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Toddlers in rear-facing seat until 2


In a new policy statement published in the April 2011 issue of Pediatrics, the American Academy of Pediatrics now advises parents to keep toddlers in rear-facing car seats until age 2, or until they exceed the height or weight limit for the car seat, which can be found on the back of the seat.

Previously, the AAP advised parents to keep kids rear-facing as long as possible, up to the maximum limit of the car seat, and this has not changed.

But it also cited one year and 20 pounds as the minimum for flipping the seat, which many parents and pediatricians interpreted as conventional wisdom on the best time to make the switch.

The new policy clarifies the AAP's recommendation, making age 2 the new guideline -- a real game-changer for parents of toddlers.

A 2007 study in the journal Injury Prevention found that children under age 2 are 75 percent less likely to die or to be severely injured in a crash if they are rear-facing. Another study found riding rear-facing to be five times safer than forward-facing.

"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," said Dennis Durbin, M.D., F.A.A.P., a pediatric emergency physician and co-scientific director of the Center for Injury Research and Prevention at The Children's Hospital of Philadelphia and lead author of the policy statement and accompanying technical report.

Recall Finder: Check if your child's car seat has been recalled

Parenting talked to Ben Hoffman, M.D., associate professor of pediatrics at the University of New Mexico in Albuquerque and a child passenger safety technician, to get answers to parents' most pressing questions about the new policy.

Although the new baseline is now age 2, the AAP has advised parents since 2002 to keep kids rear-facing until they reach the height or weight limit of their car seat. Why are parents so eager to turn their car seats?

"Parents are interested in milestones, and the minimum of one year and 20 pounds has been interpreted as gold standard instead of the minimum," says Hoffman. "Parents are always looking for the next stage of development because in every other scenario, that's a good thing. With car safety seats, however, that's often not the case."

But isn't forward-facing easier for everyone?

Yes, it's easier to interact with your child when she is facing forward, and less awkward to get her into the seat. But safety should be the main concern. "I would ask parents to consider the protection of the child in addition to comfort," says Hoffman. "It's minimally acceptable to change to forward-facing at a year, but parents can do better than that."

New infant and convertible car seats to keep your child safe

What about squished legs?

New car seat guidelines for kids Kids who have been only rear-faced will most likely not be bothered, since they don't know anything else. And it's completely fine for their feet to touch the seat back, or for their legs to bend. "Once you make the switch, it's hard to go back, so try not to ever switch them before they are ready," says Hoffman.

Why are so few parents aware of even the older guidelines that say kids should stay rear-facing as long as possible?

There may have been some confusion with the message, with many parents mistaking the minimum for the ideal age to make the switch. The AAP hopes that by making age 2 the new guideline, the message will be less confusing for parents and for pediatricians.

If my child turns 2 before he reaches the height or weight limit for the seat, should I keep him rear-facing?

Yes. The safest decision is to keep him rear-facing until he reaches the height or weight limit for the seat.

10 Car Seat Mistakes You May Be Making

If my child reaches the height or weight limit for my seat before age 2, what should I do?

Once your child exceeds the height and weight limit of his infant car seat, purchase a convertible car seat with a higher height or weight limit (most go to 35 pounds rear-facing) and continue to use it rear-facing until age two, or until your child hits the height or weight limit for rear-facing use. At that point you can make the switch to forward-facing-- or you can purchase a convertible car seat with a higher weight limit for rear-facing (some go up to 45 pounds). "That's a very personal decision for the parent," says Hoffman, one that may also be influenced by the size of your car, the arrival of a younger sibling, or your budget.

What should I do if I've already switched my under-2 child for forward-facing?

The best advice is for parents to consider switching their child back to rear-facing. But the next best thing is to, at a minimum, make sure you correctly use the seat you have: Make sure the seat is harnessed tightly to the vehicle, that the harness is snug over the child and the chest clip is in the correct position, and that the seatbelt or LATCH system are installed correctly.

Why didn't my pediatrician tell me about this?

"Pediatricians should be talking about this," says Hoffman. "But given everything else that needs to happen in a well-child visit, sometimes this message gets left behind. I would love to see a day where every family-care health provider knew the best possible advice and shared it with their patients."

