Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics

revised

  • e20182460
From the American Academy of PediatricsPolicy Statement

Child Passenger Safety

Committee on Injury, Violence, and Poison Prevention
Pediatrics April 2011, 127 (4) 788-793; DOI: https://doi.org/10.1542/peds.2011-0213
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading
Download PDF

Abstract

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit.

  • child passenger safety
  • motor vehicle crash
  • child restraint system

Improved vehicle crashworthiness and greater use of child restraint systems have significantly affected the safety of children in automobiles. Major shifts in child restraint use, particularly the use of booster seats among older children, have occurred in response to public education programs and enhancements to child restraint laws in nearly every state.1,–,3 In addition, there has been a substantial increase in scientific evidence on which to base recommendations for best practices in child passenger safety. Current estimates of child restraint effectiveness indicate that child safety seats reduce the risk of injury by 71% to 82%4,5 and reduce the risk of death by 28% when compared with those for children of similar ages in seat belts.6 Booster seats reduce the risk of nonfatal injury among 4- to 8-year-olds by 45% compared with seat belts.7 Despite this progress, approximately 1500 children younger than 16 years die in motor vehicle crashes each year in the United States, nearly half of whom were completely unrestrained.8

The American Academy of Pediatrics (AAP) strongly supports optimal safety for children and adolescents of all ages during all forms of travel. This policy statement provides 5 evidence-based recommendations for best practices to optimize safety in passenger vehicles for all children, from birth through adolescence (a summary of recommendations is listed in Table 1):

  1. All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their CSS.

  2. All children 2 years or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their CSS, should use a forward-facing CSS with a harness for as long as possible, up to the highest weight or height allowed by the manufacturer of their CSS.

  3. All children whose weight or height is above the forward-facing limit for their CSS should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.

  4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap-and-shoulder seat belts for optimal protection.

  5. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

View this table:
  • View inline
  • View popup
TABLE 1

Summary of Best-Practice Recommendations

It should be noted that the recommendation that all children younger than 2 years be restrained in an infant-only or convertible CSS used rear-facing represents a significant change from previous AAP policy and is based on new data from the United States9 as well as extensive experience in Sweden.10,11 It is important to note that most currently available CSSs have weight limits for rear-facing use that can accommodate the new recommendations.12

Certain considerations contained in this policy statement are relevant to commercial airline travel as well and are noted in the accompanying technical report.13 Other AAP policy statements provide specific recommendations to optimize safety for preterm and low birth weight infants,14 children in school buses,15 and children using other forms of travel and recreational vehicles.16,–,18 In addition, complementary AAP policy statements provide recommendations for teenaged drivers19 and the safe transport of newborn infants20 and children with special health care needs.21,22

Pediatricians play a critical role in promoting child passenger safety. To facilitate their widespread implementation in practice, evidence-based recommendations for optimal protection of children of all ages in passenger vehicles are presented in the form of an algorithm (Fig 1) with an accompanying table of explanations and definitions (Table 2). A summary of the evidence in support of these recommendations is provided in the accompanying technical report.13 Because pediatricians are a trusted source of information to parents, every pediatrician must maintain a basic level of knowledge of these best-practice recommendations and promote and document them at every health-supervision visit. Prevention of motor vehicle crash injury is unique in health-supervision topics, because it is the only topic recommended at every health-supervision visit by Bright Futures.23 Pediatricians can also use this information to promote child passenger safety public education, legislation, and regulation at local, state, and national levels through a variety of advocacy activities, including ensuring that their state's child passenger safety law is in better alignment with the best-practice recommendations promoted in this policy statement.

FIGURE 1
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1

Algorithm to guide the implementation of best-practice recommendations for optimal child passenger safety (see Table 1 for a summary of recommendations and Table 2 for definitions and explanations).

View this table:
  • View inline
  • View popup
TABLE 2

Explanations of Decision Points and Additional Resources

Because motor vehicle safety for children is multifaceted and will continue to evolve, all pediatricians should familiarize themselves with additional resources to address unique situations for their patients that may not be covered by the algorithm and to maintain current knowledge. In particular, many communities have child passenger safety technicians who have completed a standardized National Highway Traffic Safety Administration (NHTSA) course and who can provide hands-on advice and guidance to families. In most communities, child passenger safety technicians work at formal inspection stations; a list of these stations is available at www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org) or the NHTSA child safety seat inspection station locator (www.nhtsa.dot.gov/cps/cpsfitting/index.cfm). Car seat checkup events are updated at www.safekidsweb.org/events/events.asp. In addition, additional resources for pediatricians and families can be found at www.aap.org or www.healthychildren.org.

