What to consider when choosing and using a car seat

Choosing a car seat is one of the first tasks new parents do to protect their children – often even before their child is born.

Vehicle collisions are a leading cause of death for young children but proper car seat and seat belt use can reduce a child’s risk of injury by more than 70% and the risk of death by 28%, according to the American Academy of Pediatrics.

In Minnesota, 12,827 children age 7 and younger were properly restrained in car crashes between 2019 and 2023. Of those, 89% were not injured. Another 10% had only minor injuries, according to the Office of Traffic Safety. Along with being an attentive driver, following recommendations for car seat and seat belt use can save lives. Learn more about Minnesota’s car seat guidelines.

Parents and grandparents might bemoan the recommendations, saying they were fine without a booster seat as a child themselves. Nonetheless, the American Academy of Pediatrics looked at car crash data and made recommendations to keep kids safe.

“Just because you survived to a ripe age of parenthood even though you were put on the floor with no seatbelt when you were a kid doesn't mean that that's the safest choice for your child. Cars change. Guidelines change,” said Jordan Marmet, MD, a board-certified pediatric hospitalist with M Health Fairview and associate professor of pediatrics at the University of Minnesota Medical School.

There are dozens of choices, including convertible seats that convert from an infant carrier to a booster seat as the child grows. All car seats on the market meet minimum safety requirements. If you get a used car seat, even if it’s just for occasional use such as in the grandparents’ car, check for recalls. If your budget is a concern, you can also look for car seat distribution programs in your county.

The choice of which particular seat will work best for your family is yours, but there are a few universal rules for the road:

“I would read through what the manufacturer says and decide what makes the most sense for the given situation,” Marmet said.

Four car seat stages to help protect kids

Car seat recommendations are divided into four stages that take kids from infancy to their teen years. There is some wiggle room on the following the recommendations since families, kids, and

vehicles come in different shapes and sizes. For example, some kids will outgrow their car seat before the recommended age – and some will be safest riding in the smaller seat a bit longer.

Your child’s yearly wellness check is a great time to talk to their primary care provider about what’s safest for your child.

Rear-facing car seat

Young babies spend a lot of time in their car seat, particularly the ones that double as carriers. In this phase, caregivers need to be particularly mindful of their child’s positioning. The same rules that apply to safe sleeping also apply to car seats since babies often fall asleep in their car seats.

“Babies don’t have good neck strength or control,” Marmet said. “There shouldn’t be anything that can obstruct their breathing.”

In the same way that a baby can sleep in a sack in the crib, a baby should be fine in a car seat on a cold Minnesota day. Just make sure the car seat straps are tight to avoid slippage and check that there’s nothing that might cover the baby’s mouth.

Understandably, caregivers might be reluctant to wake a sleeping baby to take them out of their carrier. If that’s the case, leave all the buckles fastened to prevent the baby from slumping down in the seat, which could block their airways and restrict breathing. Keep an eye on the child and avoid setting the carrier on furniture like a table or bed, where it could be knocked over.

The safest place for the littlest kids to ride is in a rear-facing car seat in the back seat of the vehicle. Try not to be in a rush to turn them around. Kids should stay in their rear-facing seat until they reach the maximum height or weight of the car seat model, which is usually 35-40 pounds. These seats are designed to correctly position little kids, who are at particular risk of head and spine injuries.

“If you're in a car collision, you want to make sure that baby's head is safe,” Marmet said. “When their neck is relatively weaker, we want to make sure that they're protected from the most common kind of crash, which is a front-to-back crash.”

Forward-facing car seat

Once they outgrow their rear-facing car seat, kids in the wiggly preschooler stage can move into a forward-facing seat with a harness and top tether. Kids usually stay in these seats until they turn 5 or reach the maximum height or weight for the seat.

Booster seat

Once they no longer fit in the forward-facing seat, kids can move into a booster seat and use the car’s seat belt. Booster seats are recommended until kids reach the maximum weight for the booster and the vehicle’s seat belt fits properly without a booster seat. Kids usually outgrow their booster seats between the ages of 9 and 12.

Vehicle’s seat belt

You’ll know a child is ready to use a car’s seat belt without a booster when:

For all car seat stages, read the manual that came with the seat and follow height and weight guidelines. 

Special circumstances

Kids and adults with special needs may need to consult with an orthotist who can help with a modified car seat tailored to the individual.