It is true that the most dangerous thing that children do as part of their daily life is to ride in a car. With more and more distracted drivers on the road (texting and talking for example), car crashes remain the leading cause of death for children 4 and older. It’s simple physics that riding rear facing is safer in a collision and correctly using a car seat or booster seat can help decrease the risk of death or serious injury by over 70%.
Based on new evidence, the American Academy of Pediatrics has updated their car seat recommendations to keep kids rear facing longer… but is this really practical for busy families, carpools, and multiple kids? Below are the new recommendations along with my thoughts as a pediatrician and busy mom of 3.
- All infants and toddlers should ride in a rear-facing car seat as long as possible until they reach the highest weight or height allowed by their car seat manufacturer (check the sticker on your car seat to find out the limit).
Well, this is definitely safest, as size (height and weight) should be the most important factor when deciding when it’s time to flip your convertible car seat around to forward facing. It is true that most convertible car seats now are large enough (and heavy enough) to accommodate kids until over age 2 rear facing. That said, how many kids over age 2 are going to be happy not being able to see the family and take part in the conversation? That combined with the practicality of the car seat fitting rear-facing in your car, carpools that require installations several times a day, and multiple kids in car seats in the back seat, often make it challenging.
That said, what do I recommend to my patients? Keeping kids rear facing as long as you can is definitely safer, so at least 2 years of age depending on your child’s height and weight. I help parents assess this at the two-year checkup, weigh the pros and cons and decide what is best for their family. If your child is happy, leave them rear facing as long as you can, but to be honest with you, I don’t think my boys would have made it past 2 ½ due to their size and personality.
- All children who have outgrown the rear-facing weight or height limit for their car seat should use a forward-facing car safety seat with a harness for as long as possible, up to the highest weight or height allowed by their car seat manufacturer.
Of course, the next step when your toddler outgrows their rear-facing car seat is to turn them forward facing, but keep them in a 5-point harness. There are reasons that race car drivers use 5-point harnesses (it’s much safer). How long? I keep kids in 5-point harness as long as I can, at least through kindergarten (my boys were age 7 and 8), again depending on their height and weight.
- All children whose weight or height is above the forward-facing limit for their car seat 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 years of age.
Yes, I actually helped run one of the first ‘keep big kids in booster seat’ campaigns and I prefer a booster with a back (to position the seat belt better) for as long as possible. Another guide I use is to have a child sit with their bottom and back pressed all the way against the seat back. If they can fold their legs down to a perfect 90 degrees, they may be able to switch to a regular lap and shoulder belt (but always use both, not just a lap belt).
- All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.
Let me translate this one, do NOT let your child ride in the front seat unless they are 13 years old or 4 foot 11 inches (some state laws are 4′ 9, but I say 4′ 11)! If you are in a car accident, your child or tween could fly right through the front windshield or get crushed by an airbag. Be a parent and do what is safest for them, even if it isn’t cool!
I know that keeping your passenger front seat all the way forward so a toddler can sit rear facing behind you, keeping a second grader in a 5-point harness, and making your middle schooler ride in the back seat is really tough, but it’s important to realize that for every step down in car seat protection (rear facing to forward facing to booster to seat belt to front seat), the greater chance of your child being seriously injured if you are involved in an accident. Keep the odds in your favor and protect your child in a properly installed car seat for as long as you both can tolerate.