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Parents Should Not Ignore New Car Seat Recomendations

by Sue Hubbard, M.D.

I have been surprised at the number of parents I have seen, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two. I try to discuss car seat safety at each check-up appointment, and have always been especially mindful of doing this at the one-year check up.

A new policy (April 2011) by colleagues at the American Academy of Pediatrics recommends what I have been discussing for a while now: children up to age two should remain in rear-facing safety seats.

The new policy is supported by research that shows children younger than 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing.

So how did we get here? Original recommendations (established in 2009), I had followed with my own patients. I discussed turning the car seat to a forward facing position if the child had reached 12 months and 20 pounds.

Then in April, an article was published (Inj Prev. 2007;13:398-402), which was the first U.S. data to substantiate the benefits of toddlers riding rear facing until they are two years of age. This study showed that children under the age of two are 75 percent less likely to die or experience a serious injury when they are riding in a rear-facing. That is a fairly compelling statistic to keep that car seat rear-facing for another year!

Studies have shown that rear-facing seats are more likely to support the back, neck, head and pelvis because the force of a crash is distributed evenly over the entire body. Toddlers between the ages of 12 and 23 months who ride rear facing are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat. There has also been concern that rear-facing toddlers whose feet reach the back of the seat are more likely to suffer injuries to the lower extremities in a car accident. But a commentary written by Dr. Marilyn Bull in Pediatrics (2008;121:619-620) dispelled the myth with documentation that lower extremity injuries were rare with rear-facing seats.

So, it has now been over two years since this data was published and recommended, and parents continue to say, “I just turned the seat around any way” or “I didn’t know.” I did go look at car-seats the other day and I noted that the labeling on the boxes had all been changed to recommend rear facing until two years or until a toddler reaches the maximum height and weight recommendations for the model. I take this to mean that some “small” toddlers could even rear face longer as they do in some European countries.

For safety sake, rather than convenience, keep that car seat in the rear facing position. I wonder if they will begin putting DVD players and cup holders facing toward these toddlers, as that seemed to be a concern of many parents. Maybe this will make it “okay” to listen to music or talk while in the car rather than watching TV, at least until a child is older!!

If you need references on car seats go to or

Send your question or comment to Dr. Sue!

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4 Responses to “Parents Should Not Ignore New Car Seat Recomendations”

  1. Jennifer says:

    I think it’s great pediatricians are trying to talk to parents more about rearfacing longer. I have to wonder why it wasn’t happening sooner as the AAP has had the reccomendation for children to rear face as long as possible for at least the past 7 years.

  2. Meghan says:

    We keep our kids rear facing to age 4 OR until they have outgrown the convertible car seat by height or weight.. we make sure we have seats with high rear facing limits though. Because getting to age 4 or as close to as possible is very important to me.

    I will never understand why people are always in such a rush to make their kids less safe, I hardly know anyone who rear faced to even 1 which is patheticly sad. I am always bombarded with funny looks when I am in parking lots getting a small 2 year old out of a rear facing seat. Even better when my 4 year 8 month old is with DH who has a rear facing radian xt in his car, which fits her with lots of room to spare rear facing.. so she rides that way with him.

  3. becca says:

    How the heck does your Four year old fit in a rear facing seat. Where does the child’s legs go? You must have an abnormally small child or an abnormally large back seat. Weird.

  4. Sarah says:

    It aggravates me when I hear people are turning their children around before the recommended time. The statistics are proof enough for me! I’d rather be safe than sorry! As long as my kids arent above the hight and weight reccomendations they willstay rearfacing.

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