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Vincent Iannelli, M.D.

New AAP Car Seat Recommendations

By March 21, 2011

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A mother fastening her child into a booster seat - Photo by Rob Van Petten / Getty ImagesA policy statement with new car seat recommendations from the American Academy of Pediatrics may surprise some people.

The policy statement, 'Child Passenger Safety,' is to be published in the April 2011 issue of Pediatrics and states that:

  • infants and toddlers should ride in a rear-facing car seat until they are two years old or reach the weight and height limits for the car seat
  • children should sit in a forward-facing car seat until they reach the weight and height limits for the car seat
  • use a booster seat until they are 4 feet 9 inches (57 inches) tall and are between 8 and 12 years of age, when regular seat belts are most likely to fit properly

While many parents are used to transitioning to forward-facing car seats once their children are 12 months and 20 pounds, it is important to keep in mind that the AAP has long recommended that 'for optimal protection,' toddlers stay rear-facing until they reach the limits of their car seat. The automatic transition to a booster seat at 4 years or 40 pounds has also not been an AAP recommendation lately, as they have said that kids should sit in a forward-facing car seat with a full harness as long as they fit, which is usually well after 40 pounds.

So while the latest AAP car seat recommendations may be a surprise for some parents and may mean that some kids have to move to a new car seat or move back to their previous car seat, for many other parents and pediatricians who have been keeping up with the latest safety advise, the new AAP car seat recommendations will seem like old news.

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Comments
March 21, 2011 at 10:54 am
(1) Michelle says:

Wow, luckily i grew those 3 extra inches. At 35 years old, i’m only 3 inches taller than the requirement for a booster seat!

March 21, 2011 at 12:57 pm
(2) Dimple says:

Michelle, go ahead make fun at the people trying to protect and save your children’s lives.
I speak from experience, I have taught parents how to properly restrain their children in the correct car seats and in the back seat, where all children should be.
I thank God for those parents who want to make a difference for the sake of their child(ren) lives. I don’t laugh when I have been at the scene of an accident, where young children haven’t been properly restrained, are thrown through windows or are put in the front seat of a car where the air bag, meant for an adult, has critically injured a child.
Not laughing here. Hope all parents learn the law and understand why it is so important!

March 21, 2011 at 1:20 pm
(3) Rachel says:

For what it’s worth – I don’t think Michelle was making fun of the new recommendations – she was more laughing about her situation putting her only about 3 inches taller than the suggested requirement. At least that’s the way I took it – because I’m in the same situation and thought the same thing.

March 21, 2011 at 1:28 pm
(4) Dimple says:

I do see the humor in that. My height and weight almost puts me in the back seat with a booster.

March 21, 2011 at 2:03 pm
(5) Steve says:

I think the concept of “risk management” has nearly gone extinct. It seems like every day I hear of another rule making things “safer”. Dimple properly mentions that people not following current safety standards causes needless injury & probably a lot.

How much does this NEW rule actually help, though? One child saved every 5 years? Maybe substantially more than that, but I’d be curious if anyone has actually done a serious study that could tell me the answer. The fact is there ARE costs to these rules.

- Rear-facing seats are more likely to be installed incorrectly because they are harder to get level.
- Children are harder to get in & out of seats. Therefore, parents are likely to be lazier about proper buckling. Or even permanently make the straps too loose.
- Children don’t like facing backwards. Maybe trivial, but millions of miles of roads travelled per year harming a toddler’s imagination & fun is a cost nonetheless.

I simply wish more people could put life in perspective. An “obvious” policy to save lives ALWAYS comes with costs. Which is greater?

March 21, 2011 at 2:27 pm
(6) Heather says:

In this case, you tell me. Tell me how it truly increases creativity for a child to see the view of where he is going as opposed to where they have been. And is this negligible difference (he basic scenery is pretty much the same for him whichever way he faces) worth the possibility of losing his life or his ability to walk? My children stayed rear facing as long as they could and I have some of the most imaginative kids out there.

As to lazy parents and incorrectly installed carseats… this is not a cause or cost of these recommendations. These are facts of life. So don’t put it on the recommendations. These same parents will install them incorrectly forward facing and will leave the straps and tethers too lose regardless. Just because you allow them to change the position of their child does not suddenly make them model parents.

There is a cost to everything. You are saying it costs more to seat them backwards. I say, you are looking at it wrong. By the right carseat from the get go and you will spend less, your child will be safer and as for stunting their imagination… if this is the only way you encourage creativity and imagination, facing backwards in the car seat is not the problem!

