Car seat stress: Pro tips from a Cotswold pediatrician

“Buckle up, buttercup.”

I used to say this to my daughter when she was a toddler to try and convince her not to fight the car seat. Sometimes it worked and sometimes it didn’t. Funny, though — of all of the things I as a parent would compromise or negotiate on, this was not one of them. Safety is non-negotiable.

Which one should I buy?

I am always asked at the office what car seats I recommend. Which brand did I use? My answer has always been the same:

1) I checked the car seat crash test ratings online at www.nhtsa.gov and looked up the 5-star ratings (who wants a 1-star car seat?)
2) I cross-checked pricing of the top 5-star rated car seats based on my child’s age and weight, and…
3) Bought it at a local retailer — Target, Wal-Mart, etc.

I DO NOT buy car seats secondhand, at consignment stores or yard sales etc. because the history of those seats is NOT known. Any car seat that has been in an accident should be thrown away as it may have been weakened from a crash, or it may have been recalled.

How do I install it?

Read the instructions for your vehicle and the child safety seat to determine the best location and way to secure your child’s car seat. Still having problems? Visit the calendar at www.safekidscharmeck.org to find a car seat check where a certified technician will help you install your seat, or attend a class on choosing, using and installing a child safety seat at Carolinas Medical Center.

Need another area of the state or country? Visit www.buckleupnc.org or www.seatcheck.org.

Even as a pediatrician who read every manual for my children’s car seats, I struggled with putting them in correctly. And once I was sure it was correctly installed and secure — despite the infant seat being safer than my own seat belt — I still ‘white knuckled’ the steering wheel and put my flashers on as I drove home from the hospital with my wife and newborn son in the back.

How old, again?

The American Academy of Pediatrics recommends as best practice, children convert from rear-facing to front-facing no earlier than two years old. After the age of 2, consult the height/weight instructions for your car seat to determine the best seat and seating position for your child.

A booster seat can be used for children over 40 pounds and less than age 8 (or under 80 pounds). The booster seats help properly position the seat belt over your child’s shoulder (not neck) and hips/waist (not stomach). Most children cannot sit in just a seat belt without a booster until age 8, are over 80 pounds and close to the 57-inches-tall mark. My kids begged and begged to get out!

A regular shoulder-lap belt for children should be used when the child is age 8 or 80 pounds. A correctly fitted seatbelt has the following requirements:

1) the child can sit all the way back against the seat
2) their knees bend comfortably/hang down at the edge of the seat
3) the shoulder belt crosses between their shoulder and neck
4) the belt portion sits on hips and touches their thighs
5) they will not unbuckle it!

Winter coats make a difference, too

Don’t forget that bulky winter coats reduce the safety of car seats. Taking your child out of a coat and using it as a blanket is much safer! Stay safe AND warm.

“But my friends all sit up front”

I have the same answer for my kids as my parents did about many things: “I am not their parent.” Sure, the law says children age 13 and older could sit up front. But considering most deaths in car accidents are in front passengers, my answer is always no when there is a seat available in the back… Non-negotiable, remember?

The laws and rules seem like a confusing mess, but if you ever have questions, ask your pediatrician or check out www.buckleupnc.org.

Andrew W. Gunter, MD

Medical Director, Cotswold Pediatrics

(Note: This content was co-created with Atrium Health.)