A Car Seat Conundrum

A recent study in the British Medical Journal caught me up short: It said that kids should be kept in rear-facing car seats until the age of 4. I pictured my own preschooler in a rear-facing car seat: The image that came to mind was of Wyatt practically folded in half, with nowhere for his on-the-verge-of-gangly legs to go.

At the same time, I could see why the BMJ findings made sense; what I couldn’t figure out was what I, or the mom of any little kid, should do with this info -- especially since I was pretty sure that the American Academy of Pediatrics, official recommendation on when to do the car seat flip-flop is when a child is at least a year old and weighs at least 20 pounds. So I called up Ben Hoffman, a pediatrician in New Mexico who’s on the AAP’s Committee on Injury, Violence, and Poison Protection and who’s also a nationally certified passenger safety technician (read: car seat fitter).

Dr. Hoffman gave me a quickie synopsis of the British study that caused me to regard the concept of car seat graduation in a whole new light: "Most parents tend to think about it as a right of passage,” he said. "What the study highlights is that it’s really not: Every time you move up, you lose protection.” He cited another study, published last year in the Journal of Injury Prevention, that showed that kids between 1 and 2 are more than five times more likely to be injured forward-facing than rear-facing. He went on to explain that when a child (or anyone!) is rear-facing, the force of an impact is spread over the entire back, so there’s less chance of serious injury. On a tot who’s sitting face-forward, all the impact would be concentrated where the harness straps of the car seat are touching his body. Plus, his head would be thrown forward; if he’s sitting backward, the seat would cradle his head and neck.

Finally, he underscored that the AAP’s 1 year/20-pound guidelines are absolute minimums: In other words, the point is not that at a year old you should turn a child around, but rather that a child should be at least a year old and weigh at least 20 pounds before you do it.

It all made sense, but to my knowledge there are few backward-facing car seat designed to accommodate the typical 4-year-old, which brought me back to my original question: What exactly do I do with this knowledge? The bottom line, Dr. Hoffman told me, is to keep your child rear-facing for as long as possible, up to the weight and height limits listed on his car seat.

If you’re interested in purchasing a seat that does allow preschoolers to sit backward, there are a few models on the market. Orbit’s Toddler Car Seat (shown, $360) is designed to be rear-facing up to 35 pounds. And Graco just came out with My Ride 65 ($159.99) that’s safe for rear-facing kids up to 40 pounds.

Meanwhile, I’m relieved that Wyatt’s fine in his forward-facing seat: I’m pretty sure he wouldn’t have taken a reversal sitting down.