UW Today

April 13, 2011

Child safety experts advise that children ride in rear-facing car seats until age two

UW Health Sciences/UW Medicine

This advice comes from new safety guidelines for child passengers published in the April Pediatrics.

Previously, the American Academy of Pediatrics had recommended that infants ride in rear-facing car seats until their first birthday. However, new research shows that rear-facing car seats are the safest option for children under 2 years of age. Children who ride rear-facing between 1 and 2 years of age have a 5-fold reduction in the risk of death or serious injury.

Dr. Beth Ebel, a UW associate professor of pediatrics and director of the Injury Prevention and Research Center at UW Medicines Harborview Medical Center in Seattle, was a member of the committee that made the recommendations. Ebel provides pediatric trauma care at Harborview Medical Center and is a pediatrician at Seattle Childrens Hospital. Dr.  Dennis R. Durbin of the Childrens Hospital of Philadelphia, is the lead author of the policy statement and technical report.

“Children should ride properly restrained for every trip, every time,” says Ebel, who is the mother of three young children. Motor vehicle accidents remain the leading cause of death for children. Most crashes occur during short trips close to home.

Its not only a matter of law, but it is also good parenting. “Consistency in protecting your child in this way is part of being a good parent,” Ebel says.  From her experience as a pediatrician, she knows that parents want to learn the right way to protect a child from injury in a crash.  She says, “Using the right car seat or seat belt on every trip should be the rule. When there are no exceptions, there are fewer child complaints.” Parents can set a good example by always using their own lap and shoulder belts on every car trip.

Dr. Beth Ebel, director, Harborview Injury Research and Prevention Center

Dr. Beth Ebel, director, Harborview Injury Research and Prevention Center

She explains that a correct fitting, rear-facing seat is safer for children up to age two because of the shape of a toddlers body.  Compared to older children, she says, toddlers heads are large and heavy in proportion to their bodies.  A toddlers neck and spine are also more vulnerable to injury.  A securely harnessed, rear-facing seat keeps the toddlers head from being abruptly thrown forward during the violent impact of a crash.

Recommendations from pediatric safety experts add that a child is safest rear-facing until he or she exceeds the height and weight restriction of the rear-facing car seat. Children who have outgrown the rear-facing limits should use a forward facing seat.

Ebel also explains that children under 8 years, as well as older children under 4 feet 9 inches, do not   fit properly in an adult seat belt.  After outgrowing the harness seat, a child needs a booster seat to be buckled in safely.

A booster seat correctly positions a child so that the lap and shoulder portions of the belt are in the right place. The lap portion should be low across the hips, pelvis and upper thighs. The booster seat keeps the lap belt over the strong pelvic bones instead of riding up over the soft organs of the abdomen – the spleen, liver and bowels, which can rupture during a crash. The shoulder belt should pass across the middle of the shoulder and chest, and should not rub against the childs neck or face. A booster seat also makes the childs ride more comfortable, since the childs knees can bend at the edge of the seat without slouching.

After a child out-grows a booster seat – which may not occur until the child is 10 or older— the child should always ride buckled with a lap and shoulder belt and remain in the back seat at least until age 13.

“Riding in the back seat and wearing the correct restraints for their age and size is the safest way for anyone 13 and under to ride,” Ebel says.

Each transition to the next level of restraint, the child safety group noted, is associated with some loss of protection. Therefore the group encourages parents to delay moving their child to the next level for as long as they remain within the limits of the current restraint.

Children who have certain physical or behavioral disabilities may require specially designed car restraint systems, the policy group noted.

Working in Harborview Medical Centers trauma center, Ebel takes care of babies, children and teens from Washington, Montana, Idaho and Alaska who are brought in after a serious car accident.

Restraints allow the crashworthy safety features of a vehicle to function in the way they were designed, Ebel explains. When passengers are where they should be, the cars safety systems can do their job to absorb forces and protect the occupants. Even at lower speeds, if passengers are flung out of position, injuries occur.

“As a pediatric trauma specialist Ive seen countless children walk away from frightening crashes because they were properly restrained, Ebel says.  “We rejoice every time a parent made sure that the child was buckled into the age-appropriate child restraint.”

The child passenger safety report and policy published March 21 in Pediatrics was developed by the Committee on Injury, Violence, and Poison Prevention of the American Academy of Pediatrics.  The committee was  chaired by Dr. H. Garry Gardner of the Northwestern University Feinberg School of Medicine in Chicago, and  included other pediatricians specializing in child safety and injury prevention from around the country, along with contributions from the Partnership for Policy Implementation and liaisons with the Centers for Disease Control and Prevention, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Consumer Product Safety Commission, the National Highway Traffic Safety Administration, and the Canadian Paediatric Society.