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Infant Car Seats

Pediatrics Expert Advice from Henry Bernstein, M.D.

Q: My son is nine months old and weighs just under 20 pounds. We are using an infant car seat that is not to be used over 20 pounds. We have a car seat that is built into our vehicle that is to be used between 20 and 40 pounds. However, I recently read that babies should not face forward in a car seat until they are one year old. We began shopping for another car seat but found that they all state that when a baby reaches 20 pounds, the seat must be turned to face forward. What do we do? Can we keep the seats rear-facing or should we turn them around? Also, my baby is delayed and his neck might not be as strong as the average baby's. Help.

A: I would recommend using the conventional car seat even though your vehicle has one built-in. It is safest for you to keep the baby rear-facing in a federally approved car seat. The American Academy of Pediatrics recommends that infants weighing under 20 pounds or under one year always ride in a rear-facing child safety seat in the back of the vehicle--even vehicles with passenger-side airbags. This appears to be the safest position for your baby.

Properly used and positioned car seats have been shown to save lives. according to the Insurance Institute for Highway Safety study, placing children in the back seat reduces the fatality risk by 35 percent in vehicles without passenger airbags. Certainly, child passenger safety laws may vary from state to state, and issues related to airbags inflating and suffocation children come into play. Infants and children should also not be placed in the front seat of a car. Benefits of being able to observe a child will rarely outweigh the greater risk of placing the child in the front seat, even when that airbag is turned off. You also point out that your child's development may be a bit delayed or less strong than the average baby--only emphasizing the importance of being more cautious and keeping the baby rear-facing in the back seat a little longer.

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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.

Please note: This "Expert Advice" area of should be used for general information purposes only. Advice given here is not intended to provide a basis for action in particular circumstances without consideration by a competent professional. Before using this Expert Advice area, please review our General and Medical Disclaimers.


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