Lead Author

Dennis R. Durbin, MD, MSCE

Committee on Injury, Violence, and Poison Prevention, 2008–2010

H. Garry Gardner, MD, Chairperson

Carl R. Baum, MD

M. Denise Dowd, MD, MPH

Dennis R. Durbin, MD, MSCE

Beth E. Ebel, MD

Michele Burns Ewald, MD

Richard Lichenstein, MD

Mary Ann P. Limbos, MD

Joseph O'Neil, MD, MPH

Elizabeth C. Powell, MD

Kyran P. Quinlan, MD, MPH

Seth J. Scholer, MD, MPH

Robert D. Sege, MD, PhD

Michael S. Turner, MD

Jeffrey Weiss, MD

Contributor

Stuart Weinberg, MD

Partnership for Policy Implementation (PPI)

Liaisons

Julie Gilchrist, MD

Centers for Disease Control and Prevention

Lynne Janecek Haverkos, MD

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Jonathan D. Midgett, PhD

Consumer Product Safety Commission

Alexander S. Sinclair

National Highway Traffic Safety Administration

Natalie L. Yanchar, MD

Canadian Paediatric Society

Staff

Bonnie Kozial

dshp{at}aap.org

Footnotes

  • This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

  • All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

  • AAP =
    American Academy of Pediatrics •
    CSS =
    car safety seat

REFERENCES

  1. 1.↵
    1. Durbin DR,
    2. Kallan MJ,
    3. Winston FK
    . Trends in booster seat use among young children in crashes. Pediatrics. 2001;108(6). Available at: www.pediatrics.org/cgi/content/full/108/6/e109
  2. 2.↵
    1. Winston FK,
    2. Chen IG,
    3. Elliott MR,
    4. Arbogast KB,
    5. Durbin DR
    . Recent trends in child restraint practices in the United States. Pediatrics. 2004;113(5). Available at: www.pediatrics.org/cgi/content/full/113/5/e458
  3. 3.↵
    Insurance Institute for Highway Safety. Child restraint/belt use laws. Available at: www.iihs.org/laws/restraintoverview.aspx. Accessed August 17, 2010
  4. 4.↵
    1. Arbogast KB,
    2. Durbin DR,
    3. Cornejo RA,
    4. Kallan MJ,
    5. Winston FK
    . An evaluation of the effectiveness of forward facing child restraint systems. Accid Anal Prev. 2004;36(4):585–589
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Zaloshnja E,
    2. Miller TR,
    3. Hendrie D
    . Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Arch Pediatr Adolesc Med. 2007;161(1):65–68
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Elliott MR,
    2. Kallan MJ,
    3. Durbin DR,
    4. Winston FK
    . Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes [published correction appears in Arch Pediatr Adolesc Med. 2006;160(9):952]. Arch Pediatr Adolesc Med. 2006;160(6):617–621
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Arbogast KB,
    2. Jermakian JS,
    3. Kallan MJ,
    4. Durbin DR
    . Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics. 2009;124(5):1281–1286
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    National Highway Traffic Safety Administration. FARS encyclopedia. Available at: www-fars.nhtsa.dot.gov. Accessed August 17, 2010
  9. 9.↵
    1. Henary B,
    2. Sherwood CP,
    3. Crandall JR,
    4. et al
    . Car safety seats for children: rear facing for best protection. Inj Prev. 2007;13(6):398–402
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Isaksson-Hellman I,
    2. Jakobsson L,
    3. Gustafsson C,
    4. Norin HA
    . Trends and effects of child restraint systems based on Volvo's Swedish accident database. In: Proceedings of Child Occupant Protection 2nd Symposium. Warrendale, PA: Society of Automotive Engineers Inc; 1997:316
  11. 11.↵
    1. Jakobsson L,
    2. Isaksson-Hellman I,
    3. Lundell B
    . Safety for the growing child: experiences from Swedish accident data [Abstr 05-0330]. In: Proceedings: 19th International Technical Conference on the Enhanced Safety of Vehicles. Washington, DC: National Highway Traffic Safety Administration; 2005
  12. 12.↵
    American Academy of Pediatrics. Car safety seats: product listing for 2011. Available at: www.healthychildren.org/carseatlist. Accessed January 7, 2011
  13. 13.↵
    Durbin DR; American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. Technical report: child passenger safety. Pediatrics. 2011;127(4). Available at: www.pediatrics.org/cgi/content/full/127/4/eXXX
  14. 14.↵
    1. Bull MJ,
    2. Engle WA
    ; American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009;123(5):1424–1429
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention, Council on School Health. School transportation safety. Pediatrics. 2007;120(1):213–220
    OpenUrlAbstract/FREE Full Text
  16. 16.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. All-terrain vehicle injury prevention: two-, three-, and four-wheeled unlicensed motor vehicles. Pediatrics. 2000;105(6):1352–1354
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. Bicycle helmets. Pediatrics. 2001;108(4):1030–1032
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. Personal watercraft use by children and adolescents. Pediatrics. 2000;105(2):452–453
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention and Committee on Adolescence. The teen driver. Pediatrics. 2006;118(6):2570–2581
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. Safe transportation of newborns at hospital discharge. Pediatrics. 1999;104(4):986–987
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. School bus transportation of children with special health care needs. Pediatrics. 2001;108(2):516–518
    OpenUrlAbstract/FREE Full Text
  22. 22.↵
    American Academy of Pediatrics, Committee on Injury and Poison Prevention. Transporting children with special health care needs. Pediatrics. 1999;104(4 pt 1):988–992
    OpenUrlAbstract/FREE Full Text
  23. 23.↵
    American Academy of Pediatrics. Bright Futures: health care professionals tools and resources Web site. Available at: http://brightfutures.aap.org. Accessed August 17, 2010
  • Copyright © 2011 by the American Academy of Pediatrics
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics
Vol. 127, Issue 4
1 Apr 2011
  • Table of Contents
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Child Passenger Safety
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Child Passenger Safety
Committee on Injury, Violence, and Poison Prevention
Pediatrics Apr 2011, 127 (4) 788-793; DOI: 10.1542/peds.2011-0213

