The American Academy of Pediatrics has updated their child passenger safety recommendations, but do they make kids safer?

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Is it time to reframe the way we think of car seats? Photo: Getty Images

On August 30th, the American Academy of Pediatrics (AAP) released new recommendations for car seat safety. In their updated policy statement, they removed the previous recommendation that children remain rear-facing in car seats until the age of 2. Instead, they are now advocating for children to remain rear-facing until they reach the car seat’s height or weight maximums.

While some parents are applauding the update, others aren’t so sure it’s warranted, and worry it could cause additional issues for some families.

Those who welcome the change are quick to point to the science, such as:

  • Research published in the Association for the Advancement of Automotive Medicine discussed the ossification process of a child’s spine, finding only a 50 percent probability that the primary closure of the C3 will be complete by age 2, a 50 percent probability that the primary closure of the axis will be complete by age 5, and a 50 percent probability that the primary closure of the atlas will be complete by age 7. Up to those points, a child’s vertebrae are connected by cartilage rather than bone — making them more susceptible to spinal injuries.
  • The National Highway Traffic Safety Administration also released data regarding the probability of different points of impact in a crash, finding a 60 percent chance of frontal impacts and a 20 percent chance of side impacts — both scenarios in which children would be safer in a rear-facing car seat.
  • Also, a report released in April of 2018 found that the effectiveness of rear-facing seats holds up in rear-end crashes as well.

On the other side of the argument are parents who like to point out that most of us as children sat in less-than-adequate car seats, or no car seats at all, and “we survived just fine.”

The problem with that argument is, many kids did not survive.

In fact, with improved car seat development and adherence to car seat recommendations by parents, the Centers for Disease Control and Prevention (CDC) reported a decrease in child passenger deaths of 43 percent between 2002 and 2011.

Dr. Benjamin Hoffman, lead author of the new AAP policy statement on car seats, and chair of the AAP Council on Injury, Violence and Poison Prevention, told Healthline, “If we look at what happened in terms of motor vehicle deaths, they’ve gone down significantly. The reason that drowning is now a greater cause of death for kids aged 1 to 4 than motor vehicle accidents is because of the effect of car seats. Because they work.”

Still, he explained that the latest policy statement really isn’t a drastic shift from the previous recommendations. In the past, the recommendation of using rear-facing car seats until the age of 2 was used because it was a milestone parents could easily recognize and adhere to.

However, it was also based on old data that showed kids ages 1 to 2 were five times less likely to be injured rear-facing than forward-facing. There simply wasn’t data that existed beyond that point, because as Dr. Hoffman explained, most parents weren’t rear-facing their kids past that age until fairly recently.

Even now, he explained there aren’t enough data points for accidents where kids were seated rear-facing to definitively conclude that rear-facing is safer past the age of 2.

Nevertheless, the trend of data we do have is leaning in that direction.

“We don’t want people panicking about this. There’s nothing earth shattering about the new recommendations. There’s nothing even new,” Hoffman explained. “We just want people to reframe the way they think about car seats — turning your kids around shouldn’t necessarily be an exciting milestone to look forward to, because it could potentially mean putting them at greater risk. The longer you can keep them rear-facing, the better.”

Marsha Greene, a mother in Maryland, understands the shift, but she’s not sold on the current research. She described what exists as of now to be theoretical-based research.

“It really needs to be backed up by empirical studies, and so far, that has not really been done in car seat safety research,” she said.

While Greene kept her own son rear-facing beyond the point the law in her state required at the time, she’s not a fan of the mom shaming that occurs when the discussion of car seats, and rear-facing in particular, comes up.

“I don’t see any real drawbacks to the new recommendations from a safety perspective,” she told Healthline. “However, I do think that some will use it as a basis to mom shame, and that I think is sad and unfortunate.”

She discussed the myriad of reasons kids, and parents, may be uncomfortable with extended rear-facing (ERF). For instance, some children struggle more with carsickness, not being able to see their parents during the drive, or can simply be uncomfortable being in a rear-facing position.