March 21, 2011 at 2:41 pm
(7) Steve says:

Heather – A very heartfelt response, but in my view not answering my problem. The point is, what is the risk? In theory, all of us could stay in 5-point restraints at all times while in vehicles. We could set speed limits to 5 mph. We could make vehicles virtually indestructible. Heck, we could ban driving entirely. Why don’t we? There are costs.

You rightly point out that my examples are silly. Even silly examples, however, start to count for a lot when EVERY SINGLE PERSON suffers from them. In exchange for maybe one life saved in the entire country. It is NOT worth in that case. However, I honestly don’t know what what the decreased chance of death is due to these new recommendations. I would feel a little better, though, if I felt that SOMEONE knew.

And to answer part of your complaint, do you not care about saving the lives of children if they belong to lazy parents? It IS harder to put a child in a rear facing car seat – do you not have a child? If that is the case, it is very simple to deduce that this encourages an increased improper use of rear-facing car seats. Isn’t the point of these recommendations, after all, to save lives?

March 21, 2011 at 2:29 pm
(8) Vincent Iannelli, MD says:

“I simply wish more people could put life in perspective. An “obvious” policy to save lives ALWAYS comes with costs. Which is greater?”

People were probably saying the same thing when the push to put more kids in child car seats (CSSs) started in the 1990s and now, the AAP states that ‘In the 10 years from 1999 to 2008, the number of children younger than 15 years who died in motor vehicle crashes in the United States declined by 45%.’

Also according to the AAP, in a study of the ‘effectiveness of rear-facing CSSs compared with forward-facing CSSs for children 0 through 23 months of age in crashes from 1988 to 2003,’ they found that ‘children in forward-facing CSSs were significantly more likely to be seriously injured when compared with children restrained in rear-facing CSSs in all crash types.’ The study also found that ‘When children 12 to 23 months of age were analyzed separately, those who were restrained in forward-facing CSSs were also more likely to be seriously injured.’

So there is a good reason for the new recommendations.

While some kids don’t like facing backwards, some don’t like being in a car seat at all. That doesn’t mean you let them out. Sometimes you just have to do what is safest for your child.

March 21, 2011 at 2:45 pm
(9) Steve says:

Dr Ianelli –

Now your reasoning, on the hand, seems more solid. While I would like to see #s behind the statement that “‘When children 12 to 23 months of age were analyzed separately, those who were restrained in forward-facing CSSs were also more likely to be seriously injured.’ “, at least this is in indicator that these recommendation have some reasoning beyond knee-jerk emotions.

March 21, 2011 at 3:46 pm
(10) Dimple says:

There is a lot of great information on NHTSA ( National
Highway Traffic Safety Admin.)

http://www.nhtsa.gov

March 21, 2011 at 3:54 pm
(11) Vincent Iannelli, MD says:

“There is a lot of great information on NHTSA ( National
Highway Traffic Safety Admin.)”

As I mentioned in another blog post, the NHTSA updated their car seat recommendations today too.

They used age-based recommendations though, which might leave some room for confusion as compared to the AAP recommendations.

March 21, 2011 at 4:19 pm
(12) Dimple says:

Dr. Iannelli, I aplogize for overlooking the mention of NHTSA in your forum. I recieved my training with NHTSA. It was pretty important to me, with the free safety clinics they would put on, I can’t count the number of free car seats given out.
I applaud your forum!

March 21, 2011 at 9:11 pm
(13) Sue says:

I would love to keep my 15 month old rear facing longer, but she is so tall, that she would just be miserably cramped with her legs toward the back seat, pushing and kicking (as she has already done at 12 months). I agree, safety first, but long car rides with a worked up toddler affects my cool and ability to concentrate on the traffic, too. I welcome any suggestions!

March 22, 2011 at 2:45 am
(14) jonjara says:

my child is only 4 feet and now i need to buy a booster seat.
wow! just because of 9 inches.

March 22, 2011 at 9:42 am
(15) Vincent Iannelli, MD says:

“my child is only 4 feet and now i need to buy a booster seat.wow! just because of 9 inches.”

How old is he?

It is important to keep in mind that seat belts are designed for adults, so if your child is not ‘adult-sized’ yet, then the seat belts will likely not provide full protection for him in a crash.

He likely won’t mind going back into a no-back booster if he needs to.

