Child Passenger Safety with Dr. Ben, Senior Neonatalist and Pediatrician

In honor of Child Passenger Safety Week (CPSW), we sat down with Doona’s in-house Neonatalist and Pediatrician, Dr. Ben to discuss the most common questions parents ask about child passenger safety. From car seat basics to expert-approved tips, here’s what every parent should know to help ensure safer car rides with your little ones. 

When should my baby switch from a rear-facing to a forward-facing car seat?

While previous recommendations cited the age of 2 years as the time to switch from rear-facing to forward-facing, this is no longer the current recommendation. Both the American Academy of Pediatrics (AAP) and National Highway Traffic Safety Administration (NHTSA) strongly recommend keeping your baby in a rear-facing car seat for as long as possible, not based solely on age, but on the car seat's weight and height limits.

What’s the safest position in the car for my child’s seat? Is it safe to put a car seat in the front seat?

The back seat is the safest place for all children under 13 years old. Specifically, the center of the back seat is the optimal position when possible. Seating your child in the back seat is safest for a few reasons. First, it is furthest from impact during frontal collisions, and away from airbags that can cause serious injuries to children. It also protects from dashboard contact in crashes.
The middle back seat is considered the safest position because it’s furthest from side impact crashes, with maximum distance from all potential crash forces. If the center seat isn't available, then either side of the back seat is acceptable. For more information, check out  The safest position for an infant car seat.

How do I know if my car seat is installed correctly?

First and foremost, it’s important to read and follow the instructions of your specific car seat. When installing, make sure to correctly use the seatbelt or a latching system. You can ensure the seat is secure using the “Inch Test,” which means moving the seat forward, back, and side to side, making sure it doesn’t move more than an inch in any direction. It’s also important to make sure the straps and chest clip are correctly positioned and tightened. For this you can use the “Pinch Test,” pinching the vertical strap over your child’s collarbone. If you can pinch the strap material between your fingers, the harness is too loose. Lastly, it’s important to maintain a correct angle for the seat, which is 30-45 degrees from vertical. If in doubt, have your installation checked by a certified Child Passenger Safety Technician (CPST). 

What’s the difference between infant-only, convertible, and all-in-one car seats, and which is safest?

The most important safety factor is correct installation and usage, not the specific type of seat. The safest approach is choosing a car seat that allows your child to stay rear-facing until at least age 2 (preferably longer) and ensuring correct installation and proper harness adjustment every time. All three types of car seats are safe when used correctly, however convertible and all-in-one car seats offer safety advantages through extended rear-facing capability, superior head protection for older infants or toddlers, and longer harness use before transitioning to a booster seat.

What should I do if my baby falls asleep in the car seat? Is it safe to let them continue sleeping there? 

There's no definitive upper time limit for infants in car seats. In fact, The American Academy of Pediatrics and National Highway Traffic Safety Administration do not specify a maximum duration, whether awake or asleep. On the contrary, it is widely considered safe for infants to spend prolonged periods of time in car seats. To ensure your baby’s safety and comfort, always make sure they are correctly positioned in the seat, with their back fully supported and not slouched. Whether in the car, lying down or in a carrier, it is recommended to change the baby’s position every two hours, especially on longer journeys. Also note that you should use car seats for sleep only while traveling. They should not be the primary place for sleep when not traveling. 

How do premature or low-birth-weight babies travel safely in a car seat?

The American Academy of Pediatrics defines high-risk infants as those who are born before 37 weeks gestation, or with a birth weight less than 2,500 grams. Additional high risk infants include those with respiratory, cardiovascular or neuromuscular conditions. For high-risk infants, it’s recommended to perform a Car Seat Challenge (also called a Car Seat Tolerance Screening) before you leave the hospital. This is because preterm infants can have an increased risk of oxygen desaturation, apnea, or bradycardia when placed in a semi-reclined position. If relevant, talk to your pediatrician about testing your baby.

Infant-only car seats are recommended over convertible or other kinds of seats for low birth weight or premature infants, as they typically accommodate babies starting at 4-5 pounds, provide better recline angles, and include removable newborn inserts designed for smaller babies. Always ensure your baby is secured with the proper harness positioning and tightness, chest clip placement, and head support. Be sure to avoid using aftermarket head supports or inserts, additional padding behind your child, harness strap covers that interfere with chest clip placement, or any product not specifically approved by the car seat manufacturer.

Is it safe to use a secondhand or hand-me-down car seat?

While used car seats can be safe under strict conditions, the AAP and NHTSA recommend buying new when possible. Avoid used car seats if you don't know the seat's exact history. Never use secondhand seats if they are too old (check expiration date), have any visible cracks, don't have labels with the manufacture date and model number, don't come with instructions, are missing parts, have been recalled, or were in a moderate or severe crash. Safety experts emphasize that you should only accept used car seats from trusted friends or family members who can guarantee the seat's complete history. Never buy from garage sales or yard sales, thrift stores, or unknown online sellers.

Looking for more information on car seat safety? Check out How Doona provides the highest level of newborn car seat safety, or Child reminder devices are revolutionizing parenting on the go on the Parenting tips blog.

At Doona, we’re committed to making parenting simple for every family. That's why we’ve created our innovative and revolutionary Doona Car Seat and Stroller, transforming from car seat to a stroller in seconds; and Liki Trike — the most compact folding toddler trike on the market that grows alongside your toddler from 10-36 months.