Each of these issues can lead to extensive crying in the car, and Greene pointed out that crying has the potential to increase the risk of an accident if the driver is distracted as a result.

She also brought up the issues of cost for car seats that can accommodate the new recommendation for bigger kids. In addition to that, she worries about the struggles parents with physical disabilities may face who could have a harder time getting bigger kids in and out of rear-facing car seats if the recommendation becomes law.

“I suspect many parents go through the struggles of wanting to keep their kids safe, but also needing to make decisions that work best for their kids and overall safety in the vehicle,” she said.

These are all concerns Senior Captain Corey Winkler of the Crestview Fire Department in Crestview, Florida understands. But as a Child Passenger Safety Technician (CPST), he also urges parents to look to the information we do have.

“A common phrase we use in the fire service is ‘complacency kills,’” he told Healthline. “If a car seat is not maintained or used properly, your child can be seriously injured.”

He added, “Don’t look at ‘stricter recommendations’ as a nuisance. Look at them from a perspective that researchers have developed better ways to use car seats.”

He urges parents to not cut corners, and to see safety as a must, not an inconvenience. Pointing to his own 10 years of experience as a fire fighter responding to vehicle crashes, he explained, “It is gut-wrenching to see children exposed to injuries that can be easily avoided with a little education.”

As a CPST and a firefighter, he supports the latest AAP recommendations completely, and said he always urges parents to keep their children rear-facing as long as possible.

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Education is key for better child passenger safety.

A change in recommendations alone may not be enough to affect a change in behavior. A national poll conducted by researchers at the University of Michigan in 2011 and 2013 found that many parents ignored the last round of recommendations by the AAP, choosing instead to follow the less-strict laws in their states some even turning their children around before the local laws allowed.

Nevertheless, Hoffman does hope to see the latest recommendations used to potentially enact changes to car seat laws across the country.

“Laws and policies are the most effective way to change behaviors around not only car seat use, but injury prevention in general,” he said. “Because most people look to those laws as best practice, it becomes the minimum standard. And if we can elevate the minimum standard and it leads to more kids surviving, what’s not great about that?”

He was also quick to point out that every convertible car seat on the market allows for children to be seated rear-facing up to at least 40 pounds, which for most kids will last until around the age of 4.

There are convertible car seats that run, on average, around the same price as forward-facing only seats. However, only the convertible seats can grow with a child through various stages, potentially saving parents money in the long run.

But Greene wants to see more research done before a push for changes to the laws is made. “I don’t really think there is enough scientific evidence to support mandatory laws at this time,” she said. “I think that parents generally want to keep their children safe, and that those for whom ERF works, or is an option, should certainly exercise that right. But most children do just fine within the current guidelines.”

However, one thing both Greene and Hoffman agree on is the benefit of more research.

As Hoffman told Healthline, “There is a need for better data, because these are important questions we need to answer. We need better data to help protect kids.”

Until more data becomes available, Winkler says he, and other car seat experts like him, will continue working to help parents keep their kids as safe as possible.

“Car seats can be extremely intimidating and overwhelming for a new parent that is not familiar with installing one,” he explained.

He recommends parents do as much research as possible, calling car seat manufacturers, looking up car seat reviews on the internet, and even watching YouTube videos about car seat installation procedures.

“One of the most common misconceptions we see is that parents think the more expensive a car seat is, the better it may be. We want parents to understand that no matter the cost, all car seats are tested to the same standard. They would not be allowed to be sold if they were not tested and certified,” Winkler said.

His advice? Don’t spend more money than you can afford on a car seat you think will be safer, just make sure you’re buying a good car seat that has been properly tested and certified.

While there isn’t conclusive data showing keeping children rear-facing in car seats until they pass the height or weight limitations of the device will keep them safer than the previous recommendation, there’s also no harm in doing so.

Parents concerned about child passenger safety shouldn’t hesitate to reach out to a CPST. They can answer any questions about best practices and help ensure your car seat is installed correctly.

Also, because CPSTs are typically volunteers, they won’t charge you for the assistance they provide.

CPSTs can be found at your local fire department, police department, and hospitals.