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AAP Advises Children Should Ride in Rear-Facing Safety Seats Until Age Two


Parents and society want to keep children safe. One of the simplest ways to do this is to this is the proper use of seat belts and restrains in vehicles.

The American Academy of Pediatrics (AAP) has published their new car seat policy guidelines in the April 2011 issue of Pediatrics (published online March 21).

The new guidelines will change the way many parents buckle up their children for a drive as the AAP advises parents to keep their toddlers in rear-facing car seats until age 2.

If the toddler is on the small size, it is recommended the child remain rear-facing until they reach the maximum height and weight for their seat.

The AAP also advises most children need to ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age. The child’s height is more important than the age, so once again if the child is small for age use the height standard.

The previous policy, from 2002, advised that it is safest for infants and toddlers to ride rear-facing up to the limits of the car seat, but it also cited age 12 months and 20 pounds as a minimum. As a result, many parents turned the seat to face the front of the car when their child celebrated his or her first birthday.

Dennis Durbin, MD, FAAP, lead author of the policy statement and accompanying technical report, notes “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.”

“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,” Dr. Durbin said.

New research has found children are safer in rear-facing car seats. A 2007 study in the journal Injury Prevention showed that children under age 2 are 75% less likely to die or be severely injured in a crash if they are riding rear-facing.

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“The ‘age 2’ recommendation is not a deadline, but rather a guideline to help parents decide when to make the transition,” Dr. Durbin said. “Smaller children will benefit from remaining rear-facing longer, while other children may reach the maximum height or weight before 2 years of age.”

Children should transition from a rear-facing seat to a forward-facing seat with a harness, until they reach the maximum weight or height for that seat. 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

Then a booster will make sure the vehicle’s lap-and-shoulder belt fit properly. The shoulder belt should lie across the middle of the chest and shoulder, not near the neck or face. The lap belt should fit low and snug on the hips and upper thighs, not across the belly. Most children will need a booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years old.

Prior research shows booster seats can reduce the risk of injury by 45% in 4- to 8-year olds compared to kids of that age in seat belts.

Children should ride in the rear of a vehicle until they are 13 years old. Studies have shown this reduces the risk of injury by 40 to 70%.

The rate of deaths in children under age 16 due to motor vehicle crashes has decreased substantially – dropping 45 percent between 1997 and 2009. Still motor vehicle crashes remain the leading cause of death for children ages 4 and older.

Counting children and teens up to age 21, there are more than 5,000 deaths each year. Fatalities are just the tip of the iceberg; for every fatality, roughly 18 children are hospitalized and more than 400 are injured seriously enough to require medical treatment.

Let’s keep our children safe. Use proper seat belt restrains.

A car seat guide for parents is available at www.healthychildren.org/carseatguide

American Academy of Pediatrics Press Release
Car Seats Policy
Car Seat Technical Report