Toddlers Need Rear-Facing Car Seats, Too

Mar. 23, 2011 - The time your child needs to spend in a rear-facing car seat just doubled - from one year to two.

The American Academy of Pediatrics has released new guidelines on car safety seat use, and they mark a significant change from previous recommendations. Those earlier guidelines said that a child should ride in a rear-facing car seat until he or she turned 1 and weighed 20 pounds. The new recommendation says kids should stay facing the rear until age 2, or until they have reached the maximum height and weight for their particular car seat.

Rear-facing seats offer more support for a child's head, back, and spine in a crash, so keeping youngsters in that type of seat longer is better, says lead author Dennis Durbin, M.D., at Children's Hospital of Philadelphia.

Beyond age 2

Even when your child turns 2, you may want to hold off switching out the seat if your youngster is small for his or her age.

Most rear-facing car seats available today can accommodate children up to age 2, the AAP says.

"There's been this perception that it's a good idea to move from rear-facing to forward-facing," says Benjamin Hoffman, M.D., at the University of Mexico. "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."

The guidelines, published in the April issue of Pediatrics, also say that a forward-facing car seat with a harness offers more protection than a booster seat, and a booster seat is better than a seat belt alone.

Boosters important

Kids should be kept in a forward-facing car seat as long as possible, according to the new guidelines. After kids outgrow their car seat, they should ride in a booster seat until they are 4 feet, 9 inches tall. That's usually between ages 8 and 12.

Boosters position the seat belt so that the shoulder belt lies across the middle of the chest and shoulder and keep it off the neck or face, and the lap belt fits low and snug on the hips and upper thighs, not across the stomach.

Studies show that car seats reduce the risk for child injury by up to 82 percent, compared with just wearing seat belts. And booster seats reduce the risk for injury by 45 percent over just wearing seat belts.

Back seat best

Once out of a booster seat, children should continue to ride in the back seat of a vehicle until age 13, the AAP says.

"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," says Dr. Durbin.

Safe Kids USA estimates that three out of four children are restrained incorrectly in car seats or booster seats. Here's what to do:

• Don't use a defective car seat. Don't buy a used car seat; you don't know its history. Pass up a hand-me-down that's more than 10 years old, especially with missing parts or cracks. And never use seats that are missing a label or instructions, have been recalled, or were in a crash.
• Install the car seat correctly. One of the main errors that parents make is not securing the seat tightly enough. The seat shouldn't move more than 1 inch.
• Secure the harness straps. They should always be snug and straight. For rear-facing car seats, use the two lower slots and strap the harness slightly at or below the shoulders. For forward-facing, use the top slot and strap slightly at or above the shoulders.
• Position the chest clip. Snap the chest clip at armpit level for rear-facing car seats, and at mid-chest or armpit level for forward-facing ones.

Always talk with your health care provider to find out more information.