Parents should wait until children are aged older than 2 years or until they grow too big for seat specifications to turn car seats from rear- to front-facing positions, according to a new policy statement from the American Academy of Pediatrics (AAP).

Previous guidelines recommended that children stay in rear-facing seats as long as possible, but also included a minimum threshold of 1 year or 20 pounds.

The AAP’s Committee on Injury, Violence and Poison Prevention decided to revise these recommendations based on data from studies in Sweden, where children typically stay in rear-facing car seats until the age of 4 years, and the United States, that indicate rear-facing seats continue to reduce the risk for serious injury after the age of 1 year.

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Compared with standard seat belt use, child safety seats reduce the risk of injury by 71% to 81% and the risk of death by 28%, whereas booster seats reduced the risk of nonfatal injury by 45% among children aged 4-to-8 years, according to background information included in the statement.

“The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit,” the committee wrote.

In addition to extending the age for rear-facing child safety seats, the policy statement included the following evidence-based recommendations for child restraint systems:

  • After children outgrow rear-facing seats they should be placed in a forward-facing car seat with a harness through 4 years of age or until they outgrow height and weight indications.
  • Belt-positioning booster seats should be used for children who outgrow front facing seats until lap and shoulder seat belts fit properly, which usually occurs between the ages of 8 and12 years, after a child grows to 4 feet 9 inches tall.
  • All children who have outgrown booster seats should wear lap and shoulder seatbelts at all times.
  • Children younger than 13 years should ride in the back seat at all times.

“Parents should be encouraged to delay these transitions as long as possible,” the committee wrote, noting that every transition period is accompanied by a decrease in protection.

Approximately 1,500 children younger than 16 years die in motor vehicle crashes each year according to data from the National Highway Traffic Safety Administration, which also announced updated child passenger safety guidelines consistent with the AAP recommendations.