness as long as possible. Most seats are appropriate up to 65 lb (29 kg) with some
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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