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Status Report, Vol. 46, No. 7 | August 18, 2011 Subscribe

Kids should use rear-facing seats at least until 2

Until recently, as soon as a 1 year-old tipped the scale at 20 pounds, it was a signal to turn around the car seat. Child safety advocates have long urged parents not to be in such a hurry, and now it's official. The American Academy of Pediatrics recently updated its guidelines to make it the norm for children to ride rear-facing until age 2. The National Highway Traffic Safety Administration (NHTSA) also is recommending that toddlers remain rear-facing as long as possible.

The new guidelines are aimed at promoting best practices in child passenger safety, but one thing they can't do is provide simple solutions for parents. The full recommendation from the pediatricians' group is that children should be rear-facing until age 2 or until they reach the height or weight limits of their restraints. The reality is that it's not always possible to use a rear-facing restraint until age 2 while also heeding limits set by a seat's manufacturer. Beyond age 2, parents also are encouraged to keep their children rear-facing if they haven't reached the height or weight limits.

When to switch from rear-facing to front-facing is just one in a dizzying series of decisions parents must make about child seats, and confusion can lead to misuse. A 2004 federal study found that child seats were misused in a way that could increase the risk of injury 73 percent of the time. Efforts such as the Institute's booster seat ratings for belt fit have had some success in simplifying the process, but it's still not easy.

"Any restraint is better than none, but to be most effective, it's important that the restraint fits both the child and the vehicle," says Anne McCartt, Institute senior vice president for research. "Unfortunately, the burden is on parents to sift through multiple rankings and instruction manuals — and still be prepared for some trial and error — to find the right seat and make sure they're using it correctly."

When it comes to the updated guidance on rear-facing restraints, there is good reason for the change. During a crash, rear-facing child seats provide more support for the head, neck, and spine, which is why children should use them for as long as possible, even beyond the 2-year mark if their seats still fit.

That advice would be easier to follow if all convertible child restraints — the type used after a child has outgrown an infant seat — had height and weight limits that could accommodate the typical 2 year-old in the rear-facing position. While many convertible seats now have rear-facing limits of 40 pounds or more, others have lower limits. A tall, skinny child may outgrow the height limit before reaching the maximum weight.

Some parents may choose to buy another seat rather than allow their children to ride forward-facing before age 2. For many families that's not an option, either because of the expense or because they drive a small car that can't accommodate a bigger child restraint.

Which seat for which vehicle?

The question is one NHTSA has been studying. The agency announced in 2009 that it would launch a voluntary program in which automakers could identify specific child seats — rear-facing, front-facing, and boosters — that fit their vehicles (see "NHTSA hands off child seat issue to automakers," June 11, 2009). Details are still being hammered out, and the Institute and other organizations recently submitted comments to NHTSA on the proposal.

The issue is complicated because of differences in the placement of safety belts and LATCH anchors for child restraints, the width of vehicle seats, and other factors.

The plan calls for automakers to offer choices for children of different ages in three different price ranges, each from a different manufacturer. NHTSA is proposing that recommended seats fit in all rear seats. Nissan and Infiniti already recommend ones for their vehicles, but most automakers don't.

Consumers Union, publisher of Consumer Reports, has pointed out that some restraints fit well in the second row of vehicles but not the third. Requiring seats to fit in every seating position could end up driving the market toward smaller rear-facing seats that can't accommodate heavy children, the group cautioned in a comment to NHTSA.

The Institute told NHTSA that boosters should be evaluated for belt fit before being recommended. Boosters help position a safety belt correctly on a child's body, so when judging whether a booster fits a vehicle, it's important to look at belt fit. If manufacturers fail to do so, they could end up recommending a booster that positions the belt incorrectly.

The Institute is urging the agency to incorporate into the program a belt-fit procedure that uses a child-size dummy, similar to the method the Institute uses to rate boosters according to how well they position belts on a typical child in most vehicles.

The proposed program might not simplify things immediately since it will add yet another layer of information for parents to sift through. NHTSA rates child seats on ease of use, the Institute evaluates boosters for belt fit, and Consumer Reports rates child seats for crash protection, ease of use, and fit in a variety of vehicle types. The various ratings programs don't always give the highest marks to the same seats.

Alisa Baer, a New York pediatrician who runs The Car Seat Lady website, is skeptical about the value of a vehicle-child seat compatibility list. She says it doesn't address "the larger problem of widespread incompatibility" and says NHTSA should focus its energy on mandating designs that will eliminate common problems. For example, safety belt anchor points in the center of many vehicles are too narrow for child seats and should be set wider apart, she says.

Nudging the industry

NHTSA hopes the program will lead to improvements in both vehicle design and child seat design, as the two industries "will likely have to work together to address the need for increased compatibility," the agency said in its request for comments.

The new physicians' guidelines also are expected to lead to improvements — in particular, more seats that can accommodate heavier children in rear-facing mode.

Another change that could broaden the options for rear-facing seats has been proposed by Volvo. The Swedish automaker designs child seats for its own vehicles for all ages but in the United States offers options only for older children. The seats it sells in other countries for younger children are designed to be used rear-facing until age 3 or 4.

These rear-facing seats that can handle higher weights can't be sold in the U.S. because they use a support leg that extends to the floor of the vehicle. Safety rules require child seats to pass compliance tests using only vehicle belts or LATCH attachments. Volvo wants the agency to change the regulation to accommodate seats with legs.

"In an ideal world, parents would be able to follow the rear-facing-longer recommendation without having to worry that their child will outgrow the restraint before age 2. And they'd be able to buy a seat and be confident that it will fit in their car and won't require an advanced degree to install correctly," McCartt says. "We're still a long way from that point, but the new guidelines and the focus on child seat-vehicle compatibility should push the industry in the right direction."

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