Patty Huang, MD, a developmental pediatrician at The Children’s Hospital of Philadelphia, cares for children with trisomy 21, autism, and related disorders. She is also the moderator of the Research In Action blog from CHOP’s Center for Injury Research and Prevention.

When New Jersey’s new law regarding motor vehicle restraints for children went into effect in September 2015, it provided a nice opportunity to not only review car seat safety among my colleagues, but also with my patients’ families.

We pediatricians play a key role in counseling families about child passenger safety, but significant gaps in our awareness of current best practices remain. In a survey research study (led by my colleague Mark Zonfrillo, MD) of more than 500 American Academy of Pediatric members in the years following the 2011 AAP recommendations on car seat restraints, almost 10% of the respondents did not know the recommended age and/or conditions at which a child should be transitioned from a rear-facing child restraint system (CRS) to a forward-facing CRS. This New Jersey law, which is based on those AAP recommendations, only heightens our need to be aware of and to properly counsel families around best practices for child passenger safety, regardless of where we practice.

The basics of the new law:

  • Children need to remain in a rear-facing seat with a 5-point harness until they reach 2 years and 30 lbs.
  • Children need to remain in a rear- or forward-facing seat with a 5-point harness until they reach 4 years and 40 lbs.
  • Children need to sit in a booster seat until they reach 8 years and 57 inches.

Parents consistently cite pediatricians as a primary source of information for child passenger safety. With an average of 3 children being killed and 470 children being injured every day in traffic crashes (National Highway Traffic Safety Administration 2013 statistics), it is critical that we remain up to date on the best practices so that we can help to keep our families safe.

Discussion Tips

Zonfrillo offers these tips on how to fit in a meaningful discussion during a busy office visit:

  • The more doctors know, the more likely they are to discuss the topic with families. Tailored training for physicians exists. For example, the AAP offers a 1-hour child passenger safety training module. CHOP’s Center for Injury Research and Prevention in conjunction with Kohl’s Injury Prevention Program gives information for clinicians and families at
  • Leverage your electronic medical record system (if available) so it provides prompts based on the child’s age, weight, and height. This can take out the guesswork of which CRS is appropriate.
  • Refer families to the widely available car seat inspection stations nationwide. Trained technicians at each site can guide families on safe CRS installation—no matter the child’s age. A 2013 study of car seat inspections revealed that although many older children were at the inspection only because parents were getting a younger sibling’s seat checked, older children were far more likely than younger children to leave in a more protective CRS than when they arrived.