About face: Car seat experts now recommend parents keep children in rear-facing seats for longer than a year

FAIRWAY, Kan. -- Anne Epperson thought little of it when she flipped her daughter's convertible car seat around so she could face forward after her first birthday.

But if car seat advocates get their way, parents like Epperson will be delaying the switch, possibly for years.

The American Academy of Pediatrics is revising recommendations that they hope will clear up confusion over how long children should spend riding rear-facing in car seats and make them safer in the process.

Some experts, citing a much-touted 2007 study, say tots are being put at risk switching to the forward-facing position at 1 year of age and 20 pounds, currently the minimum guideline from the pediatrics group and the U.S. National Transportation Highway Safety Administration.

"Rear-facing seats are recommended because of the forces incurred during an accident and the size of the baby," said Dr. Heather K. Dodson, a pediatrician with Cape Physician Associates, in an e-mail interview. "The infant and small child have a head size that is disproportionately large compared to the size of their body. This fact, combined with the forces incurred during an accident, combine to increase the risk of spinal cord injuries --which can lead to death -- in children if they are in a forward-facing seat."

Some frontal crashes can jerk the heads of forward-facing children away from their immature bodies. When a child is rear-facing, the seat and back absorb the impact of the crash, distributing stress among a larger area.

The issue becomes confusing because both groups also advise that children are safer if they remain rear-facing until the upper height and weight limit of their car seats. Many seats top out at 35 pounds in the rear-facing position, a weight many children don't reach until somewhere between their third and fourth birthdays.

It's rare in the U.S. for children to remain rear-facing that long, although several countries require their youngest passengers to ride rear-facing until they are 4 or 5 years old and 55 pounds.

The issue has attracted growing attention since a 2007 article in the journal Injury Prevention showed that U.S. children are five times less likely to be injured in a crash between their first and second birthdays if they are rear-facing.

"We rarely if ever see spine injuries in children in rear-facing car seats," said Dr. Marilyn J. Bull, the contributing pediatric researcher in the study. "We will see head injuries or we will see a few other injuries, but the vast majority of serious injuries occur when children are forward facing."

The American Academy of Pediatrics is still discussing how it is going to revise the recommendations.

Dr. Dennis Durbin, who is leading the effort to update the group's policy on child passenger safety, said the emphasis will be more on remaining rear-facing to the upper weight limit of the seat. The academy is hoping to introduce the new guidelines late next year.

Durbin said he is well aware of the research and said one of the goals with the revision is to reorder the policy and "really state what the ideal is."

Pediatricians get some of the blame, said Dr. Benjamin Hoffman, part of an American Academy of Pediatrics committee that helps educate parents and doctors about injury prevention. The Albuquerque, N.M., pediatrician said some are still promoting old guidelines that say children must be turned forward at a year.

Hoffman, also a certified car seat technician, came across a mother recently whose pediatrician had given her that old advice, and she balked when he suggested she keep her 1-year-old son in the rear-facing position.

"The parent should always read the manual to see what the limits are and the limits are also on the labels attached to the seat," Brooke Kirby, health educator coordinator with Safe Kids Cape Girardeau, said in an e-mail interview. Kirby is a child passenger safety instructor and said parents should leave their child rear-facing until he or she tops out the recommended weight limit.

Motor vehicle crashes are the single leading cause of death for U.S. children, claiming an average of about four lives a day. Hoffman said it is tragic that "people are not operating on the best information they possibly could."

"The bottom line is that in a crash, a child who is rear-facing is going to have all the crash forces spread over their entire back, from the tops of their head to the tips of their toes," Hoffman said. "And spreading all that force out over such a wide area significantly decreases the risk of injury."

Experts said part of the problem is that parents often have viewed switching their children to the forward-facing position as a rite of passage, but Dodson from Cape Physician Associates said the switch should be on a case by case determination.

"As each seat fits into each car differently and each child fits into each seat differently, proper fit should be determined on an individual basis," she said.

Features editor Chris Harris contributed to this report.