March 22, 2011 at 8:56 am
(16) Robin says:

“Just because of 9 inches” ???? Are you kidding me? It is sad that parents don’t want to keep their kids safer as long as possible. Your child should never been out of a booster anyways. Why are parents SO eager to make their babies grown up so dang fast. My 5 yr old is in a 5 point harness and will be until he reaches the 65lb maximum. Then he will go into a booster. Young children do not fit in seat belts as adults do. Quit making excuses. This only shows that you are a lazy parent. If keeping my kids safe adds on 3 more hours to my day, so be it. I am their parent, and it is my job to protect my children.

March 22, 2011 at 12:44 pm
(17) Tara says:

I want to keep my kid safe and I follow all the recommendations. But this one took me by surprise. I have a very tall 2 year old – he was 38 inches and 35 lbs at 2. He would not have fit rear-facing in my Lexis Sedan, which is one of the safest cars on the road. I am now pregnant with my second child. I will have to buy an SUV or minivan, which are not as safe as my current car, to fit my kids in the backseat with these recommendations. I wonder if the AAP considered the impact of that when they made these recommendations. I specifically bought this car before I had kids because of the safety recommendations. I have just paid it off, now I need to buy a new car? Also, the 2 “or until the child outgrows the weight and height maximum” of a car seat is confusing. All rear-facing car seats have different weight and height requirements, which one do I go with. My son grew out of his rear facing infant seat at 8 months so I bought a convertible seat that could stay rear-facing, but also converts to a toddler seat and will last until he is 55 lbs. If my next son is a big as my first, I will also have to drive with my seat pulled all the way forward to fit his rear-facing car seat once he is over a certain height, will that make me drive safer? Also, what if your kid gets car sick rear facing. Usually the younger kids do ok, but around a certain age they can get car sick. I can’t ride backwards in a car (not even in a train).

March 22, 2011 at 1:40 pm
(18) Vincent Iannelli, MD says:

“I want to keep my kid safe and I follow all the recommendations. But this one took me by surprise. ”

Safety recommendations that have to include so many different situations can sometimes be confusing. In the case of car seats, it is sometimes best to just visit a car seat safety inspection station to make sure you understand everything.

“I have a very tall 2 year old – he was 38 inches and 35 lbs at 2. He would not have fit rear-facing in my Lexus Sedan, which is one of the safest cars on the road. ”

There are several convertible seats that can be used rear-facing 40 pounds and 49 inches tall.

Whether or not they fit well in your car has more to do with your car than the car seat or the recommendations. There is a website where you can search for car seat compatibility for specific cars. It might help you find a car seat that fits in your car.

March 22, 2011 at 1:41 pm
(19) Vincent Iannelli, MD says:

“I am now pregnant with my second child. I will have to buy an SUV or minivan, which are not as safe as my current car, to fit my kids in the backseat with these recommendations. I wonder if the AAP considered the impact of that when they made these recommendations. I specifically bought this car before I had kids because of the safety recommendations. I have just paid it off, now I need to buy a new car? ”

I think the AAP intends for people to do what is safest using the car they have.

For example, when they answer the question ‘What if I drive more children than can be buckled safely in the back seat?,’ they don’t say buy a bigger car, they answer that ‘It’s best to avoid this, especially if your vehicle has air bags in the front seat. All children younger than 13 years should ride in the back seat. If absolutely necessary, a child in a forward-facing car safety seat with a harness may be the best choice to ride in front. Just be sure the vehicle seat is moved as far back away from the dashboard (and the air bag) as possible.’

“Also, the 2 ‘or until the child outgrows the weight and height maximum’ of a car seat is confusing. All rear-facing car seats have different weight and height requirements, which one do I go with? ”

The AAP doesn’t formally recommend any specific car seat. They offer a list of car seats and booster seats so that parents can see what’s available. They state that ‘No one seat is the ‘best’ or ‘safest.’ The best seat is the one that fits your child’s size, is correctly installed, fits well in your vehicle, and is used properly every time you drive.’

Since you don’t want to replace your car seats more than necessary though, get one that you are pretty sure your child won’t outgrow though.

March 23, 2011 at 3:52 pm
(20) lea says:

no kid under 13 should EVER sit in the front seat! they can get decapitated from an airbag. figure out a different solution. i see parents all the time… some even in mini-vans w/ their pre-schoolers sitting in the front seat in a booster. why? b/c they want to? my daughter said she wanted to and i told her the truth. the airbag can kill you. your head can come off! guess what??? no more argument about sitting in the front. she chose life and so did i. people are so eager to please their kids or make excuses. bottom line. how can someone live w/ themselves if their child dies in a collision b/c they wanted to sit in the front seat???

March 22, 2011 at 1:41 pm
(21) Vincent Iannelli, MD says:

“If my next son is a big as my first, I will also have to drive with my seat pulled all the way forward to fit his rear-facing car seat once he is over a certain height, will that make me drive safer?”

