Car Seat Update: Backwards Is Better

Traveling by car just got safer for your most precious cargo. As of March 2011, the American Academy of Pediatrics (AAP) has officially changed its position regarding car seats. Parents are now strongly advised to keep children in rear-facing seats until they are at least two years old.

The new policy is a departure from a decades-old recommendation that advised flipping the seat much sooner—at one year and 20 pounds. Until now, car seat turn around time has been a one-year milestone.

The new guideline is primarily based on a 2007 University of Virginia study finding that children under age 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear. Numerous other studies concur including one that found riding rear-facing to be five times safer than forward-facing. The evidence prompted the AAP-the nation's leading pediatricians' group-to advocate using them in a way that makes car travel even safer for the littlest passengers.

Backwards is better, say the experts and the reason has to do with head size. Experts believe the entire body is better supported by the shell of a rear-facing seat since a young child's neck bones are immature and babies' heads tend to be large in proportion to the rest of his body. In Sweden, where the fatality rate for children under 6 is the lowest in the world, children ride rear facing until the age of 4.

"When baby is forward-facing, his shoulders and trunk may be well restrained, but in a violent crash, his head and neck can fly forward," said the statement's lead author, Dennis R. Durbin, MD, F.A.A.P., a pediatric emergency physician and scientific co-director of the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia.

A child's height and weight are more meaningful indicators for turn-around time than a child's age. "Our recommendations are meant to help parents move away from long-held notions that are based on a child's age. "Parents should recognize that when transitioning from rear-facing to forward-facing, safety declines and the AAP wants to delay that transition for as long as possible," Dr. Durbin said.

Car seats are clearly effective. The National Highway Traffic Safety Administration (NHTSA) reports 8,959 lives were saved by child restraints between 1975 and 2008. They do the job so well that emergency medical technicians (E.M.Ts) have dubbed the rear-facing seat the "orphan seat"—reflecting the sad reality that young children are often the only ones to survive car crashes.

The NHTSA advises parents to check the label on the back of the car seat to be sure your child does not exceed the height or weight limits for it. Until recently, most car seats that could be turned to face the rear did not accommodate children weighing more than 20 pounds. Today, however, the limits go much higher—30 or 35 pounds.

Although child passenger safety has improved dramatically during the last decade, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. In 2005, the Centers for Disease Control and Prevention reported that 1,335 children ages 14 years and younger died as occupants in motor vehicle crashes and 184,000 were injured. That's an average of 4 deaths and 504 injuries each day.

The AAP policy statement has four evidence-based recommendations for optimal safety in children from birth through adolescence and a fifth recommendation for children younger than 13:

1. Rear-facing car safety seats for most infants up to 2 years of age
2. Forward-facing car safety seats for most children through 4 years of age
3. Seat belt-positioning booster seats for most children through 8 years of age
4. Lap-and-shoulder seat belts for children who have outgrown booster seats
5. All children younger than 13 years should only be seated in the rear seats of vehicles

For parents currently using car seats for children that will likely exceed the height and weight limit before the their second birthday, the AAP urges them to purchase a convertible car seat that can accommodate larger children-some go up to 45 pounds.

Unfortunately, the NHTSA estimates that 3 out of 4 parents do not properly use child restraints. Visit to locate a child safety seat inspection station near you. Certified technicians are available to inspect your safety seat and show you how to correctly install and use it.

American Academy of Pediatrics

The Journal of Pediatrics

The Centers for Disease Control and Prevention

National Highway Traffic Safety Administration.