FAIRWAY, Kan. -- Anne Epperson thought little of it when she flipped her daughter's convertible car seat around so she could face forward after her first birthday. But if car seat advocates get their way, parents like Epperson will be delaying the switch, possibly for years.
The American Academy of Pediatrics (AAP) is revising recommendations that it hopes will clear up confusion over how long children should spend riding rear facing in car seats and make them safer in the process.
Some experts say tots are being put at risk by switching to the forward-facing position at 1 year of age and 20 pounds, currently the minimum guideline from the AAP and the National Transportation Highway Safety Administration.
Car seat importance
- Motor vehicle crashes are the single leading cause of death for U.S. children, claiming an average of about four lives a day.
That's because the extreme forces in some frontal crashes can jerk the heads of forward-facing children away from their immature bodies, creating a risk of spinal cord injuries. Rear-facing children are safer because their entire backs absorb the force of the crash.
The issue becomes confusing because both groups also advise that children are safer if they remain rear facing until the upper height and weight limit of their car seats. Many seats top out at 35 pounds in the rear-facing position, a weight many children don't reach until somewhere between their third and fourth birthdays.
The issue has attracted growing attention since a 2007 article in the journal Injury Prevention showed that U.S. children are five times less likely to be injured in a crash between their first and second birthdays if they are rear facing.
"We rarely if ever see spine injuries in children in rear-facing car seats," says Dr. Marilyn J. Bull, the contributing pediatric researcher in the study. "We will see head injuries or we will see a few other injuries, but the vast majority of serious injuries occur when children are forward facing."
The AAP is still discussing how it is going to revise the recommendations.
Dr. Dennis Durbin, who is leading the effort to update the group's policy on child passenger safety, says the emphasis will be more on remaining rear facing to the upper weight limit of the seat. The academy is hoping to introduce the new guidelines late next year.
That's good news to safety advocates.
"When it is written '1 year and 20 pounds,' parents don't pay attention to the rest," says Pam Holt, the previous chairwoman of the National Child Passenger Safety Board and the trauma prevention coordinator at St. John's Hospital in Springfield, Mo.
Count Epperson among the confused parents. The 35-year-old said she doesn't recall getting advice to keep her 23-month-old daughter or 3-year-old daughter rear facing longer.
"I've read a lot of books, but I've never heard that," Epperson said as she picked her daughters up from a day care in the Kansas City suburb of Fairway. "I had no idea."
Experts say part of the problem is that parents often view switching their children to the forward-facing position as a rite of passage.
"It's like graduating from preschool into kindergarten," says Dr. Benjamin Hoffman, part of an American Academy of Pediatrics committee that helps educate parents and doctors about injury prevention. "They view it as a good thing."
"What we need to do is work on changing people's attitudes so that they recognize that every step you make -- from rear facing to forward facing to booster -- you lose some safety, and that people should switch only when absolutely necessary."