**The American Academy of Pediatrics has updated their recommendations since this blog published in 2011. Children should ride in rear-facing car seats until they reach the height or weight limit provided by the car seat manufacturer. This is likely well past age 2. To view the new guidelines and data, click here.**
Did you hear the news? The AAP has made it official. 2 is now officially the new 1.
Last year I wrote a blog post entitled “2 is the new 1” that discussed my opinion that you keep your children rear-facing in the car seat until at least age 2. This week the AAP announced the official change in recommendations for car seats, which includes the rear-facing until at least age 2 years and also adds some additional pointers on how to keep kids safe at all ages.
Some highlights of the new report and policy that uses evidence to guide the best way to protect your infant or child from serious injury in the car:
- 2 is Officially the New 1. Rear Facing Until At Least Age 2. Keep all infants and toddlers rear-racing from birth until at least age 2. No need and no advantage to turn them around earlier. And there is nothing magic about the 2nd birthday. Most convertible car seats allow for children to be rear-facing until about 35 pounds, so if your 2 year old is doing well rear facing and under 35 pounds, you can continue to keep them positioned that way. Check your seat for specific weight limits. But know, toddlers between the age of 12 months and 24 months are 75% less likely to have serious injury or die in a car accident if they are rear-facing. Even at older ages, rear facing is a safer position because of forces on the head and neck during and accident. A no brainer, keep your babe facing the back of the car until at least age 2. There’s no data to support concerns about injury to legs when toddlers are rear-facing and there is no safety issue if your child’s legs and feet rest on the back seat.
- Don’t Rush Into A Booster. There’s no rush to transition from a 5 point restraint or child safety seat that has a harness to a booster. Children are safer in a 5 point restraint. Instead of transitioning to a booster seat right when your child reaches 40 lbs, the AAP recommends staying in a 5 point restraint for as long as possible based on the weight and height restriction of the seat. Many car seats with 5 point restraints accommodate children facing forward up to 65 or even 80 pounds. No rush to use the booster! Data finds it is advantageous to transition to the booster later.
- Making It to 4 Foot 9 Inches or 12 years: Children need to be in a booster seat until they reach 4 foot 9 inches and are between 8 and 12 years of age. Children need to stay in a booster until the car’s lap and shoulder seat belt fits properly. Booster seats work by positioning the child so that the lap and shoulder positions are over strong bones to prevent injury to soft organs during a very rapid slow-down or crash. Going to a seat belt too soon can leave your child at risk for severe internal injuries. My friend, Dr Alanna Levine, suggested a great trick to help with your “negotiations” at home. Put a mark on the wall at 4 foot 9 and instruct your kids to talk with you about ditching the booster only after they measure up!
- Lap and Shoulder belt: Children are best protected once over 4 foot 9 when in a seat belt that has a lap an shoulder component. The lap portion should fit low across a child’s hips and pelvis, and the shoulder strap needs to rest across the middle of the chest and mid point of the shoulder so it’s not rubbing against their face and neck.
- Back Seat Until 13! All children younger than 13 years of age should be restrained in the rear seats for maximal protection.
There’s no rush to transition from each step if your child doesn’t exceed the seat’s weight and height requirement. Remember this: with each transition you make (from infant rear facing–>forward facing–>booster seat–>seat belt–>front seat with seat belt) the position is associated with decreasing protection. Often there is no rush to transition (other than your child’s wishes, of course)!
Some science and rationale:
- When you stop quickly or are involved in an impact, your body continues to fly forward at the velocity the car was going. This sounds likes a 8th grade math word problem; it isn’t. Infants and toddlers have disproportionately big heads for their necks and bodies so as the car slows, their heads and and upper neck continue to move forward rapidly while the straps of the car seat hold their body in place. This motion puts them at risk for head, cervical spine, and severe neck injuries.
- When rear facing, the head, neck and entire body can absorb the impact at once. This rear-facing position can prevent neck injuries leading to paralysis or even death.
