By: Dr. Madison Harpenau, Occupational Therapy Intern
The United States Department of Transportation recommends children under the age of one should ride in a rear-facing car seat, in an infant only seat. The ages of one to three your child should progress to a convertible rear-facing car seat or an all-in-one car seat that will support their growing height and weight. During the years of one to three it is recommended your child remain in a rear-facing car seat. Around the age of four, it is recommended that your child ride in a forward-facing car seat with a harness and tether until they outgrow the height and weight restriction. After the age of seven, it is recommended that your child begin to ride in a booster seat with the seat belt to secure them. Booster seats are recommended to help the seat belt fit better on your child to ensure their safety in the car. After the age of 8, dependent upon your child’s height and weight, it is recommended that your child may begin to ride with only a seat belt, as long as it lies across the shoulder and chest. (2019)
There can be controversy between the appropriate time to have your child’s car seat become forward-facing. Juggling information from car seat companies, state regulations, federal guidelines, and familial opinions, can be difficult and overwhelming at times. There can be gray areas between each of these guidelines and regulations. In general, it is common for parents to switch their children’s car seat to forward-facing at or around the age of two. According to the United States Department of Transportation, the recommendation is to have children remain rear-facing until the age of three. In a study by Macy et al., in 2013 only 23% of parents kept their children rear-facing after the age of two (2015). In that same study, majority of parents turned their children’s car seats to forward-facing between 13 and 15 months of age (Macy et al., 2015).
The United States Department of Transportation has recently increased the age to remain rear-facing until the age of three due to the deaths and injuries that have been related to premature forward-facing of car seats (2019). Many parents are concerned about their child’s comfort and leg room with rear-facing car seats when the child is over the age of two. Fortunately children are good at adapting and are not likely to be as uncomfortable as their parents may believe. Children who continue to face the rear in their car seats after the age of two also do not know the difference between front-facing and rear-facing.
Despite the benefits of remaining rear-facing until the age of three, parents must be knowledgeable about the height and weight guidelines of their child’s car seat (2019). If your child reaches the height or weight limit for their rear-facing car seat, they are ready for a forward facing car seat. Parents are encouraged to review how to properly strap their child into their rear-facing and forward-facing car seats to avoid misuse of them.
Macy, M. L., Butchart, A. T., Singer, D. C., Gebremariam, A., Clark, S. J., & Davis, M. M. (2015). Looking back on rear-facing car seats: Surveying US parents in 2011 and 2013. Academic Pediatrics, 15, 526-533.
United States Department on Transportation. (2019). Car seats and booster seats. Retrieved April 15, 2019, from NHTSA website: https://www.nhtsa.gov/equipment/ car-seats-and-booster-seats
Madison Harpenau is a Doctor of Occupational Therapy student from St. Ambrose University in Davenport, Iowa. Madison is anticipated to graduate in August of 2019. She has completed two prior internships in the settings of outpatient pediatrics and inpatient rehabilitation hospital. Madison’s Doctoral Project is focused on Connecting Holistic Health Care Professionals; such as Chiropractic and Occupational Therapy. Her project is largely rooted in health and wellness promotion for all clients.