Kids should ride facing backwards longer

Laws and public relations campaigns to get children into car seats are paying off, according to the American Academy of Pediatrics, but more kids can be saved from injury or death by leaving them in rear-facing seats for a longer time.

The AAP issued a new policy in the April edition of Pediatrics stating that parents should 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 recommends that children ride in a belt-positioning booster seat until they are 4 feet 9 inches tall and between 8 and 12 years old.

"A rear-facing child safety seat does a better job of supporting the head, neck and spine of infands and toddlers in a crash," said Dennis Durbin, MD, lead author of the policy statement and accompanying technical report, "because it distributes the force of the collision over the entire body.

"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," he said.

It's not that the old recommendation, keep infants and toddlers in rear-facing seats up to 12 months and 20 pounds as a minimum, were dangerous.

In fact, the rate of deaths in motor vehicle crashes in children under age 16 has decreased substantially, dropping 45 percent between 1997 and 2009. However, car crashes are 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. And, for every fatality, roughly 18 children are hospitalized and more than 400 are injured seriously enough to require medical treatment.

New research backs up the idea that 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.

And the age 2 recommendation is not a strict deadline, Durin said. "Smaller children will benefit from remaining rear-facing longer, while other children may reach the maximum height or weight before two 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. More children 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 in an airplane, they are best protected by riding in an age- and size-appropriate restraint.

Contact your local hospital or law enforcement agency for help in making sure your car seats are properly installed and used, or visit www.healthychildren.org/carseatguide