Rear-facing car seat offers extra protection for toddlers

With a succession of five active 1-year-olds in for their physicals one fine fall morning, I had plenty of opportunity for entertainment. I also had plenty of time to discuss changing eating habits and emerging social and motor skills with their parents.

We had a lot of ground to cover, but the No. 1 parental question was, “When can my baby sit forward in his/her car seat?”

It's a good question, since toddler car seat recommendations have changed over the last few years as automobile safety research has evolved. While the old rule of thumb advised turning a car seat from rear-facing to forward-facing once a child reached at least 20 pounds and 12 months of age, this recommendation has been revised.

In their 2008 article in the journal Pediatrics, physicians Marilyn Bull and Dennis Durbin recommend that children ride rear-facing until they meet the highest rear-facing weight or height limits allowed by their seat's manufacturer.

When a child reaches a weight of about 20 pounds and when the top of the child's head is within an inch of the top of his rear-facing infant seat, the authors instruct parents to invest in a convertible seat. This new seat will allow larger infants and toddlers to continue sitting in the safer, rear-facing position for an extended period of time. The current upper weight limit for most rear-facing convertible seats sold in the United States is 30 to 35 pounds.

Bull and Durbin find that kids under 2 years of age are 75 percent less likely to sustain fatal or severe injuries when secured in the rear-facing position versus the forward-facing position. The physicians also note that childhood automobile-related death and injury rates are quite low in Sweden, where children ride rear-facing up to age 4.

The U.S. Department of Transportation explains that when rear-facing, a car seat supports the child's entire head, neck and back. In this position a seat's full shell, rather than its harness, absorbs the crash forces. Since a rear-facing seat cradles and moves with its little passenger, a head-on collision occurring while rear-facing also results in less stress to the neck and spine.

The DOT also reassures parents that leg discomfort is not a significant issue for rear-facing children since kids tend to ride with their legs crossed or resting on the back of the vehicle's seat. During a crash, the risk of infant and toddler leg injury is actually low.

Any leg injuries received generally pale in comparison to the head, neck and spine injuries seen more commonly when a little one is forward-facing.

Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.