Rear-Facing Safety Seats Save Lives

Children’s car safety seats should face the rear of vehicles for longer than experts originally suggested. The American Association of Pediatricians recommends that all infants should ride in rear-facing seats, starting with their first ride home from the hospital until they are two years old, or until they reach the highest weight or height allowed by their safety seat’s manufacturer. 

Car seats are one of the greatest safety tools parents have. In fact, car accident deaths have declined drastically since the implementation of safety seat laws. Research shows that child safety seats reduce fatal injuries by 71% for infants less than one year old and 54% for children ages one to four years.

As safety guidelines change, parents often have many questions. I’d like to share some recent questions I have received from parents to help answer some of those questions: 

Q. My 18-month-old screams when she can’t see me and we’re in the car. What can I do to stop this when I’m alone in the car with her? 

A.  Prepare for the road trip before you leave home. Make sure your toddler is fed and changed. Give your toddler his/her favorite toy. Play his/her favorite music in the car. Talk to your toddler without looking back while driving. Do not go in the car if your child is very fussy because this can distract you while driving. I do not advise having dual mirrors because they can lead to distraction and possibly accidents.

Q. My child has very long legs and there won’t be enough room for them if I face the seat to the rear. 

A. You will find a car seat for every child’s size. Convertible car seats are usually bigger and can fit bigger toddlers. You can always bend the child’s legs a little. Injuries to legs are very rare in rear-facing children.

Q. I don’t understand why my 17-month-old can’t face forward in her seat. She’s small, but she shouldn’t be penalized for that. All the other children I know her age face forward. 

A. Not anymore. All children under the age of 2 years will have to face the rear of the car since the newest car safety recommendations came out in April.

Q. I don’t understand this change in recommendations. When I had my first children years ago, they were facing forward in their seats much earlier and they were never harmed. 

A. We learn as we go. Ongoing studies and observation make us aware of what we do wrong and we try to improve our practices always.

There was a similar situation with the back-to-sleep campaign--we realized that Europe had fewer crib deaths than the United States. The only thing they did differently was putting babies to sleep on their backs, so we did the same and are seeing fewer crib deaths. 
Types of car safety seats at a glance

  • Infants/Toddlers: All seats should face to the rear and should continue to do so until a child is 2 years old or they reach the highest weight or height allowed by their car safety seat’s manufacturer.
  • Ages 2-Preschool: Use a forward-facing safety seat with a harness for as long as possible, up to the highest weight or height allowed by the safety seat’s manufacturer.
  • School-age: Use belt-positioning booster seats until they have reached 4'9" in height and are between 8 and 12 years of age.
  • Older children: Use lap and shoulder seat belts for optimal protection.

Note: All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.  

If you have questions or need help installing your car safety seat, find a certified CPS technician. Lists of certified CPS technicians and child seat fitting stations are available at the following:

  • The National Highway Traffic Safety Administration Vehicle Safety Hotline: call 888-327-4236 or go to
  • SeatCheck: call 866-732-8243 or go to
  • National Child Passenger Safety Certified Technologies: call 877-366-8154 or go to This site offers information in Spanish and also provides a list of CPS technicians with enhanced training in protection of children with special needs.

Nada Haddad, MD, Pediatrician

Dr.  Haddad and Dr. Fred Pearlman are pediatricians at the MetroHealth Lakewood Health Center, 14701 Detroit Ave., Suite 400. Call 216-227-1330 for appointments. Same-day sick appointments are available.

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Volume 7, Issue 16, Posted 1:16 PM, 08.09.2011