Kids Love Dr. Barton

Should Toddlers Stay Rear-Facing Longer?

by Dr. Douglas Barton, M.D., Pediatrician 06/12/2009

By now, most of my readers are aware of the Missouri law that took effect in August of 2006 regarding car seats and children. For those who aren’t aware, the significant change was that children older than four, but younger than eight years old (who are less than 4’9” or 80 pounds) must be in an approved car seat or booster seat appropriate for age and size when riding in a car. This was a significant change which, when adhered to, will probably save some lives.

What most people are unaware of, however, is a study that was published in 2007 in the journal Injury Prevention. The authors of the article looked at accident and mortality data from 1988-2003 in the United States. They were specifically looking to see how children fared in rear-facing car seats versus forward-facing car seats. Their data demonstrates some interesting points. When children under one year old were involved in an automobile accident, the ones that were facing forward were between two and five times more likely to sustain a “serious injury.” Side impact collisions were much more likely to result in a serious injury than frontal impact. We (pediatricians) have always recommended that children younger than 12 months old be rear facing, so these results didn’t surprise anyone.

What was surprising, however, was when the authors looked at children between the ages of 12 and 23 months old.  When children this age were involved in a motor vehicle collision, they were also up to five times more likely to sustain a “serious injury” if they were forward facing instead of rear facing. This is an age group that pediatricians routinely recommend switching to forward facing!

While the nature of the study prevents researchers from knowing exactly what happened to reduce risk for rear-facing kids (are rear-facing 15-month-olds safer because they are rear facing or are rear-facing 15- month-olds generally smaller or do their parents generally drive more safely?), the conclusion is strongly suggestive that there may be reasons to keep children rear facing until they are two years old. The American Academy of Pediatrics has stopped short of recommending this universally to parents because further study needs to be done. I have been routinely recommending it since first reading the article just over a year ago.

“But my child is too big!” Car seat manufacturers are a little late to the show on this one so it may be difficult to find the right car seat. I recommend that when you are shopping for the car seat after the “pumpkin” seat, get the largest car seat you can find that can be both forward and rear facing. Make sure to look at manufacturer recommendations as these reflect the safety testing that has been done with that particular seat. Then, leave the seat rear facing until your child is two years old (or older, by some recommendations). In this way, you can ensure that you have done your best to keep your child safe while on the highway.

Dr. Barton sees pediatric patients from Wright City to St. Peters.




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