American Academy of Pediatrics (AAP) Advises Changes to Car Seat use for Toddlers

In a new pol­icy, the AAP advises par­ents to keep their tod­dlers in rear-facing car seats until age 2, or until they reach the max­i­mum height and weight for their seat. It also advises that most chil­dren will need to ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age.

The pre­vi­ous pol­icy, from 2002, advised that it is safest for infants and tod­dlers to ride rear-facing up to the lim­its of the car seat, but it also cited age 12 months and 20 pounds as a min­i­mum. As a result, many par­ents turned the seat to face the front of the car when their child cel­e­brated his or her first birthday.

“Par­ents often look for­ward to tran­si­tion­ing from one stage to the next, but these tran­si­tions should gen­er­ally be delayed until they’re nec­es­sary, when the child fully out­grows the lim­its for his or her cur­rent stage,” said Den­nis Durbin, MD, FAAP, lead author of the pol­icy state­ment and accom­pa­ny­ing tech­ni­cal report.

“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,” Dr. Durbin said. “For larger chil­dren, a forward-facing seat with a har­ness is safer than a booster, and a belt-positioning booster seat pro­vides bet­ter pro­tec­tion than a seat belt alone until the seat belt fits correctly.”

While the rate of deaths in motor vehi­cle crashes in chil­dren under age 16 has decreased sub­stan­tially – drop­ping 45 per­cent between 1997 and 2009 – it is still the lead­ing cause of death for chil­dren ages 4 and older. Count­ing chil­dren and teens up to age 21, there are more than 5,000 deaths each year. Fatal­i­ties are just the tip of the ice­berg; for every fatal­ity, roughly 18 chil­dren are hos­pi­tal­ized and more than 400 are injured seri­ously enough to require med­ical treatment.

New research has found chil­dren are safer in rear-facing car seats. A 2007 study in the jour­nal Injury Pre­ven­tion showed that chil­dren under age 2 are 75 per­cent less likely to die or be severely injured in a crash if they are rid­ing rear-facing.

“The ‘age 2’ rec­om­men­da­tion is not a dead­line, but rather a guide­line to help par­ents decide when to make the tran­si­tion,” Dr. Durbin said. “Smaller chil­dren will ben­e­fit from remain­ing rear-facing longer, while other chil­dren may reach the max­i­mum height or weight before 2 years of age.”

Chil­dren should tran­si­tion from a rear-facing seat to a forward-facing seat with a har­ness, until they reach the max­i­mum weight or height for that seat. Then 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 thighs, 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 a vehi­cle until they are 13 years old.

Although the Fed­eral Avi­a­tion Admin­is­tra­tion per­mits chil­dren under age 2 to ride on an adult’s lap on an air­plane, they are best pro­tected by rid­ing in an age– and size-appropriate restraint.

“Chil­dren should ride prop­erly restrained on every trip in every type of trans­porta­tion, on the road or in the air,” Dr. Durbin said.