Parents Room

Put That Kid in a Car Seat!

Copyright 2006 Mike Patrick Jr, MD

I don’t currently advocate road rage. Laying on the horn, swearing like a sailor, and swerving around the slow guy in the passing lane is not my style. Of course, tastes change over time, so I’d like to reserve the right to practice road rage in the future. But understand this: It won’t be the slow guy in the passing lane that sets me off. Instead, it will be stupid parents.

You know the ones I’m talking about. You see them on interstate highways and city streets and country roads. You point them out to your spouse, and explain their poor judgment to your children. At least I hope you do. These are the parents who drive with unrestrained kids in the car, ones who let Little Bobby climb over the headrest and crouch on the floorboard and roam from window to window, pausing only to stick his tongue out at cars in the cruising lane.

Why do some parents allow their children such freedom? I think it boils down to convenience. Dad doesn’t want to wear a seatbelt and he doesn’t want to hear Little Bobby screaming to get out of his. So Dad lets him roam.

In every state, they’re breaking the law. Not that it matters. Most states have secondary seatbelt laws, even for kids. This means police can only write a citation for an unrestrained occupant in the course of pulling a car over for another violation. But let’s face it, toughening seatbelt laws into primary violations would do little to reduce the thousands of unrestrained children killed and injured in the United States each year. Why? Because you can’t force common sense through legislation. Don’t forget, these parents are stupid.

If you are still reading, I suspect you are either not a stupid parent or you are motivated to rise above your stupidity. And since smart parents ask lots of good questions about the appropriate use of car seats, booster seats, and seatbelts, I will review the basics for you.

The rules are pretty simple really. Until your child is a year old AND twenty pounds, use a rear-facing infant carrier in the back seat of your car. The middle of the seat is safest. Once your child is twenty pounds AND one year of age, it’s safe to use a forward-facing car seat. Again, keep it in the back, and if possible, put it in the middle.

When do you graduate to a booster seat? For most kids, you can make the move when they weigh forty pounds. Start with the type that has its own restraining harness. When your child outgrows the harness (usually between 50 and 65 pounds), advance to a booster that incorporates the car’s safety belt. The important thing here is to make certain the belt fits properly. The lap belt should fit over the pelvic bones and not slip up to the belly. The shoulder belt should cross the chest, not the upper shoulder and not the neck. Many of these boosters feature an adjustable clip to keep the shoulder belt in a good position. Never forsake the shoulder belt. Serious injury is common among children in booster seats who only use a lap belt.

For all car seats and boosters, be sure to follow the manufacturers guidelines for proper positioning and securing. You’ll have to pay close attention here. Some seats are rear-facing only, some only face forward, others are reversible. Also pay attention to minimum and maximum length and weight for a given seat. If your child outgrows the length recommendation of a rear-facing infant seat, but is not yet a year old AND twenty pounds, you’ll need a bigger reversible seat. Keep it rear-facing until he is big enough and old enough to face forward.

When are kids ready for seat belts without a booster? When their feet reach the floor while their back is against the seat. The lap belt must fit snuggly across the pelvic bones (not the stomach), and the shoulder belt must fit snugly across the chest (not the upper shoulder or neck). The exact age varies from kid to kid. If your son or daughter is petite, he or she might be 10 or 11 years old before meeting this criteria. I realize this is much older than most people (especially children) want to believe. But I bring you the facts. Please, don’t shoot the messenger.

There’s much more to say about car safety. When can kids ride up front? What about air bags? How do you secure premature babies and disabled children? The American Academy of Pediatrics has an excellent resource answering these and other questions at

So what do we do with the dad who won’t buckle Little Bobby? It’s a tough call. This is America. Parents have rights. Does Little Bobby have the right to life, liberty, and the pursuit of happiness? Is Dad interfering with that right? Maybe. Until we sort that out, you’ll do well to avoid Dad’s mistake. Be a good example to your children and always wear your seat belt. Insist on your children being properly secured from day one. Always use a car seat. Make no exceptions. Little Bobby figured out that if he screams loud enough and long enough, he gets to roam the car and stick his tongue out at passing cars. If you have a Little Bobby in your car, it’s not too late. Let him scream. It won’t last long. Will you be interfering with his life, liberty, and the pursuit of happiness? Maybe. But I know which choice I’d make. How about you?

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