Pediatricians recommend rear-facing car seats until age 2

The American Academy of Pediatrics has changed its recommendations for kids in car seats and now advises toddlers stay in rear-facing car seats a year longer, until they’re 2.

Dr. Christopher Haines, medical director of the emergency department at St. Christopher’s Hospital for Children in Philadelphia, said kids should sit in rear-facing seats until they are 2 or reach the upper weight limit of their seat design.

With a front-facing seat “the head and neck are going to go forward when you have an impact that’s a frontal impact,” Haines said. “Versus if you’re rear-facing, you have support behind your head and neck.”

Haines said for a child in a rear-facing seat during a collision, the impact of a crash is spread over the entire back rather than being focused under the chest straps, which is the case in a forward-facing car seat. The rear-facing seat acts as a cradle, keeping the child’s spine and head in line.

The change to the recommendation is based on a 2007 study that showed children younger than 2 are 75 percent less likely to die or be severely injured in a crash if they are in a rear-facing seat.

Jennifer Stockburger tests car seats for Consumer Reports, which has been recommending rear-facing seats for older kids for years. She said colleagues have been asking her if it is OK for their kids’ legs to be crossed or squished as they grow bigger. Her answer: absolutely.

“They’re not uncomfortable, they don’t know any different yet,” Stockburger said. “They haven’t turned forward facing, so they’re not missing it. You’d much rather have their legs bent than a head or neck injury.”

Stockburger said manufacturers have been making car seats a little longer to accommodate older kids. As a result, it is becoming more difficult to find cars that fit into compact cars.

“They may make a seat which has a deeper shell so the baby sits more bent but not necessarily longer,” Stockburger said, “But, without question, it’s harder to fit a rear-facing seat in a small car.”

Stockburger recommends testing the seat before buying to ensure it fits in your car, and making sure it is returnable.

To make it easier to keep antsy toddlers facing away from the action, be consistent. Avoid letting them sit front-facing when riding with Grandma or on special occasions.

“What they don’t know they don’t miss,” Stockburger said.

The new guidelines also recommend booster seats for children until they have reached 4 feet 9 inches tall.