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The topic of car seat safety inspires many questions from parents during my well child exams. While most parents know their children need to be in some form of safety restraint system, they are often unsure when to transition from one stage to the next –now add in the new recommendations for even greater confusion! The American Academy of Pediatrics (AAP) makes its best-practice recommendations for car seat safety, but each individual state mandates its own laws. In April 2011, the AAP changed its recommendation with two key suggestions.

First, the AAP advises parents to keep their infants and toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight recommendations for their specific car seat. This, however, does not mean that you can turn them forward facing prior to 1 year of age. Since this is only a recommendation, you are not required to keep them rear facing until 2 years, though it is the safest way to travel. Fortunately, there are many convertible car seats that allow your child to remain rear facing until 2 years of age and then change to forward facing. Remember, you should always follow the manufacturer’s instructions, along with their maximum height and weight guidelines. Finally, it is the law that they remain rear facing until 1 year of age AND 20 pounds. Both of these requirements must be met before you can turn them around. The potential for confusion is understandable!

The second recommendation is that children will need to ride in a belt-positioning booster seat until they have reached 4 feet, 9 inches tall and are between 8 and 12 years of age. California adopted this recommendation and made it a law effective January 1, 2012. The new California law states “Children MUST be secured in an appropriate child passenger restraint (safety seat or booster seat) IN THE BACK SEAT OF A VEHICLE until they are at least 8 YEARS OLD or 4’9″ in height.” It is also highly recommended that children ride in the rear of a vehicle until they are 13 years old.

So that’s a summary of the newest AAP best-practice recommendations and the new California law; now for a quick explanation as to the thinking behind these recommendations. A rear-facing car seat does a better job supporting the head, neck and spine of infants and toddlers in a crash because it distributes the force of the collision over the entire body. A 2007 study published in the Journal of Injury Prevention showed that children under the age of 2 are 75% less likely to die or be severely injured when they ride rear facing. Although the rate of deaths in motor vehicle accidents in children under 16 has decreased since 1997, it is still the leading cause of death in children 4 years of age and older, with over 5,000 deaths per year. Moreover, for every fatality there are 18 hospitalizations and 400 injuries requiring medical attention. Finally, most children between 2 and 8 years of age are not large enough to fit properly in the vehicle lap and shoulder belt and will require a child safety seat or booster seat for optimal restraint. Riding in the backseat in a proper-fitting child safety seat, booster seat, or lap and shoulder belt should help reduce the number of injuries and fatalities.

I often remind parents how difficult it can be to be a good parent, and that it is much more important to be that good parent than to make your child happy. Please follow the AAP best-practice recommendations by keeping your child rear facing until 2, placing them in a booster seat no sooner than 4 years AND 40 pounds, making sure that they ride in the backseat in a proper fitting child safety or booster seat until 8 years or 4’9″ tall, and keeping them in the backseat until 13 years of age. We can only control so much of our environment, but by following these important laws and guidelines, you can help ensure that your child is as SAFE as possible while riding in the car.

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