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Child Passenger Safety
Committee on Injury, Violence, and Poison Prevention
Pediatrics Apr 2011, 127 (4) 788-793; DOI: 10.1542/peds.2011-0213
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Abstract
    • Lead Author
    • Committee on Injury, Violence, and Poison Prevention, 2008–2010
    • Contributor
    • Liaisons
    • Staff
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • Child Passenger Safety
  • PubMed
  • Google Scholar

Cited By...

  • Telehealth Applied to Deliver In-situ Behavioral Skills Training to Reduce Car Seat Misuse During the Covid-19 Pandemic
  • Virtual car seat checks during a pandemic
  • Comparison of the effectiveness of hands-on versus online education in child passenger safety
  • School Bus Transportation of Children With Special Health Care Needs
  • Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour
  • Rourke Baby Record 2014: Evidence-based tool for the health of infants and children from birth to age 5
  • Releve postnatal Rourke 2014: Outil fonde sur des donnees probantes pour la sante des nourrissons et des enfants de la naissance jusqu'a 5 ans
  • Child Safety and Injury Prevention
  • Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation
  • Are parents following the recommendations for keeping children younger than 2 years rear facing during motor vehicle travel?
  • Car Safety
  • An observational survey of child car safety practices in private pre-primary and primary schools in two local government areas of Lagos State, Nigeria
  • Association Between Weight and Risk of Crash-Related Injuries for Children in Child Restraints
  • Rear view until age 2: Strong evidence supports new AAP child passenger safety recommendations
  • Child Passenger Safety
  • Rear view until age 2: Strong evidence supports new AAP child passenger safety recommendations
  • Google Scholar

More in this TOC Section

  • Ethical Considerations in Pediatricians’ Use of Social Media
  • 2021 Recommendations for Preventive Pediatric Health Care
  • Recommended Childhood and Adolescent Immunization Schedule: United States, 2021
Show more From the American Academy of Pediatrics

Similar Articles

Subjects

  • Current Policy
  • Journal Info
  • Editorial Board
  • Editorial Policies
  • Overview
  • Licensing Information
  • Authors/Reviewers
  • Author Guidelines
  • Submit My Manuscript
  • Open Access
  • Reviewer Guidelines
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
  • RSS
American Academy of Pediatrics

© 2021 American Academy of Pediatrics