So, we were wrong previously when saying it was okay to turn your baby around when he/she reached a year of age.
2 or 3 (years) really is the new 1 (year). See?
Spread the word. You may just save someone’s life.
For Infants, Do This Now:
- Get a car seat safety check if you have any concerns about how you installed the car seat or booster your child rides in. Many injuries in children are related to not using the car seat correctly.
- Make sure you and any one who drives with your children uses the 5 point restraint correctly! In Seattle, you can come here for help.
- Inform yourself about how to use your car seat. Watch this video
- Keep your 12-24 month old rear-facing until at least their 2nd birthday if not over the weight based restrictions of the seat. Most seats accommodate up to 35 pounds rear-facing.
- Talk to your pediatrician if you have questions or leave a comment below.
Resources To Help You:
Children with special health care needs
Locate a child passenger safety technician with special training in special health needs
AAP Information/Lists on Currently available Car and Booster Seats
Jen says
Thanks so much for doing this post. I saw the article on MSN the other day and hoped you would follow up. Such important safety information that is so easy to do. So many people complain their kids put up a fight about following the recommendations at any age. I always say who is the parent. I would rather know I did the most I possibly could to keep them safe then put them in harms way because they threw a tantrum.
Elizabeth says
To be exact, “All infants and toddlers should ride in a Rear-Facing Car Safety Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer.” (It goes on to say that when your child gets too big for the “baby bucket” seat, get a convertible that can rear-face. Hopefully parents will read that far – my own son was too tall for the baby bucket before he could even sit unassisted, so of course he had a convertible seat until he outgrew the rear-facing configuration for that, too.)
While you can get rear-facing seats that go to pretty high weights, my own experience was that my kids got too tall for them long before they reached the target weight. Consult the manual for your car seat to see where the head and shoulders must fall in the rear-facing position. Don’t try to use a seat in an untested configuration (e.g., moving the shoulder straps above the bottom slot while the seat is rear facing).
BookMama/CPST_AndyPandy says
Great post! I was hoping you’d be writing about these new recommendations soon. I’ve been a tech since 2007, and it’s really helpful to have something like this – from a pediatrician, especially – to refer parents to when they start the “but my kid is to big … my car is too small … etc.” comments.
I would also add http://www.car-seat.org to your list of resources. They can help resolve just about any specific car seat problem or question a parent might have.
Wendy Sue Swanson, MD says
Thanks BookMama, for the link to car-seat.org, and to Elizabeth, for her advice…
BookMama/CPST_AndyPandy says
Elizabeth, most rear-facing seats allow more than just the bottom slot to be used rear-facing (in fact, I can’t think of any seat currently on the market that allows only the bottom slot). Also, most kids do not outgrow seats by height and weight at the same time. The corollary to your situation is the child who outgrows seats by height before reaching the stated weight limit.
That said, the vast majority of convertible seats on the market (the only exceptions I can think of offhand are one small-ish niche seat and one small-ish seat that hasn’t been updated in about 10 years) can get the vast majority of kids to age two rear-facing.
The selection of car seats available these days is amazing, with something to fit just about every child and every budget.
Shelly says
I agree with the previous posts in that caution must be used and the wording is a little vague in that it is recommended that they be rear facing until age 2 or until they grow out of their car seat. Most rear facing infant seats max out at 22 pounds and it will take a lot of time (accompanied by law) until car seat manufacturers follow the trend in making infant seats that have higher upper weight and height limits; there are some out there but few and they aren’t typically the ones that parents grab first due to higher cost.
As a certified car seat technician and senior checker I have found that the more you can encourage parents to become hands on and find local resources that do seat checks, the safer that child will be in the long run because they learn the safety features of the seats and what to look for as their children age. If you have any influence over parents with young children, encourage them to get their car seats checked for all of their children as many are riding at risk!
