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Just a reminder! Thanks for visiting us at Shots Hurt Less Blog! This is just a reminder that the information on this site is intended to be for informational purposes only. It should never replace the recommendations of your doctor - check with your doctor if you have any specific questions! We will always honor and protect patient confidentiality, and we ask that you all do the same, if you choose to comment on our posts. Thanks for visiting!

Monday
Sep102012

FYI: Rear Facing until 2 years 

We recently celebrated my son, Henry's, second birthday at our house and along with the balloons and cupcakes came more excitement - turning him forward facing in his car seat!  My husband and I were more excited about the change than Henry. Although he seems pleased with his new vantage point, his reaction was rather underwhelming once it came time for his first forward-facing car ride.

Two years may seem like a long time to be rear-facing, especially since we pediatricians used to recommend turning kids around in their car seats as early as their first birthday.  However, in March 2011, the American Academy of Pediatrics (AAP) changed the recommendation to keep children rear facing as long as possible - at least through 2 years.   Many of you have older children who were turned around at 1 year and did just fine, so...very reasonably, we are often asked about the reasoning behind this change in recommendations. Pictured at right, Henry's unenthusiastic first forward facing ride.

Why wait until 2?
Safety:  A study published in a premier pediatric journal in 2007 showed that children are 75% less likely to die or incur a serious injury if rear-facing when riding in the car.  The impact of a collision is distributed over the entire body and therefore, the rear-facing child safety seats do a better job of supporting the head, neck and spine of infants and toddlers in a crash.

What if they are "big for their age"? 
I faced this issue since my son, Henry, is very tall and weighs more than most 2 year olds.   I understand the temptation to go ahead and turn them around, but the risk of injury is based on their head still being out of proportion to their bodies and their skeletal maturity (how hard their bones are) rather than their height or weight.  Their large heads (relative to the size of their bodies) puts them at a much greater risk of cervical spine injuries, and their immature bones also makes them much more prone to serious head injuries like skull fractures.

But my child's legs are all scrunched together...won’t my toddler be uncomfortable? 
No, most toddlers are actually more comfortable rear-facing because the carseat is reclined and it’s much more comfortable to sleep that way than sitting upright in the forward-facing position.  And it's fine for their feet to touch the seat back, or for their legs to bend.  In the event of a crash, leg inuries are uncommon in rear-facing seats, and it’s much more important to protect the head, neck and spinal cord in a crash, which is exactly what rear-facing car seats do so well.  A recent study reviewed injuries to children ages 1 – 4 who were hurt in car crashes, and leg injuries were rare for those kids in rear-facing seats, but were the second most common type of injury for the kids in forward-facing seats.  That’s because the legs of a child in a forward-facing seat are thrown forward and can hit the console or the back of the front seat.

Here is a run down of the current AAP Car Seat recommendations:

Birth - 24 months

Your child under age 2 years should always ride in a rear-facing car seat.
There are different types of rear-facing car seats:
- Infant-only seats can only be used rear-facing (maximum weight usually 22-35 pounds and height 32 inches).
- Convertible and 3-in-1 car seats can be used rear or forward facing and typically have higher height and weight limits for the rear-facing position (up to 40-50 pounds and 49 inches), allowing you to keep your child rear-facing for a longer period of time.
2-4 years
Keep your child rear-facing as long as possible, but at least until 2 years (although many European countries keep toddlers rear facing until 3 or 4 years)!  Your child should remain in a rear-facing car seat until he or she reaches the top height or weight limit allowed by your car seat’s manufacturer.
4 - 7 years
Keep your child in a forward-facing car seat with a harness (five point harness preferred) until he or she reaches the top height or weight limit allowed by your car seat’s manufacturer.
8 - 12 years
Keep your child in a booster seat until he or she is big enough to fit in a seat belt properly, usually when they are at least 4 feet 9 inches tall and are 8-12 years old. For a seat belt to fit properly the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember: your child should still ride in the back seat until their 13th birthday, due to risk of injury from airbags.
 
See these links below for great tips on car seats and proper car seat installation:
HealthyChildren.org Car Seat Guide
 

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