10 Responses
Avatar universal
I saw this on the news this morning, my grandson will really be upset when he finds out he has to be 13 to sit in the front now.
377493 tn?1356505749
When Ryder hit 1 we were going to switch him.  It seemed mean to keep him facing backward.  My Pediatrician and the Public Health Nurse (they do the vaccines here) both advised me to wait until he was 2.  It is just so much safer for them.  I am not surprised they are changing this.  You know what really blows my mind though?  How many little ones I see riding around in cars on a parents lap still.  Not just illegal, but so very very dangerous.  I will never understand why anyone takes chances like that.
982214 tn?1471458381
I saw this on the news tonight and my question is where do their legs go? I can see if your little one is shorter and their legs don't go over the edge of the seat but what about the ones that do? I know whn my now almost 11 year old was 2 there was NO WAY he would have fit backwards in a car till 2... His little legs would have been smushed into his little body and I don't think that is very safe or good for his development... Just a thought!
377493 tn?1356505749
Good point.  Even Ryder's legs are getting a bit long, but he still fits ok.  But he is on the tall side, so I wonder how long that will be ok..hmmm. You certainly can't have the car seat pushed back or anything.  Didn't think of that.
1639856 tn?1395189207
I live in Cincinnati,Ohio. They are talking about a law that would keep you 12 year old child in a booster seat. If it keeps them safe. Let's do it!!!! To many people drive down the street smacking at their children jumping around in the back seat. It's so sad.
1035252 tn?1427231433
Yeah....my daughter quite literally couldn't fit after her first birthday and her brother is shaping up to be even taller. Just like Krichar we didn't have much of an option for switching her, and I wouldn't have kept her backward until 2 anyway. We live in a rural community that involves a lot of driving (which means that many more miles with the legs crammed) and I personally think (from experience, seeing my SIL wreck her car twice with her kids in it) that a kid in a carseat is going to be at risk no matter what if they're in a crash...and while I think it's moderately safer to be backwards, there are other risk factors. My nephew and niece were in the car when my SIL wrecked it the 2nd time (the first time it was just my nephew) - my nephew was facing forward and my niece was facing backward. The back window shattered and she was cut from head to toe..my nephew didn't have even the slightest bump.

Just saying. there's always going to be a risk and while, yes, it's good to minimize it....I think 2 is a little ridiculous. I think size has more to do with it than age after a year (obviously before a year you're looking at problems with neck development and spinal development...but after a year it's just about equalized), and both of my kids are quite tall (both 90%+ for height). Some people may disagree with me, but anyone who knows me knows I"m a super careful parent...but this is one place where the AAP and I butt heads.
419158 tn?1316575204
Looks like my older boys will be in a booster untill they turn 18, lol!! All my kids are tiny. My 9 year old is only 50 lbs, I acually just took him out of a booster but if they pass a new law it looks like he will be back in it:(
535822 tn?1443980380
Whilst I can understand the safety issues in this I can see there will be many problems for children in the booster seats .I guess the size of the car will also be a problem with small cars now how many can one fit into the back along with the 13 year olds .
1310633 tn?1430227691
1) Have insurance companies MANDATE that those with children must declare them and have them on their policies.

2) Have said insurance companies distribute a 'speed governor' for their clients (those that declared they have children) to put on their vehicle so it can't exceed a certain, predefined, speed-limit. (Offer a discount for those that install this device on their vehicle)

You could even have it be self-adjustable depending on the actual speed-limit of the road their traveling on.

Just think if people with kids were made to drive, say, 25mph SLOWER than everyone else. That might shorten the long list of accidents and child deaths quite a bit, wouldn't you think?

Also, a positive side-effect of the lowered speeds is increased gas-mileage!

Think GREEN people!!!
377493 tn?1356505749
Having a car accident with my son in the car is one of my worst nightmares.  It sounds silly, but one of the things that helps...I have a "Baby on Board" sign hanging on my car window.  I really do find that others seem to drive with more caution around my vehicle..less tailgating, etc.  I obey the speed limit anyway..I'm a pretty cautious driver, and especially when he is in the car.

In addition to what you said above, I wish they would go zero tolerance for alcohol, especially with a child in the car.  I personally think driving with one drink in you is one too many.  
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