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New child passenger safety seat guidance advises kids to ride rear-facing as long as possible

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The most dangerous thing that U.S. children do as part of daily life is ride in a car. Motor vehicle crashes remain the leading cause of death for children 4 years and older. Using the correct car safety seat or booster seat can help decrease the risk of death or serious injury by over 70%, and parents look to their pediatricians as a trusted source of guidance.

New evidence over the past decade prompted the Academy to update the policy statement and technical report Child Passenger Safety. The documents are available at https://doi.org/10.1542/peds.2018-2460 and https://doi.org/10.1542/peds.2018-2461, and will be published in the November issue of Pediatrics.

The impact of the revised policy should be minimal, as the only significant change is the removal of a specific age, 2 years, as a criterion for when a child changes from a rear- to a forward-facing car safety seat.

Guidance for families

Pediatricians should be prepared to provide advice at every health maintenance visit to ensure that children are as safe as possible. The evidence-based recommendations call for the following:

  • Children should ride in a rear-facing car safety seat as long as possible, up to the limits of their car safety seat. This will include virtually all children under 2 years of age and most children up to age 4.
  • Once they have been turned around, children should remain in a forward-facing car safety seatup to that seat’s weight and length limits. Most seats can accommodate children up to 60 pounds or more.
  • When they exceed these limits, child passengers should ride in a belt-positioning booster seat until they can use a seat belt that fits correctly.
  • Once they exceed the booster limits and are large enough to use the vehicle seat belt alone, they should always use a lap and shoulder belt.
  • All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

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