At the Lifesavers Conference held last month in Chicago, I presented on my research examining the awareness, attitudes, and dissemination practices of pediatricians two years following the release of the revised American Academy of Pediatrics (AAP) policy statement on child passenger safety. The presentation elicited some interesting questions that I thought would be worth sharing:
If the Swedish evidence for keeping kids restrained rear-facing through age 4 is so strong, why wasn’t that the US recommendation?
In Sweden, having older kids rear-facing requires moving them to the front seat and de-activating air bags, which was felt to be too complex a technologic leap to make. In addition, because the previous AAP recommendations were to switch children to forward-facing at 1 year and 20 pounds, it was felt that extending the rear facing recommendations until 4 years of age would have been too much of a change, and could potentially discourage adoption of the practice at all. By raising the best practice recommendation to age 2 for rear-facing, the AAP is “moving the needle” in the right direction based on the available evidence.
Why didn’t the AAP recommend to keep kids rear-facing for at least 2 years or until the rear-facing weight or height limit of the seat? Wouldn’t this have encouraged parents and caregivers to keep children rear-facing beyond the age of 2?
Authors of the AAP recommendations wanted to keep the final wording as evidence-based as possible, and there simply was no US data on rear-facing children over age 2. However, child passenger safety information communicated to parents often uses the “at least 2 years” language; this includes the AAP’s Car Seats: Information for Families 2015 website. This nuance highlights that children should remain rear-facing until they outgrow the height or weight limitations for their rear-facing car seat. Although this often occurs around the age of 2, every child is unique and should be evaluated individually for when the time is right to transition to the next phase of child passenger safety.