The American Academy of Pediatrics (AAP) has released new advice regarding the view our little kiddos should have during the first two years of life (in the car that is).  In the April 2011 issue of Pediatrics, the AAP is now advising that we should keep children under the age of 2 in a rear-facing car seat or ‘until they reach the maximum height and weight for their seat’.    I think they are referring to the conversion car seat that many of us used between the biceps-workout infant car seat and the fanny lifter booster seat usage periods.  The minimum time to wait until revealing the mesmerizing (and potentially silencing) world on the other side of the front windshield is still cited at age 12 months and 20 pounds.  Just to provide the full advice in this post, most children will need to ride in a belt-positioning (hopefully, not neck scraping) booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age.  Speaking as an Asian Indian, I think that some of the tiny women in my family might be in that booster seat well into the high school years with that height requirement.

The reason for the delayed rotational recommendation for those toddlers… the rear-facing child safety seat does a better job supporting the head, neck and spine in infants and toddlers in a crash.  So even though rates of motor vehicular death rates in children under age 16 have dramatically decreased in the last decade or more, it is still the leading cause of death for children age 4 and up.

The new guidelines are not a requirement, but a recommendation to consider for parents.  I always discuss risks, benefits and alternatives with my patients when considering a health care decision.  Obviously, there is some research to point to benefits in reductions of injuries during car crashes.  That’s a lot of points on the benefits side.  The risk seems to be more psychosocial (that little mirror on the rear seats reflecting your little faces doesn’t seem to be a good substitute for real face to face communication and stimulation).  Not much in the way of alternatives unless someone starts mounting the car’s DVD player for the rear-facers so they have something to occupy their little developing curiosities.

The truth is, this is a potential preventive ‘therapeutic lifestyle choice’ when you really think about it.  Actually, I’m torn about how to advise my parents who are ‘post-flipping car seat stage’ with kids between age 1 and 2 right now.  Should they turn them back around for the additional safety benefits?   Are we going to see a world where our 10 year olds are routinely in booster seats?  I know that I had to purchase extra car seats for the other transporters in my network.  Will I have to do this until my kids are in middle school?  On the other side, are we going too far with this ‘safety thing’ because ‘we never used car seats so much as kids and we turned out just fine’?  What’s your vote?  How will you position your child’s safety against their desire to experience more of the world?