Are you having twins? If not, then maybe don’t put his car seat behind you and use the center seat instead. Your car can fit three people or three car seats in the back seat, can’t it?

“Also, what if your kid gets car sick rear facing. Usually the younger kids do ok, but around a certain age they can get car sick. I can’t ride backwards in a car (not even in a train).”

But what if riding backwards for longer periods of time in your car seat helps you build up an immunity to getting sick from riding backwards. If your child always get sick riding backwards and is over 12 months old, then you can likely talk to your pediatrician about the risks vs benefits of turning him around early.

March 22, 2011 at 3:48 pm
(22) Tara says:

No I can’t fit a car seat in the middle and one on the side. If I have two car seat they will only fit one on each side. Its not that I can’t find a bigger rear facing car seat (I did that with my first son as I said), the problem is that the bigger ones will not fit directly behind the driver/passenger seats without pulling the seats all the way forward. It also seems really unsafe the way the wedged in but I will have the CHP check it out. When I only had one kid I could put the bigger seat in the center. The AAP’s list of car seats has my smaller Graco car seat on it that goes up to 29 inches. That is why I say it is confusing. Because you can find rear facing car seats (like the other one I have) that go up to 50 lbs. So they don’t seem to take a clear stand on this. I think they should either say until 2 or until a certain weight they their studies have determined is safe. Otherwise I am following their recommendation if I have the Graco and turn my child around at 13 months when he is 29 inches.

March 22, 2011 at 3:49 pm
(23) Dimple says:

What is so hard to understand? With all the information out there it should be a peice of cake. If your the kids are in the back seat and the belts do not fit around your child, i.e; seat belt going around their face, or riding to high or low on their chest, hello….your kids need a booster or car seat.

What information do you need? Run a crash scene through your head if you need to with the way your kids are buckled
in. Do you feel they would be safe?

Another thing you can do, stop by a fire station, they will tell you if the kids are safe.

March 22, 2011 at 4:36 pm
(24) moty says:

Looking at the referenced paper, the gains in child safety, though statistically significant (for 13-23 month olds) seem marginal at best, and I would hate to see them codified into law.

I do wonder if the gains would be offset be an increased incidence rate of accidents due to drivers being distracted while trying to interact with there kids. There is a big difference in child/parent interaction for older children.

The prohibition of 12 year olds smacks more of a “bright line” rule of thumb than anything based on physics, where recommendations would be made based on height and weight. .

March 22, 2011 at 6:08 pm
(25) Vincent Iannelli, MD says:

“Looking at the referenced paper, the gains in child safety, though statistically significant (for 13-23 month olds) seem marginal at best, and I would hate to see them codified into law.”

Do you really see that much benefit to being forward facing to question the new recommendations? Many parents have already been keep their kids rear-facing longer than 12 months/20 pounds, which is likely why there are so many car seats with high rear-facing limits available already.

Any evidence of more accidents in countries that are already rear facing longer?

Sweden has there kids rear facing until four. Have you studied their accident data?

March 23, 2011 at 11:51 am
(26) CMM says:

Yet again a generic one size fits all recommendation is usurping more accurate detailed recommendations. We are supposed to go by our vehicle’s recommendations for the car seat size and seat belt capabilities.

My minivan has adjustable seatbelts that allows the height to be correct for different heights of the passengers. Some car’s seats are smaller than others. My minivan’s recommendation is okay to sit on the seat without a booster if the knee bends around the front of the seat. This was in effect for my son at age 6. Between the seat being small and fitting a kid under age 12 down to 8, plus the lowering of the seat belt there is no reason to wait until 57 inches tall or to try to put an upper age on it (12 yrs old).

My 2nd child was 20 lbs at 12 weeks of age. Yet a girl I know who is 9 weighs 30 lbs and has as small delicate frame that is nothing like what that either of my sons had. IN fact that girl’s mother is so petite & small I guess she should be in a booster right now.

We can think for ourselves. I am smart enough to read my vehicle’s owner manual and see what MY seats and MY seatbelts are sized for. One size fits all recommendations made to the general public always are a problem.

These “experts” try to drive parents crazy and insane with worry!

Our kids are getting sick from stress, go see Race to Nowhere — look at what schools and parents are doing to kids. How about the AAP make some recommendations on that?

March 23, 2011 at 3:17 pm
(27) Vincent Iannelli, MD says:

“This was in effect for my son at age 6. Between the seat being small and fitting a kid under age 12 down to 8, plus the lowering of the seat belt there is no reason to wait until 57 inches tall or to try to put an upper age on it (12 yrs old).”

