Thursday, March 24, 2011

New Guidelines on Car Seat Safety from the American Academy of Pediatrics

Q&A with Joel Bass, MD

The American Academy of Pediatrics published new guidelines for car seat safety this week. In general, the new guidelines recommend delaying each transition until it's necessary, when the child fully outgrows the limits for his or her current stage. Joel Bass, MD, chair of the department of pediatrics at MassGeneral for Children at Newton-Wellesley Hospital, explains the new guidelines:

1. Infants and toddlers should ride in a rear-facing safety seat until they are 2 years old or until they reach the highest weight or height allowed by the manufacturer of the seat.


Joel Bass, MD
Joel Bass, MD Chair of the Department of Pediatrics at MassGeneral for Children at Newton-Wellesley Hospital.

Dr. Bass explains: Infants are at particular risk for head and spinal cord injury in a crash because their heads are large relative to their bodies. The rear-facing seat supports the head and helps to distribute the impact forces over the rest of the body. Research from Sweden (where rear-facing seats are used until age 4) showed a 90% reduction in significant injury. Studies in the US showed that children in forward-facing child safety seats were significantly more likely to be seriously injured when compared to children in rear-facing seats.

Q: What about kids who are fussy when they're rear-facing but happier when they’re front-facing?

A: If possible it may help to have a properly restrained older passenger in the rear of the car to attend to the child, or to give the child an age-appropriate book or toy. In any case, because of safety considerations they should remain in rear-facing seats as long as possible.

Q: You can't see kids when they're rear facing--isn't that dangerous?

A: If the parent ensures that the child is properly positioned and does not have access to objects that could cause suffocation, the danger would be minimized. Having an older passenger in the rear could also help, particularly for very small infants. In any case, the relative risk of travel in a forward-facing seat would remain the greater danger.

2. Children 2 years or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their safety seat, should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by the manufacturer.

Dr. Bass explains: Forward-facing safety seats with a harness have been estimated to reduce the risk of death and injury by about 70%. Some of these seats can accommodate children up to 80 lbs.

3. Children who have outgrown their car seat should use a booster seat until the lap-and-shoulder seat belt fits them properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.

Dr. Bass explains: Improperly fitting seat belts can cause an injury to the abdominal organs known as “seat belt syndrome” as well as injury to the lumbar spine. Belt-positioning booster seats can reduce deaths and hospitalizations by more than 50%.

Q: How can you tell if a kid has outgrown his or her car seat?

A: The starting point is the car seat manufacturer’s guidelines for weight and size. These vary widely. Once children have outgrown these, then its time to transition to the next age- and size-appropriate safety device, The transition to lap and shoulder belts typically happens when children have reached 4 feet 9 inches of height, some time between ages 8 and 12.

Q: How do you know if the lap-and-shoulder belt is fitting properly?

A: The lap belt should fit low across the hips and pelvis (not the abdomen) and the shoulder belt should lie across the middle of the chest and shoulder (not the neck or face). The booster seat helps position the child to ensure a proper fit.

4. When children outgrow the booster seat, they should always use lap-and-shoulder seat belts.

Dr. Bass explains: Based on available data, it is estimated that the lap and shoulder seat belts reduce the chance of serious injury or death by about 40%.

5. All children younger than 13 years should be restrained in the rear seats of vehicles.

Dr. Bass explains: The elevated risk of injury in the front seat compared to the rear has been shown in different studies to be between 40 to 70%. The front seat has the added danger of air-bag injuries in smaller individuals.

Q: Is this an age recommendation, not a height/weight recommendation?

A: This is an age recommendation but size is also a problem for air-bag injuries at any age.

Additional resources

About the Research

The new guidelines are based on data from the National Highway Traffic Safety Administration (NHTSA), the Fatality Analysis Reporting System (FARS), the Crash Injury Research and Engineering Network (CIREN) and a wide range of research studies from academic medical centers throughout the country. Important studies from abroad, particularly Sweden, were also taken into account. These studies provided data on the relative risk of injury and death in a wide variety of accident circumstances. Particular attention was given to the relationship of size and protective devices and the relative protection afforded.

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