What Is New About Car Safety Seat Recommendations?

From CHOP Expert Commentary

Flaura K. Winston, MD, PhD

Hello, I'm Dr. Flaura Koplin-Winston. I'm a general pediatrician, a biomechanical engineer, and I co-direct The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia.
On March 21, 2011, the American Academy of Pediatrics released new guidelines on child passenger safety, based on up-to-date information. These created lots of buzz among parents and physicians. In this podcast, I'll review the recommendations with you and simplify them. In a subsequent podcast, I'll tell you how to use these recommendations when giving guidance to your families.
The common theme that underlies the recommendation is: don't rush the transition.
Every time a parent moves a child from one stage to the next, like rear-facing to forward-facing, they reduce the safety benefits.
Parents are excited when their children reach developmental milestones and want to push them on to the next step. But, safety often requires us to hold back.
So, here's a practical tip. When reviewing child development, make sure to applaud the developmental milestones that are reached and encourage parents to move those kids along, but caution them not to do that with safety, particularly child passenger safety.
In case you haven't had the chance to read the recommendations, let me tell you what's new. What we're doing is just becoming clearer with the recommendations.
Here are the major differences. In the past, we used to say to families: keep children rear-facing until at least 1 year of age and 20 pounds. Now, we're actually going to change that.
What you should be saying is: keep them rear-facing until at least 2 years of age or the upper height and weight limit that the manufacturer specifies for that seat.

Similarly, with forward-facing seats, instead of telling families to keep the child forward-facing until age 4 years or a weight of 40 pounds, tell them to keep that child in a seat forward-facing with the 5-point harness until the child is at least the upper weight limit of that seat, which is often higher than 4 years or 40 pounds.

For booster seats, many clinicians will recommend keeping the child in the booster seat until age 8 years.

The fact is that the seatbelt doesn't fit well until the child is a minimum height of 4 feet, 9 inches. What we should be saying to families is: keep the child in a booster seat until at least 4 feet, 9 inches and that usually is reached around age 8-12 years, at which point a child should go in a 3-point restraint.
There's no change to the backseat recommendation.
Children should stay in the back until age 13 years.
So, the general progression hasn't changed. The new report just recommends keeping the children in each of these steps longer.
Here's a practical tip. The American Academy of Pediatrics produced this very helpful algorithm to help you figure out, based on a child's age, height, and weight, the right restraint for the child. Print it out, keep it in your office. It will help you give advice to families.
What I really want to assure you is that you do not have to be a child passenger safety expert. You just need to be familiar with the guidelines and, when families have questions, know where to send them.
There are 2 places. You can send them to our Website, where you will find lots of information in English and Spanish for families.
The other is Seatcheck.org or 1-866-SEAT-CHECK for families wishing to locate a car seat technician.
In the second Webcast, I will give you some guidance on how to help families with these guidelines and how to answer those questions.