Please reread the AAP recommendations. They clearly state that kids ‘should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 y of age.’

And that ‘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.’

Did the new recommendations take into account adjustable seat belts? No. But the overall gist of the recommendations is that kids should be in a car seat and then a booster seat until seat belts fit properly.

March 23, 2011 at 9:58 pm
(28) lovemykids says:

I am appreciative of the new recommendations! I love my children greatly and could not imagine anything (especially a car crash) happening to them. If there is even one study shown that says my child will be safer rear-facing, then I’m ok with that… Even if it means buying another car seat. But I have always bought great seats with large weight capacities anyways. To the guy who said something about the new recommendations saving only one child in the country, what if that ONE child was yours?! Its worth it to me. Could you look your child in the face and tell him or her that they are not worth you buying a new seat or spending an extra minute strapping them in rear-facing?

March 25, 2011 at 3:33 pm
(29) Erin says:

Candy, thank you! I was scrolling to the bottom to tell Dimple to calm down!! I think Tara’s comments are valid..it is a lot to take in, especially when Every source that has slightly differing information is screaming that they are right (like Dimple haha). I’m with Steve and Tara on this one. Yes, Dimple and Dr. I, go ahead and bash me for not “loving my kids” or some crap like that. You need to be looking someone in the face to say something along those lines. Hide behind your computer and make people feel like bad parents…yeah that is getting something productive accomplished?!?!

October 23, 2012 at 8:18 pm
(30) Teresa says:

Michelle, your comment made me laugh. I understand the importance, but there ARE adults out there that are smaller than some children.

December 29, 2012 at 8:30 pm
(31) Tina says:

I have three rear facing britax car seats in my prius. I highly doubt a Lexus Would be smaller. Perhaps you should go to a car seat check location for some ideas. Just like everything with parenting it is not one size fits all. You need to do what is right for your situation.
As far as Steve’s comment it it much more than one kid every 5 years! I work in a pediatric ICU and I see kids all the time that were improperly restrained or were in a booster too soon etc that would’ve had a much better outcome had they been rear facing. This is a guideline to help parents make the best decision. Kids are 72% less likely to be killed when rear facing. With those statistics you’d have to be CRAZY not to think about extended rear facing.

February 7, 2013 at 2:13 pm
(32) kat says:

It is easy to point finger at lazy parents, but fact is the driver. If a person is texting or talking on their phone while they feel “safe” that their 8 year old is in a harness and runs a red light and crashes. Now the driver is stuck in the car and the child is unable help or get out due to the harness. At 8 a child is fully aware that in a crash that they would need to get to safty, but now by locking them in a harness that looses the ability to help themselves. This is from being a witness to a. Actual event. The car was fliped, no one could reach the child and we all had to watch in horror as she screamed locked in her harness. Now tell me how that helps… 

February 14, 2013 at 5:55 pm
(33) jjs mom says:

Help! Serious question. My daughter who is one n a half 20 months exactly. Is only 16 pounds. From the way things seem shell remain there for awhile. She is still in her newborn carseat rear facing. However shes 28 inches very tall so her legs n feet are always squished back,there. I feel bad a am tired of ppl tellIng me about that. Someone recommended i face her forward. id like to do that but her safety is ultimate for me. Id rrather her squished n safe Than sorry. Any body help me out what should i do

February 27, 2013 at 7:43 am
(34) Molly's mom says:

Jjs mom- buy a rear facing car seat that has a high weight limit. They make several great ones that rear face upto 40+ pounds then can convert to forward facing and into boosters.

I know this post is several years old but it still makes me sick to think that people won’t do simple things to keep their children safe. My daughter rear faced well over 2 years old, and guess what, no car sickness and she has a high imagination. Ooh and I drive a small sante fe and I’m 5’9″ so don’t complain about cramped seating to me. If you don’t want to do what’s best for kids then here’s a thought, don’t have kids! Don’t be selfish with your time, so what’s right!

August 22, 2013 at 4:51 pm
(35) Mai Mommy says:

I shouldn’t be surprised at the amount of insults hurled at some posters on this thread. Seriously…no need to tell someone they are being “lazy.” I am sure you feel you are one of those people who just “tell it like it is.” If you can’t be respectful, then I am not likely to take your advice in the first place.

It comes down to this: Every child is different, and there are different car seats. Pick and choose, do your research and pray. Put them in the car and head on to work. Everything works itself out in the long run, recommendations, studies or not.

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