Your Voice: How big is too big for a car seat? Plus, the language of toilet training

June 1, 2009

Readers write in to respond to articles about car seat safety and how to instruct children in toilet training.

How big is too big for a car seat?

The AAP recently commented on research evaluating safety of children who ride in rear-facing car seats until the age of 2, suggesting that children should ride rear facing as long as possible (the age of 2 years or until they have reached the maximum height and weight recommendations for the model of car seat they have). Of note, weights of children at 2 years of age at the 50th and 97th percentiles are ~26 and ~34 pounds, respectively, which can be accommodated by almost all convertible car seats in a rear-facing position (with upper weight limits of 35 pounds).

Additionally, several brands of forward-facing seats have upper weight limits of 40 to 70 pounds, and booster seats of up to 80 to 100 pounds. Thus, children with higher weights can still ride safely in age-appropriate car seats until they fit properly in the seat of a car with only a lap- and shoulder belt (usually around 4' 9" in height and 80 pounds, which corresponds to about age 11 for 50% of the population).

Ultimately, the questions we should be asking are: how can we work with our lawmakers to update our state laws so that our children are transported safely? How can health care providers and communities work together to ensure that people know about the safest way for infants and children to travel in automobiles? How can we help families obtain car seats for their children, especially those who may not be able to afford them?

I would challenge health care providers to learn the AAP recommendations and their state laws for child passenger safety seats to best educate patients and families regarding the most appropriate child passenger safety seats for each individual child. For more informa-tion on car seats, state laws regarding child passenger safety, and locations where families can have their car seats evaluated for proper fit and installation, visit http://www.usa.safekids.org/.

Kristi Williams, MD, CPSTKansas City, Mo.