American Academy of Pediatrics Says Rear-facing Until Age 2 (at least)

REAR-FACING & YOUR TODDLER

Evidence-Based Recommendations from 

Dr. Alisa Baer - Pediatrician & The Car Seat Lady

** For an easy-to-print version of this tip sheet, click here**

Accidents happen - but you can prevent injuries. Car crashes are the #1 cause of preventable death & injury to children in the US. Give your child the BEST protection possible - so in case of a crash you'll have no regrets.

***April 2011 the American Academy of Pediatrics recommends rear-facing until age 2 (at least)***

I want to share with you new information and research published in the last several years that strongly recommends keeping kids rear-facing as long as possible. The American Academy of Pediatrics (AAP) has for many years now recommended keeping kids rear-facing until they are too big for their convertible seat, and new research published both in American and international medical journals fully supports this. Convertible seats are ones that start rear-facing and then convert to forward-facing for older kids; kids typically start using a convertible seat after out-growing the infant seat. 


A 2007 article in the journal Injury Prevention showed that 2 year-olds were FIVE TIMES SAFER riding rear-facing than 2 year-olds riding forward facing.1 A 2008 article in the journal of the AAP urged pediatricians to "implement what we know to be best practice: children should ride in a rear-facing seat to the highest weight or height allowed for use rear-facing by the manufacturer of the seat."2 The AAP further reinforced this message, publishing "New advice: Rear-facing car seats safer for children until they are 2" and a handout for pediatricians to give to their patients entitled "Keep your toddler in a rear-facing car seat until at least age 2 (not 1)".3 In June 2009 the British Medical Journal (a highly regarded peer-reviewed journal) published an article entitled "Advise use of rear facing child car seats for children under 4 years old."4 The push to keep pre-schoolers rear-facing is now a worldwide movement. The Swedes, who for more than 35 years have kept kids rear-facing until 4 years of age with extremely low death and injury rates as a result, are probably wondering what took the rest of the world so long to catch on.

As kids get older, their feet will touch the back of the vehicle seat; this is safe & comfortable. Ever watched a 4-year-old sleep with his chin on his chest? They never wake up complaining of a stiff neck! Kids' joints aren't fully formed, which lets them sit comfortably in positions that would be painful for even a limber adult. For this reason, a 3 year old can sit comfortably rear-facing with her legs crossed or in the "frog leg" position. Other parents worry about leg injuries; studies5 show that forward-facing children suffer far more leg injuries than rear-facing kids.

Rear-facing does not have to be boring! Older kids can ride quite upright so they can see out the side and rear windows. If there is a head rest blocking your child's view out the back window, you can usually remove it. By 9-12 months your baby knows you're there when you talk to them from the front - even though they can't see you. Therefore, you can calm and entertain your child with songs, stories - and for older children games of "I spy" - all while they are rear-facing. Concerned about car sickness? Volvo looked at several thousand pre-schoolers and found the same rates of motion sickness in those riding rear-facing as those riding forward-facing. Regardless of the direction your child rides, placing
them in the center seat with an unobstructed view out the front/back window will help keep the nausea away.

In the face of growing evidence that rear-facing is by far the safest way to travel, it is my recommendation as a pediatrician and nationally certified child passenger safety instructor that children ride rear-facing until at least 2 years of age - and ideally longer, until reaching the maximum height or weight for rear-facing in their convertible car seat, which for most kids is around 2-4 years of age. The weight limit for rear-facing is 35-40 pounds for most convertible seats, with a few seats going as high as 45 pounds. The height limit for rear-facing is that the child's head must be 1 inch below the top of the car seat.

Alisa Baer, MD  www.thecarseatlady.com  (last updated 03/11)

References
1. Henary B, et al. Car Safety Seats for Children: Rear Facing for Best Protection. Injury Prevention. 2007; 13 (6): 398-402.
2. Bull M, Durbin D. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics. 2008; 121 (3): 619-20.
3. O'Keefe L. New Advice: Rear-facing Car Seats Safer for Children Until they are 2. AAP News. 2009; 30 (4): 12.
4. Watson E, Monteiro M. Advise Use of Rear Facing Child Car Seats for Children Under 4 Years Old. BMJ. 2009; 338: b1994.
5. Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annu Proc Assoc Adv Automot Med. 2002; 46: 213-30.