Safety tips

Which car seat should I use for my child?

High-back booster seat

“Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent.”

Hawaii’s Child Passenger Restraint Law

Child Passenger Restraint Law requires that children under the age of four to ride in a child safety seat and children ages four through seven to ride in a child safety seat or a booster seat when traveling in a motor vehicle. 

Children who outgrow child safety seats (between 40 and 65 lbs, depending on the seat) should use a booster seat (ideally a high back) until they are approximately 80 lbs and 4 feet 9 inches tall, so they can fit in an adult seat belt. 

The proper adult seat belt should have the shoulder harness snug against the chest, not across the neck and the lap belt should be low and tight across the hips. 

If the adult seat belt has the shoulder belt “cutting” across the neck, it can cause critical or even fatal injuries during a crash. 

Tax credit 

A Hawaii State tax credit of $25 per year can be applied for the purchase of a new booster or child safety seat. 

The driver of the vehicle is held responsible for compliance with this law. Violators of the law are required to attend a class and may be assessed a fine ranging from $100 to $500. 

The American Academy of Pediatrics recommends:

  • Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more. Car seat manufacturers have created seats that allow children to remain rear-facing until they weigh 40 pounds (18 kg) or more, which means most children can remain rear-facing past their second birthday. (author’s note: Some European countries recommend keeping toddlers up to 4 years old in a rear-facing toddler seat.)
  • According to Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention. “It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride.”
  • Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds (29 kg) or more. Always check with your car seat specific weight and height limitations. 
  • When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old. The belt should not cross the neck. 
  • When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
  • All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.


The different car seats available:

Car seats

Stage 0: Newborn car seats

Babies less than four pounds who are ready to leave the hospital need special care.

Ask your doctor about the special breathing test for preemies.

Your doctor may recommend that you buy a car bed for tiny babies.

Stage  1-2: Rear facing car seats  (Newborn to 2-4 years old)

Rear-facing only car seats. They are portable and most, but not all, can be used in strollers that are sold with the car seat or those recommended by the manufacturer. Caregivers can also purchase extra bases for the car seat so that it can be used in several cars. 

A convertible car seat is larger and stays in the car. It can be used rear facing until your child is at least 2. After that, it can change to a forward-facing seat.

A 3-in-1 car seat also stays in the car. You can use it rear facing, forward facing, and then later, as a booster seat.

Stage 3: Types of forward-facing car seats.   (Check weight and height limitations. Used forward after at least 2 years of age)

A convertible car seat can be used in a rear-facing position, and then turned to face forward when your child is big enough. If you have one of these seats, you do not need to buy a new car seat until your child is ready for a booster seat.

A forward facing only car seat  is used in only one direction and has a 5-point harness and top tether. For after 2 years of age. 

A combination seat is forward-facing, for after at least 2 years of age, with a 5-point harness and top tether, and can change into a booster seat when you remove the harness. 

A 3-in-1 car seat can be used in a rear-facing position, a forward-facing position and as a booster seat.

Stage 4: Booster seats  (after minimum years of age, check weight and height requirements)

High back booster. Provides head support

Backless booster. Convenient for travel. 

When is the EARLIEST I can change from a toddler/ child safety seat to a booster seat?

The minimum requirements to switch to a booster seat are:

  1. Reaching the appropriate weight (at least 15 kg or 30 lbs) and height 
  2. Child is at least 4 years old 
  3. Child has the mental maturity to sit still in the high back booster seat. If leaning forwards a lot, your child is outside of the seat’s protection zone. 

Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent.

Irene Papaconstadopoulos, MD FAAP


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