savannah pediatricians

Car Seat Safety Guidelines – New 2018 AAP Recommendations

by Adria H. Wilkes, MD, FAAP

At Pediatric Associates of Savannah, we know how important it is to protect your children. One of the most important ways is by keeping them safe in a possible car accident. Statistics show that greater than 50,000 children and adolescents less than the age of 21 dies in motor vehicle accidents per year and these crashes are the leading cause of death for children ages 1 to 12 years. Unfortunately, 3 out of 4 kids are not as secure in their car seats as they should be. If car seats are used correctly, they are 71% effective in preventing injury among infants and 54% in children ages 1-4, while proper use of a booster seat decreases the likelihood of being injured in a crash by 59% compared to wearing a seatbelt alone. Now that we know the sobering statistics, what are the current laws and recommendations?

Georgia law states that all children less than the age of 8 should be in a car seat or booster seat and in the back seat. The seat should be appropriate for the child’s height and weight, be installed correctly, and meet federal requirements. Exemptions would include those children taller than 57 inches. While the law states that all infants <1 year of age should be rear-facing, they recommend rear-facing as long as possible. However, the current recommendations for car seat safety are much more stringent.

The American Academy of Pediatrics just updated their recommendations as of August 30, 2018. The new policies state that rear-facing car seats are safest as long as possible until the child meets the maximum height/weight requirement from the manufacturer (at least until 2 years, but possibly as long as 4 years). They then recommend some type of forward-facing car seat with a five-point harness until the child meets maximum height/weight requirement from the manufacturer (so generally until around 8-12 years of age). Once they outgrow this seat, the child may then move to a forward-facing booster. Children may move to the standard seatbelt sometime after 8 years of age and usually at 57 inches or taller. The final recommendation is that all children less than 13 remain in the backseat of the car.

Types of Car Seats

1. Rear-Facing: These seats all have the 5-point harness, in a crash they cradle and move with the child to reduce stress to the neck and spinal cord.

  • Infant- rear-facing only, is small and portable (usually has carrying handle and the base is left in the car), infants usually outgrow by 8-9 months
  • Convertible- can start as rear-facing but then be moved to forward facing as the child grows, has both harness and tether, bulkier and stays in the car
  • All-in-One- can also start as rear-facing but then turned around, also has both harness and tether, and can then transition to booster

2. Forward-Facing: These seats have both the 5-point harness and utilize the LATCH tether system which limits the child’s forward movement

  • LATCH (lower anchor and tethers for children) – max weight usually 65lbs
  • Convertible
  • Combination – transitions from forward-facing with harness/tether to booster
  • All-in-One

3. Booster: Positions the seatbelt so that it fits properly over the stronger parts of the body

  • Booster with High Back: boosts the child’s height so that the belt fits properly, provides neck and head support
  • Backless Booster: boosts the child’s height for proper belt placement but does not provide the neck and head support
  • Combination
  • All-in-One


  • The shoulder belt should fit across shoulder and chest, NOT the neck; lap belt should fit low over the hip and thigh bones, NOT the stomach
  • All children in the back seat until 13 years of age

Other Helpful Tips:

  • Place harnesses in slots at or below the child’s shoulders and make sure it is snug. Clip plate should be at the center of the chest, even with the armpits.
  • The car seat should be installed tightly either with LATCH or locked seatbelt and should not be able to move more than 1 inch.
  • Do not put a child in the car seat with bulky clothing/jackets. These may compress when in a crash and leave the straps too loose.
  • When shopping, avoid buying a used car seat or one that has been in an accident.
  • Follow instructions from the manufacturer regarding installation and height/weight requirements.
  • Check out the National Highway Traffic Safety Administration site for more information, to utilize their Car Seat Finder (by plugging in the child’s date of birth, height, and weight), and to find a certified child passenger safety technician near you.

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