You might have already heard that the American Academy of Pediatrics (AAP) has updated their recommendations on car safety seats. The new guidance is simply that infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their car seat.

Child passenger safety technicians like me have always advised that rear-facing is safest but we, and parents, may have been using two years old as an indication that it was acceptable to turn a child forward.

So, what does this new recommendation really mean to you and your child?

Children who are riding in a rear-facing only (“infant”) seat

When your child reaches the highest weight or height allowed by the manufacturer of an “infant” seat (or it becomes too difficult for you to carry or lift into/out of your vehicle), they should move to a convertible, 3-in-1, or all-in-one car seat.

Install that seat rear-facing and keep it that way until your child has reached the maximum weight or height, according to the manufacturer’s instructions. Consider getting a seat that allows rear-racing to at least 40 pounds, or even higher.

Children who are riding rear-facing in a convertible, 3-in-1, or all-in-one car seat

Keep your child rear-facing in this seat until they reach the maximum weight or height specified by the manufacturer.

For most rear-facing car seats, there must be at least 1 inch of room between the top of the child’s head and the top of the car seat. The manufacturer may also supply a specific number (in inches and centimeters), or indicate a harness slot above which the child must ride forward-facing.

Note that for some car seats, you may need to switch from using the lower anchors to the seat belt for a safe installation for a larger child. Refer to the car seat labels and instruction manual and the owner’s manual for your vehicle, for more information.

Make sure if you are getting a seat labeled “3-in-1,” it is a seat that can be rear-facing, forward-facing with a harness, and a booster seat. There are some seats that are labeled as “3-in-1” referring to a forward-facing harnessed seat that can become a booster with a backrest or without a back.  

Children who are already riding forward facing, but have not outgrown their seat by weight or height for rear-facing

Your child should be turned back to rear-facing. That is probably going to be the trickiest for parents to do, but here’s some information from AAP to help you make this decision.

“When a child rides rear-facing, the head, neck, and spine are all supported by the hard shell of the car safety seat, allowing the car seat to absorb most of the crash forces, and protecting the most vulnerable parts of the body. When children ride forward-facing, their bodies are restrained by the harness straps, but their heads – which for toddlers are disproportionately large and heavy – are thrown forward, possibly resulting in spine and head injuries.”

Wait – what about legroom?

As the AAP says:

“Children can bend their legs easily and will be comfortable in a rear-facing seat. Injuries to the legs are very rare for children facing the rear.”

A crash that could cause leg injuries would also be highly likely to cause more severe head, neck, and spinal injuries.

I still have questions

  • Refer to the AAP webpage on Car Seats: Information for Families to review this revised recommendation and other car seat information.
  • Read the car seat instruction manual and the labels on the car seat.
  • You can also make an appointment at a car seat fitting station, where a car seat technician can help you make sure your seat is installed correctly and fits your child.
  • See the Vermont Health Department’s Be Seat Smart website for a list of fitting stations, car seat events, and resources.

Maureen Johnson, CSP, CPST-I, is a Child Passenger Safety Specialist at the University of Vermont Medical Center.

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