AAP updates car safety seat recommendations

Most children should remain in rear-facing car safety seats (CSS) until age 2 years, according to a new American Academy of Pediatrics (AAP) policy statement.

Although the previous AAP policy recommended use of rear-facing seats up to the limits of the car seat, it cited age 12 months and 20 pounds as minimum thresholds for turning seats around. As a result, many parents turned the seat around on the child’s first birthday. Now the policy recommends delaying the transition until the child reaches age 2 years or outgrows the weight and height specifications of the CSS.

The updated policy statement published online and in the April issue of Pediatrics provides evidence-based recommendations for optimizing child passenger safety. The recommendations are presented in the form of an algorithm to facilitate implementation of the recommendations in clinical practice.

The policy advises that children age 2 years and older transition from a rear-facing seat to a forward-facing seat with a harness for as long as possible or up to the highest weight or height allowed by the manufacturer of the CSS, then to a belt-positioning booster seat to ensure proper fit of the vehicle’s lap-and-shoulder belt. The shoulder belt should lie across the middle of the chest and shoulder, and the lap belt should fit low and snug on the hips and upper thighs.

Most children will need to ride in a booster seat until they are 4 feet 9 inches tall and between 8 and 12 years old. Children who have outgrown booster seats should use lap-and-shoulder belts at all times, and all children younger than 13 years should sit in the rear seat, the policy further states.

The AAP advises that pediatricians should review child passenger safety recommendations at all health-supervision visits.

Committee on Injury, Violence, and Poison Prevention. Policy statement-child passenger safety. Pediatrics. 2011;127(4):788-793.