The American Academy of Pediatrics is announcing today that parents should keep toddlers' car seats facing the rear until at least age 2.
The pediatrics group categorizes its recommendation as "a significant change from previous AAP policy," though it sticks with earlier advice to keep children in convertible car seats until they reach those seats' height and weight limits. It recommends using booster seats until children are 4 feet 9 inches tall and between 8 and 12 years old, and keeping children younger than 13 in the back seat.
Previously, the AAP had advised parents to keep their children in rear-facing car seats for as long as the manufacturer's height and weight limits allowed, but had also set a minimum age to turn the seats at 1 year old and 20 pounds. In many states, the law requires that children be rear facing until the 1 year and 20-pound mark.
"Most people see their kids in terms of milestones -- that moving from one thing to another is really a positive thing," said Ben Hoffman, a member of the committee that drafted the statement and a University of New Mexico associate professor of pediatrics. "Turns out with car seat safety, it's not."
Rear-facing car seats distribute the impact of a crash along a larger surface area, which better protects young children, Hoffman said.
Infants and toddlers, whose heads are disproportionately large and heavy compared to the size of their bodies, are at particular risk for neck injuries in a car crash, said Leslie Frank, a Pittsburgh pediatrician.
Today's recommendations are two-fold: The AAP still urges parents to keep their children in rear facing seats as long as the height and weight limits allow -- often at least 35 pounds, between ages 3 and 4 for the average child. But because an age guideline is simpler than looking up manufacturer guidelines, the AAP also urges that children face the rear until they are 2.
"What we are trying to do is simplify the message," Hoffman said. "In general, changing attitudes and behaviors is not easy and this is the next step to help parents do the best possible thing for their children."
The AAP changed its recommendations in part because of a 2007 study that found that children under age 2 are five times more likely to be killed or seriously injured in a front-facing car seat than in a rear-facing seat.