Author: Dr. Alla Gordina

Date: 8.18.2008


The issue of car safety can be confusing even in the case of a child, who is developing within usual parameters. Infants and children, who were recently adopted, do present additional challenges because of failure to thrive, developmental delays and sensory issues, to name a few. Children are not used to car rides to begin with and being restrained is making the things even worse.

The use of the car safety restraints in this situation has to be adjusted based on each child’s chronological and developmental age, growth  parameters and other variables.

General recommendations:

  1. The back seat is the safest place for children to ride.
  2. Infants must ride in rear-facing restraints until they are at least 1 year of age and weigh at least 20 pounds (depending on the car seat, it can accommodate children weighting more then that).
  3. It is best for any child to ride rear-facing until he/she reaches the highest weight and height limits allowed by this particular car safety seat
  4. A rear-facing child safety seat must never be placed in the front passenger seat of any vehicle equipped with an air bag.
  5. Assume all vehicles have air bags.
  6. Convertible seats can be used in the upright and forward-facing position for a child older than 1 year of age who weighs 20-40 pounds and as long as the child fits well.
  7. Child should stay in a car safety seat with a harness as long as possible and then ride in a belt-positioning booster seat. You can tell when your child is ready for a booster seat when one of the following is true:
    1. She reaches the top weight or height allowed for her seat.
    2. Her shoulders are above the harness slots.
    3. Her ears have reached the top of the seat.
  8. Child is ready to use a seat belt when the belt fits properly. This means 
    1. The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.
    2. The lap belt is low and snug across the thighs, not the stomach.
    3. The child is tall enough to sit against the vehicle seat back with his legs bent at the knees and feet hanging down and can stay in this position comfortably throughout a trip.

Special considerations

  1. Small children with motor delays, low muscle tone and failure to thrive are safer riding rear facing until he/she reaches the highest weight and height limits allowed by this particular car safety seat
  2. Reclined position of the rear-facing car seat (infant only or convertible) is safer for children, who are unable to sit on their own regardless of age, until he/she reaches the highest weight and height limits allowed by this particular car safety seat.

Harness Straps

  1. Harness straps must fit snugly on the strongest parts of the child’s body – the shoulders and the hips.
  2. Make sure that the belt separates your baby’s legs. Also, MAKE SURE THAT ARMS AND LEGS CANNOT GET UNDER THE HARNESS
  3. Most rear-facing seats should have straps originating at or slightly below the infant’s shoulders, while front-facing seats should have straps at or slightly above shoulders.
  4. The harness retainer clip for infant seats keeps the straps on a child’s shoulders and should rest at mid-chest, armpit level.
  5. When moving the straps, be sure to thread them properly through the shell, not just behind the pad.


Always read the instructions that come with the child safety seat.
Always read the section on safety belt and child safety seats in the vehicle owner’s manual.


Pay attention to information about child safety seat recalls via the media and notices sent from the manufacturer.
When you buy a seat, be sure to return the registration card to the manufacturer.
Keep information such as the manufacture dates, model number, and name of the child safety seat readily available.
Most manufacturers are required to fix problems free of charge. If you are not sure if your seat has been recalled or you think your seat has a defect, call the department of transportation (DOT) Auto Safety hotline at 888/327-4236.


Additional information is available at:,,,

The Educational project “Safe Arrival” is made possible with the help of the materials provided by the American Academy of Pediatrics