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New child car seat recommendations focus on height and weight rather than age

Photo by Sharon McCutcheon on Unsplash
The AAP recommends that parents keep infants and toddlers riding in a rear-facing car safety seat until they reach the highest weight or height allowed by the seat’s manufacturer.

Toddlers should ride in rear-facing car safety seats for as long as possible, according to new policy guidelines from the American Academy of Pediatrics (AAP).

The academy had previously attached an age to its recommendation regarding rear-facing car safety seats, advising parents to keep children in those seats until at least the age of 2. The AAP’s new guidelines no longer focus on age, however. Instead, they recommend that parents keep infants and toddlers riding in a rear-facing car safety seat until they reach the highest weight or height allowed by the seat’s manufacturer.

“Fortunately, car seat manufacturers have created seats that allow children to remain rear-facing until they weigh 40 pounds or more, which means most children can remain rear-facing past their second birthday,” said Dr. Benjamin Hoffman, the lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention, in a released statement. “It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride.”

The policy guidelines were updated to reflect evolving science on the topic.

“We just don’t have a large enough set of data to determine with certainty at what age it is safest to turn children to be forward-facing,” said Hoffman. “If you have a choice, keeping your child rear-facing as long as possible is the best way to keep them safe.”

A leading cause of death

As background information in the AAP’s policy statement notes, the number of children under the age of 15 who were killed or seriously injured in motor vehicle crashes fell by 45 percent in the 10 years from 1999 to 2008. That remarkable decline was due to a combination of factors, including greater use of car seats and other age-appropriate restraints, as well as stricter child-restraint laws and enforcement of those laws.

Still, motor vehicle crashes remain a leading cause of death for children and teens. Such crashes kill more 5- to 18-year-olds than any other type of unintentional injury, which is the top cause of death among children aged 1 and older. Motor vehicle crashes are the second most common cause of fatal unintentional injuries (behind drowning) among children aged 1 to 4, and the third most common for infants and babies under the age of 1 (behind suffocation and homicide).

Children spend a surprisingly lot of time in cars, trucks and other types of motor vehicles — a factor that underscores the importance of using age-appropriate restraints during every trip, the AAP points out.

“Children younger than 16 years travel nearly as much as adults, with an average of 3.4 trips per day and an average of 45 to 50 minutes per day spent in a vehicle,” the academy’s experts write.

What the recommendations say

Here are the AAP’s recommendations for safely restraining children in cars:

  • Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.
  • Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more.
  • When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.
  • When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
  • All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent, the AAP stresses.

“We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies,” said Hoffman.

Other recommendations

Parents should check the manufacturer’s instructions and the label on their child’s car safety seat to make sure they understand the device’s height and weight limits, the AAP guidelines stress.

Parents should also make sure they understand how to properly install and use the car safety seat. The most recent estimates on the misuse of child car safety seats found that almost three out of four seats aren’t installed properly. The most important errors parents make are not tightening the harness straps sufficiently and not anchoring the car seat securely (tightly) when using a seat belt.

Such installation errors increase a child’s risk of serious injury in a crash, the AAP says.

The new guidelines also note that the rising rate of childhood obesity “has significant implications for child passenger safety, because young children who are overweight may not properly fit in [car safety seats] or booster seats that would otherwise be appropriate for their age.”

Fortunately, manufacturers have responded to this problem by making more child car seats with higher weight and height limits, the guidelines add.

The AAP also warns parents about using child safety seats outside of the car. Each year, more than 8,000 infants and babies are treated in U.S. hospital emergency departments for injuries incurred when the seats were used in the home rather than in the car, the academy points out.

Most (85 percent) were head and neck injuries caused by falls — “either infants falling out of car seats or car seats falling from elevated surfaces such as countertops and tables,” the guidelines explain.

FMI: The AAP’s guidelines were published in the journal Pediatrics, where they can be read in full. For information about where you can go to get help installing your child’s car seat correctly (or having someone check to make sure you did it right), go to the website of the Minnesota Department of Public Safety’s Office of Traffic Safety.

Comments (2)

  1. Submitted by Ray Schoch on 09/04/2018 - 02:03 pm.

    For what it’s worth, this makes more sense to me than using age as the primary criteria. Neither of my grandchildren are old enough – or large enough – to have outgrown their need for a booster seat, so I’ll be hanging on to the ones I have until they’ve truly outgrown them. That time is not yet.

  2. Submitted by Matthew Steele on 09/05/2018 - 09:48 am.

    Since crashes are a leading cause of death for children and young adults per the article, why aren’t we also focused on lowering overall risk by reducing driving?

    As a parent who sometimes drives with my children in car seats, I am appreciative that we have great technology and best practices to minimize the risk of injury in a crash. But why not reduce the risk of crashes in the first place?

    I’m shocked pediatricians never ask about our annual mileage or daily transportation habits, and mention reducing vehicle miles traveled as a great way to reduce the risk of injury to children and everyone else?

    And, if we truly see car-related deaths and injuries as the public health crisis they are, wouldn’t we work towards reducing these risks through public policy? Right now our public policy encourages more driving, subsidizes greater distances between Point A and Point B. Shouldn’t we reverse that trend rather than extend it?

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