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Explaining The New Car Seat Guidelines

So, I said crankily this morning as I read about the new car-seat guidelines, our kids are basically supposed to ride in booster seats until they start driving themselves??

But that was just a moment of pique. When the American Academy of Pediatrics tells me definitively that I can keep my child safer, I'm not about to say no. Here's the AAP release, including:

The AAP advises parents to keep their toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat. It also advises that most children will need to ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age. The previous policy, from 2002, advised that it is safest for infants and toddlers to ride rear-facing up to the limits of the car seat, but it also cited age 12 months and 20 pounds as a minimum. As a result, many parents turned the seat to face the front of the car when their child celebrated his or her first birthday.

And here's some wisdom from Dr. Lois Lee, medical director of the pediatric injury prevention program at Children's Hospital Boston. The new guidelines may cause some logistical challenges, she said. For example, how do you fit three booster seats in the back of a sedan? But "It’s worth it, because there’s no price you can set on protecting your child from a permanent brain or spinal cord injury.”

The new guidelines have two main parts, she said, and each has scientific backing:

-Keeping children in rear-facing seats until age 2, rather than 1: "This comes from some research done in Philadelphia that really showed that children who are sitting in rear-facing seats up to age 2 have a significantly decreased risk of injury in the event of a crash, and particularly for side-impact crashes."
“The child’s head and neck are supported better in rear-facing seats," she said, "so it is less likely that the head and neck will be whiplashed back and forth.” In Europe, rear-facing seats for children up to 2 have been standard for years, she added.

- Keeping children in booster seats up until the age of 12: With the old recommendations to use boosters until a child was 8 or 4'9", the height guideline tended to get lost, and people tended to stop using the seats when children turned 8. "Physically," Lois said, "that doesn't make sense, because the whole idea is that you have to be tall enough that the shoulder belt crosses over the shoulder and the lap belt sits low over the hips."

Here's something I didn't know, and I'm glad I didn't have to find out the hard way: A poorly fitted seat belt can actually worsen injuries. Oftentimes, Lois said, the shoulder belt hits smaller children in the neck, which they don't like, so they put it behind their back and end up with no upper-body protection. And the lap belt rides across the abdomen, so if there's a crash, "the lap belt basically acts like a fulcrum, and so then the upper body bends forward, so they're at risk for internal organ injury — intestines, liver and spleen — as well as spinal fractures."

The idea of the booster seat is that it raises children up to the height of an adult, so the belts can be positioned correctly.

"You have no control of how people drive," Lois said. "But you do have control over maximimizing the safety of your own children in your own car, so in the event of an unexpected crash, you know you've done everything you can to keep your child safe."

Now where did I put that old booster seat that I thought my daughter had outgrown?

This program aired on March 21, 2011. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth blog.

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