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 is revising recommendations that they hope will clear up confusion over how long children should spend riding rear-facing in car seats.
Some experts, citing a much-touted 2007 study, say tots are being put at risk switching to the forward-facing position at 1 year of age and 20 pounds, currently the minimum guideline from the pediatrics group and the National Transportation Highway Safety Administration.
That's because the extreme forces in some frontal crashes can jerk the heads of forward-facing children away from their bodies, creating a risk of spinal cord injuries. Rear-facing children are safer because their entire backs absorb the force of the crash.
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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.
It's rare in the United States for children to remain rear facing that long, although several countries require their youngest passengers to ride rear facing until they are 4 or 5 years old and 55 pounds.
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," said 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, said 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 later this year.
Motor vehicle crashes are the single leading cause of death for U.S. children, claiming an average of about four lives a day. Dr. Benjamin Hoffman, part of an American Academy of Pediatrics committee that helps educate parents and doctors about injury prevention said it is tragic that "people are not operating on the best information they possibly could."