Also keep in mind that car seat laws differ from state to state and as parents travel, they should find out what those laws are before leaving their home state.
Elizabeth says
@BookMama, I actually thought about whether to put that parenthetical there at all, because I knew that not every seat necessarily had the same constraints on configuration that mine did (a seat made in 2004 and used for two children). But I wanted to be clear about what I meant by “untested configuration”. The real message is, read the manual and don’t do stuff that it says not to do. (Another example is using LATCH plus a seat belt in a booster seat – some seats are designed for that, others are not. You have to read the manual to figure out which you have.)
kate says
Thank you Thank you Thank you for posting this. I have been arguing these points with friends and family for years, to be looked on as some radical safety nut, but finally I have some backing! Finally.
To clarify one thing about harness slot position. When a child is rear facing, you want the harness slots to be at or below the shoulders and when forward facing, at or above the shoulders.
and yes, Elizabeth, most kids will outgrow seats by height long before weight (unless they have an unhealthy BMI), so it is something to consider. But there are carseats on the market that allow much more height than they used to and allow kids to stay in a 5-pt harness much longer.
Vera says
I was SO happy to see these new recommendations, because I’ve kept all of my kids rear-facing until the weight limits of their seats (they are not very tall). My five year old is also the ONLY ONE among her peers still in a five-point harness. My feeling was always – it’s safest for a race-car driver, so why not use the safest seat possible? I wish they made 5-point harnesses for ME! I don’t make parenting decisions based on peer pressure, and I don’t really care if other people think I’m silly or over-protective, but it’s still nice to have the backing of the AAP 🙂
Katie says
I love that this is now the official recommendation. Will is still rear-facing (at 2.5) and he will stay that way as long as he fits the carseat’s guidelines (we have a Britax, so he has a way to go), and then we will put him into a 5-point harness booster.
It always surprises me when people get irked about this guideline and try to fight it. I get teased by my friends all of the time and asked why I would make him sit cross-legged or be “so uncomfortable” sitting rear-facing (he never complains). I guess my perspective on this is colored by a video that I saw before I even had children. Warning, this will haunt you. But it’s an amazing reminder of WHY it is so important to follow these guidelines, even if it is not always the most convenient, popular choice.
https://www.vimeo.com/2994502
Amy says
Great post! I learn a lot here. I think it is essential for parents to learn these information before they decide to purchase a car seat for their baby, in that case, they will get a right one which is definitely needed by their baby and themselves.
Tiffany says
Hi, I came across your post and thought you might be able to help me out. I’m a pediatric certified Chiropractor and recently did a bunch of research on motor vehicle collisions and kids for my job. My husband and I have a rear facing 2 1/2 year old and a soon to be born newborn. It almost seemed from my research that due to the bucket seat surrounding the infant that the infant MAY be safer on the side position than our toddler would be. We do plan on keeping them both rear facing. Curious on your thoughts? Infant in the prized middle back row seat or toddler?
Thanks so much!
Tiffany
Wendy Sue Swanson, MD, MBE says
Thanks for your question, Tiffany. It’s a good one! I’ve been asked this exact question in clinic. I don’t know the data but have just reached out to a pediatric safety researcher who will likely know the answer. More to come…
Wendy Sue Swanson, MD, MBE says
I think it makes the most sense for you to get your car seats check by a technician (ask your dealer or local hosp) and report back. Each car and seat is different but I think your instinct is also really good. Think about convenience (as disc below) as well. Here’s what the pediatric trauma and safety expert said by email today:
“These are tricky (with bucket seats) and I usually refer to a car seat check for the complicated if/then/whats…. Some cars with bucket seats can’t handle kids in the middle position (b/c the car seat isn’t stable, or b/c the latch system doesn’t work well there). Moreover there is a practical question – harder to lift an infant seat over to the center, especially as kids get heavy. Finally (but not relevant to this family) booster seats must use a lap/shoulder, which is missing in the center position in a number of older cars.”