**The American Academy of Pediatrics has updated their recommendations since this blog published in 2011. Children should ride in rear-facing car seats until they reach the height or weight limit provided by the car seat manufacturer. This is likely well past age 2. To view the new guidelines and data, click here.**

Did you hear the news? The AAP has made it official. 2 is now officially the new 1.

Last year I wrote a blog post entitled “2 is the new 1” that discussed my opinion that you keep your children rear-facing in the car seat until at least age 2. This week the AAP announced the official change in recommendations for car seats, which includes the rear-facing until at least age 2 years and also adds some additional pointers on how to keep kids safe at all ages.

Some highlights of the new report and policy that uses evidence to guide the best way to protect your infant or child from serious injury in the car:

  1. 2 is Officially the New 1. Rear Facing Until At Least Age 2. Keep all infants and toddlers rear-racing from birth until at least age 2. No need and no advantage to turn them around earlier. And there is nothing magic about the 2nd birthday. Most convertible car seats allow for children to be rear-facing until about 35 pounds, so if your 2 year old is doing well rear facing and under 35 pounds, you can continue to keep them positioned that way. Check your seat for specific weight limits. But know, toddlers between the age of 12 months and 24 months are 75% less likely to have serious injury or die in a car accident if they are rear-facing. Even at older ages, rear facing is a safer position because of forces on the head and neck during and accident. A no brainer, keep your babe facing the back of the car until at least age 2.  There’s no data to support concerns about injury to legs when toddlers are rear-facing and there is no safety issue if your child’s legs and feet rest on the back seat.
  2. Don’t Rush Into A Booster. There’s no rush to transition from a 5 point restraint or child safety seat that has a harness to a booster. Children are safer in a 5 point restraint. Instead of transitioning to a booster seat right when your child reaches 40 lbs, the AAP recommends staying in a 5 point restraint for as long as possible based on the weight and height restriction of the seat. Many car seats with 5 point restraints accommodate children facing forward up to 65 or even 80 pounds. No rush to use the booster! Data finds it is advantageous to transition to the booster later.
  3. Making It to 4 Foot 9 Inches or 12 years: Children need to be in a booster seat until they reach 4 foot 9 inches and are between 8 and 12 years of age. Children need to stay in a booster until the car’s lap and shoulder seat belt fits properly. Booster seats work by positioning the child so that the lap and shoulder positions are over strong bones to prevent injury to soft organs during a very rapid slow-down or crash. Going to a seat belt too soon can leave your child at risk for severe internal injuries. My friend, Dr Alanna Levine, suggested a great trick to help with your “negotiations” at home. Put a mark on the wall at 4 foot 9 and instruct your kids to talk with you about ditching the booster only after they measure up!
  4. Lap and Shoulder belt: Children are best protected once over 4 foot 9 when in a seat belt that has a lap an shoulder component. The lap portion should fit low across a child’s hips and pelvis, and the shoulder strap needs to rest across the middle of the chest and mid point of the shoulder so it’s not rubbing against their face and neck.
  5. Back Seat Until 13! All children younger than 13 years of age should be restrained in the rear seats for maximal protection.

There’s no rush to transition from each step if your child doesn’t exceed the seat’s weight and height requirement. Remember this: with each transition you make (from infant rear facing–>forward facing–>booster seat–>seat belt–>front seat with seat belt) the position is associated with decreasing protection. Often there is no rush to transition (other than your child’s wishes, of course)!

put real facing

Some science and rationale:

  • When you stop quickly or are involved in an impact, your body continues to fly forward at the velocity the car was going. This sounds likes a 8th grade math word problem; it isn’t. Infants and toddlers have disproportionately big heads for their necks and bodies so as the car slows, their heads and and upper neck continue to move forward rapidly while the straps of the car seat hold their body in place. This motion puts them at risk for head, cervical spine, and severe neck injuries.
  • When rear facing, the head, neck and entire body can absorb the impact at once. This rear-facing position can prevent neck injuries leading to paralysis or even death.

So, we were wrong previously when saying it was okay to turn your baby around when he/she reached a year of age.

2 or 3 (years) really is the new 1 (year).  See?

Spread the word. You may just save someone’s life.

For Infants, Do This Now:

  • Get a car seat safety check if you have any concerns about how you installed the car seat or booster your child rides in.  Many injuries in children are related to not using the car seat correctly.
  • Make sure you and any one who drives with your children uses the 5 point restraint correctly! In Seattle, you can come here for help.
  • Inform yourself about how to use your car seat.  Watch this video
  • Keep your 12-24 month old rear-facing until at least their 2nd birthday if not over the weight based restrictions of the seat.  Most seats accommodate up to 35 pounds rear-facing.
  • Talk to your pediatrician if you have questions or leave a comment below.

Resources To Help You:

Children with special health care needs

Locate a child passenger safety technician with special training in special health needs

AAP Information/Lists on Currently available Car and Booster Seats