Q: At what age can my child sit in the front seat? I’ve heard it’s not just about height or weight, but also about bone development.
A: The transitions out of a booster seat to a regular seat, and from a rear seat to a front seat can be confusing because there are differing state laws as well as various recommendations from national health organizations (such as the American Academy of Pediatrics) and government agencies, including the National Highway Transportation Safety Administration and the Minnesota Department of Public Safety.
All these organizations have aligned on at least some of their recommendations using evidence gathered from motor vehicle accidents involving children. Collectively, they recommend:
Once children outgrow their car seats by height or weight, they should remain in the rear seat of the vehicle in booster seats that assist with appropriately positioning a seatbelt across a child’s lap and across their shoulder.
Children are generally able to transition out of a booster seat at 4 feet 9 inches tall and between ages 8–12, but should still remain in the rear seat of the car, using the standard seat belt with a shoulder strap over the shoulder.
Once children are 13 years old (no weight criteria or further height criteria), they may sit in the front seat of a vehicle, using the standard seat belt with appropriate positioning.
The state laws are quite variable, however. In Minnesota, a vehicle may be stopped as a primary offense for young children not being secured in car seats ($50 violation) or for older children not secured with seatbelts ($25 violation). Minnesota’s statute for seatbelts (169.685) notes that children who are both younger than 8 years old and shorter than 4-foot-9 must be in a car seat or booster seat, but doesn’t place legal restrictions for transitioning from the rear seat to front seat after that age or above that height. According to the Insurance Institute for Highway Safety, laws in neighboring states are similarly permissive for front-seat passenger age in Wisconsin and North Dakota and more permissive in Iowa (age 6) and South Dakota (age 5).
Despite the permissiveness of some laws, parents should remember that motor vehicle accidents are the leading cause of death for children age 4 and older. So, although children may want to join you in the front seat of the car for entertainment value, the rear seat remains the safer location for kids age 12 and younger.
Q: My son, age 12, says he feels like he is a girl. He wants to know how he would go about living as a female. What is your advice from a medical perspective?
A: It can be confusing and overwhelming when kids at any age question their gender identity or identify as transgender.
Unfortunately, transgender and gender-diverse kids experience significant stigma and health disparities. The key to protecting them and helping build resilience is parental love and support.
The first step is to reassure your children that they can safely discuss their gender concerns with you and that you love them unconditionally, regardless of their gender identity or expression.
In this pre-pubertal/peri-pubertal age, the message we give to parents is to “support without steering.” Let your child explore the expression of their gender identity to see what feels best. This may include allowing your child to select clothing, hairstyle and — if they insist — a preferred name and pronoun that align with their gender identity.
If puberty is starting or has started for your child, there is the option to hit “pause” on puberty through the use of reversible puberty-blocking medications.
Pausing puberty can give children time to reflect on their gender identity, without them having to simultaneously go through the permanent changes of puberty. This type of treatment is typically combined with psychotherapy and is undertaken in consultation with a gender health specialist to help children as they explore their identity and expression.
Children’s Minnesota offers a Gender Health Program to help kids and their families. You can call 612-813-7950 to make an appointment with specialists in pediatric and adolescent gender health to ask questions and/or explore the option of puberty-pausing medication.
Parents can learn more about this topic and find resources at tinyurl.com/hrc-trans-kids.
Dr. Gigi Chawla is a board-certified pediatrician and the chief of general pediatrics at Children’s Minnesota.