Keep Kids in Rear-Facing Car Seats Until 2, Experts
MONDAY, March 21 (HealthDay News) -- Children are best kept in
rear-facing car seats until age two or until they have reached the
height and weight maximums set by the car seat manufacturer,
according to new recommendations from a pediatricians' group.
This is a significant change from the prior recommendations,
which called for babies to stay in rear-facing seats until they
were at least one years old and 20 pounds. Rear-facing seats offer
more support to the head, neck and spin of infants and toddlers in
a crash, said report author Dr. Dennis Durbin, a pediatric
emergency physician at the Children's Hospital of Philadelphia.
The new guidelines, developed by the American Academy of
Pediatrics, appear in the April 2011 issue of
Though the recommendations were meant to encourage parents to
keep kids in the seats longer, many parents interpreted that
wording to mean they should put their children in a forward facing
seat at their first birthday -- way too soon, said Dr. Benjamin
Hoffman, an associate professor of pediatrics at the University of
New Mexico and a certified car passenger safety technician and
instructor who was not involved in the report.
"There's been this perception that it's a good idea to move from rear-facing to forward-facing," Hoffman said. "But if parents want to afford their child the best possible protection from the leading cause of death for children, they want delay that step as long as they can."
Most rear-facing child safety seats today can accomodate
children to fit the new guidelines, the report noted.
The rate of deaths due to motor vehicle crashes in children
under age 16 fell 45 percent between 1997 and 2009, according to
background information in the article.
Yet motor vehicle accidents are still the leading cause of death
for children ages 4 and older. Each year, more than 1,500 children
under age 16 are killed annually in motor vehicle accidents. And
for every death, some 18 children are hospitalized and 400 are hurt
seriously enough to require medical attention, according to the
A 2007 study in the journal
Injury Prevention found that children under age 2 are 75
percent less likely to die or be severely injured in a crash if
they're in a rear-facing car seat.
And even age two shouldn't be read as a deadline, Durbin said.
If your child is small for his or her age, you may want to delay
turning around the seat even longer, while bigger, taller kids may
need to be turned sooner than age two.
The recommendations also say that a forward-facing car seat with
a harness offers more protection than a booster seat, while a
booster seat is better than a seat belt alone.
Kids should be kept in a forward-facing car seat as long as
possible, even through age 8 if their weight or height is under the
limit allowed by their child safety seats, according to the new
guidelines. Studies show that the car seats reduce the risk of
child injury up to 82 percent and the risk of death by 28 percent,
compared to wearing seat belts.
"Car seats have more structure -- particularly side structure -- to them than most booster seats," Durbin said. "This added structure may offer additional protection, particularly in side impact crashes. In addition, most car seats sold today use 5-point harness systems which do a better job of restraining a child in the event of a crash than the 3-point vehicle seat belt, even when positioned properly with a booster seat."
Parents are also advised to keep older children in a booster
seat, which properly positions the seat belt, until they're 4 feet
9 inches tall and are between the ages of 8 and 12. The average
child reaches that stature sometime after age 10, Hoffman said.
Booster position the seat belt so that the shoulder belt lies
across the middle of the chest and shoulder and keeps it off the
neck or face, while the lap belt fits low and snug on the hips and
upper thighs, not across the soft tissue of the belly.
Prior research shows booster seats can reduce the risk of injury
by 45 percent in 4- to 8-year olds compared to kids of that age in
"Keep your children as safe as possible on every trip you take by delaying the transitions that you make between different types of car seats for as long as possible," Durbin said. "With each transition you make -- from a rear-facing to a forward-facing car seat, from the car seat to a booster seat and from the booster to the vehicle seat belt -- you give up some protection and your child is more likely to be injured in a crash."
Children should ride in the backseat until they are 13 years
old, since studies have shown this reduces the risk of injury by 40
to 70 percent, the AAP added.
The pediatricians' group also recommended that child safety
seats not be used outside the car -- as they often are -- since
they can tip and fall off tables, countertops and other surfaces.
More than 8,000 infants a year are injured in each year when child
safety seats are used improperly or for unintended purposes, a
supplemental report warned.
"Following these guidelines will give parents peace of mind that they are doing the best job they can of protecting their children from injury in the event of a car crash," Durbin said.
The typical forward-facing car seat fits children up to about 40
pounds, though there are more than 40 models that can accommodate
kids up to 60, 65 or even 85 pounds, Hoffman said.
American Academy of Pediatrics has more on car
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