Great Discussion on why Laws are not 'one size fits all'.
February 13, 2015
Legislating Child Passenger Safety is difficult, while many legislators and parents may want one simple bottom line answer or a catchy phrase like '8 and 80' for safety, it is hard to legislate an issue that covers children in many ages and stages. -CSSLLC
February 12, 2015 Mark R. Zonfrillo, MD, MSCE
Legislating Best Practice Recommendations for Child Passenger Safety
Under current best practice guidelines, children should remain in a rear-facing child safety seat until at least age 2.
In the almost four years since the American Academy of Pediatrics (AAP) last updated its best practice recommendations for child passenger safety (CPS), there has been ongoing discussion around the most publicized recommendation— that children should remain in rear-facing child restraint systems (RF CRS) until they reach age 2 years or outgrow the height and weight limitations of their RF CRS. Although all fifty states have laws that require children to travel in approved child restraint devices or booster seats to various ages, no law specifies that a child must be restrained rear-facing older than age 1 year. This may be changing with a proposed California bill that would mandate the recommendation for children to remain in RF CRS until at least age 2.
In related news, the University of Michigan recently published results from a nationally representative study of parents on their child’s transition from a rear-facing to forward-facing CRS in 2011 (when the updated recommendations from the AAP were released) and two years later in 2013. The results show that, in 2011, 16 percent of parents reported waiting until their child was 2 years or older to move them forward-facing, while in 2013, this number rose to 23 percent.
Every child safety seat varies with height and weight parameters for the rear-facing orientation. In the University of Michigan study, although the change in the percentage of children who remained rear-facing until age 2 may seem small, some children who seem to be “prematurely graduated” to forward-facing prior to their second birthday may actually be in accordance with the AAP’s best practice recommendations if they have outgrown the height and/or weight limitations for rear-facing on their particular seat. This scenario provides a complication for laws such as the one proposed in California; it is challenging to enforce height and weight, and a “one size fits all” law that relies on age alone could lead to inadvertent CRS misuse for larger children.
I spoke with my colleague Dennis Durbin, MD, MSCE, Director of the Office of Clinical and Translational Research at CHOP and lead author of the AAP’s revised policy statement on CPS. He shared the following insight: Best practice recommendations intended for pediatricians as a guide to counseling families are meant to complement legislation and cannot be easily translated into law, however tempting it might be to align all recommendations into a single message. Laws cannot account for the myriad of variations in children and restraint systems that are on the road, but can set a common standard for a given population. Pediatricians are in a good position to address the many unique situations that families may find themselves in when trying to protect their children in the car.
Although this issue can seem complex, here’s what we know:
Child restraint systems vary with the heights and weights they accommodate for children in both rear-facing and forward-facing modes. The AAP’s guide to commercially available car seats for 2015 is available here.
Based on pediatric growth charts from the Centers for Disease Control and Prevention, less than one percent of children 2 years or under would be too tall or weigh too much to remain rear-facing in their convertible car seat. However, some parents choose to use infant-only seats (which have lower height and weight limitations) and will eventually have to purchase a new seat to accommodate their child as he or she grows. It’s important to remember that when that transition is made, the child may still need to stay rear-facing if the new seat can accommodate a higher height and weight in rear-facing mode. This is evidenced by the aforementioned car seat guide from the AAP; the majority of infant-only seats (which can only be used rear-facing) accommodate children up to 30 pounds, while the majority of convertible seats are appropriate for children up to 40 pounds in rear-facing mode.
Parents wondering whether their child is ready to turn forward-facing should consult the height and weight limits of their child’s CRS (see the seat’s labeling or manual) and the current measurements of their child.
Both best practice recommendations and state/federal laws provide complementary approaches to educate parents and caregivers to ensure that children are optimally restrained on every trip.
Awareness and education are key so parents can make the best decisions for their child and family’s unique safety needs.