AAP Updates Recommendation on Car Seats

3/21/2011

Article Body

New advice from
the American Academy of Pediatrics (AAP) will change the way many
parents buckle up their children for a drive.

In a new policy
published in the April 2011 issue of Pediatrics (published online
March 21), 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.

TheAmericanAcademyof
Pediatrics is an organization of 60,000 primary care pediatricians,
pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children,
adolescents and young adults. For more information, visitwww.aap.org.