New Rules of the Road: Children Rear-Facing Until Age 2

INDIANAPOLIS – Parents who mark their children’s first birthdays by turning their car seats to face forward should think again. New advice from the American Academy of Pediatrics (AAP) suggests children stay safer longer in rear-facing car seats.

The updated AAP car seat recommendation states that parents should keep their toddlers in rear-facing car seats until age 2 or until they reach the maximum height or weight for their seat. The previous policy that many parents have followed advised that infants and toddlers ride rear-facing up to the limits of the car seat or age 12 months and 20 pounds.

“While this change is very exciting, we’ve been promoting the safety benefits of rear-facing car seats for a long time at Riley Hospital for Children at Indiana University Health through our Automotive Safety Program,” said Dr. Bull, a developmental pediatrician with Riley at IU Health, and a current AAP board member and chair of District V. “This will be an adjustment for parents certainly, but our experience shows that they want to do the right thing for their children.”

Dr. Bull and fellow Riley developmental pediatrician Dr. Joseph O’Neil have studied car seat safety for years. Both were active in the new policy through the Committee on Injury, Violence and Poison Prevention, AAP’s committee tasked with revising the child passenger safety recommendations. Dr. O’Neil currently sits on the committee; Dr. Bull is a past committee chair.

“Instead of parents looking ahead to the next transition for their child, they should instead monitor their child’s height and weight to see when they reach the limits of their car seat,” Dr. O’Neil said. “There shouldn’t be a rush to get kids to the adult seat belt because each transition up until that point comes with a reduction in the protection the restraint provides. The goal here should be safety and we know that rear-facing car seats are simply safer and provide better protection for children under age 2.”

Data supporting AAP’s updated recommendation comes from a study1 in which Dr. Bull participated. Findings of the study include:

• Infants (0-11 months) are almost two times more likely to be seriously injured in a motor vehicle crash while forward-facing compared to rear-facing.
• Children in the second year of life (12-23 months) are five times more likely to be seriously injured in a motor vehicle crash while forward-facing compared to rear-facing.

“Rear-facing car seats support the body over a wide area, distribute crash forces, and as a result, better protect the head, neck and spinal cord,” Dr. O’Neil said. “This is important because kids have big brains, high centers of gravity, weak neck muscles and less developed bones and ligaments.”

According to the AAP:

• Children should transition from a rear-facing seat to a forward-facing one with a harness, until they reach the maximum height or weight for that seat.
• 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 things - 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.
• Children should ride in the rear of the vehicle until they are 13 years old.
• Parents with questions on their car seats and the updated AAP recommendation should contact the Riley Hospital for Children Automotive Safety Program at Indiana University Health at 1-800-KID-N-CAR or visit www.preventinjury.org.

To interview Drs. Marilyn Bull or Joseph O’Neil on car seat safety and the updated AAP recommendation, please call Kit Werbe at 317.963.7692.

Source: 1. Henary, B., Sherwood, C.P., Crandall, J.R., Kent, R.W., Vaca, F.E., Arbogast, K.B., Bull, M.J. (2007). Car safety seats for children: rear facing for best protection. Injury Prevention, 13: 398-402. doi:10.1136/ip.2006.015115

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About Riley Hospital for Children at Indiana University Health For more than 85 years, Riley at IU Health has been one of the nation’s leading children’s hospitals. Each year, Riley at IU Health provides compassionate care, support and comfort to 215,000 inpatients and outpatients from across Indiana, the nation and the world. Part of Indiana University Health, our unique partnership with the Indiana University School of Medicine gives our highly skilled physicians access to innovative treatments using the latest research and technology. Discover the strength at rileyhospital.org.