In the US, when most toddlers reach their first birthday, they switch from rear-facing to forward car seats, but new advice from a leading group of pediatricians says it is safer to keep them in rear-facing seats until they reach the age of 2, or until they reach the maximum height and weight for their seat.

The new policy, from the American Academy of Pediatrics (AAP) is published in the April issue of Pediatrics, which appeared online on 21 March.

It also says that most children should ride in a belt-positioning booster seat until they are 4 feet 9 inches tall (145 cm) and are between 8 and 12 years of age, and children should ride in the rear of a vehicle until they are 13 years old.

The policy comes from the AAP’s National Committee on Injury, Violence, and Poison Prevention, a body that investigates the causes of childhood injuries and recommends initiatives and guidance in response to those issues.

Recent research found that children are safer in rear-facing seats when travelling in road vehicles.

In 2007 the journal Injury Prevention published a study that showed children under the age of 2 are 75% less likely to die or be severely injured in a road accident if they are riding in a rear-facing seat.

The previous advice, stemming from the AAP’s 2002 policy, was that it was safe for babies to ride rear-facing up to the limit of the car seat, but it also said this should be a minimum of age 1 year and 20 pounds.

Thus the current practice is that many parents turn the seat to face front when their toddler reaches their first birthday, a time to celebrate a milestone in the child’s growing up.

The new advice will change all that, says Dr Dennis Durbin, lead author of the AAP policy statement and the technical report that accompanies it in the same issue of Pediatrics:

“Parents often look forward to transitioning from one stage to the next, but these transitions should generally be delayed until they’re necessary, when the child fully outgrows the limits for his or her current stage.”

“A rear-facing child safety seat does a better job of supporting the head, neck and spine of infants and toddlers in a crash, because it distributes the force of the collision over the entire body,” explained Durbin.

“For larger children, a forward-facing seat with a harness is safer than a booster, and a belt-positioning booster seat provides better protection than a seat belt alone until the seat belt fits correctly,” he added.

Durbin also stressed that the age 2 recommendation is not a deadline as such, but a guideline age for helping parents decide when to make the change.

“Smaller children will benefit from remaining rear-facing longer, while other children may reach the maximum height or weight before 2 years of age,” he explained.

After a rear-facing seat, children should move to a forward-facing seat with a harness, until they reach the maximum weight or height for that seat, says the AAP.

After that they should be on a booster seat, so the lap and shoulder belt fits properly.

The shoulder belt should lie across the middle of the chest and shoulder, and well away from the neck or face.

Also, the lap belt should fit snug and low on the hips and upper thighs: it should not be across the belly.

The AAP says most children will need to sit on a booster seat until they are 4 ft 9 ins (145 cm) tall and aged between 8 and 12.

Although the rate of deaths in motor vehicle accidents in children under 16 in the US has dropped by a dramatic 45% between 1997 to 2009, car crashes still kill more children aged 4 and over than any other cause.

There are more than 5,000 deaths a year among American children, teenagers and young people up to the age of 21, with deaths being just the tip of an iceberg that includes about 18 young people hospitalized and more than 400 injured enough to need medical treatment for every one that dies.

The new AAP policy also covers flying safety: it says that although the Federal Aviation Administration allows children under 2 to ride on an adult’s lap on an airplane, the best way to protect them is for them to ride in an age- and size-appropriate restraint.

“Children should ride properly restrained on every trip in every type of transportation, on the road or in the air,” said Durbin.

“Policy Statement – Child Passenger Safety.”
Committee on Injury, Violence and Poison Prevention.
Pediatrics, Published online 21 March 2011
DOI:10.1542/peds.2011-0213

— More info: car seat guide for parents at healthychildren.org/carseatguide

Additional source: AAP (press release 21 Mar 2011).

Written by: Catharine Paddock, PhD