Don't Make This Car Seat Mistake

Infants in rear facing car seats turned to face forward earlier than recommended

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Babies on board should see the world through the rear window. Many kids may be switched to forward-facing car seats too soon.

New research indicates that most parents turned their children to face the front before the children were 2 years old — which is contrary to recommendations from the American Academy of Pediatrics (AAP).

If parents and caregivers followed AAP recommendations, their children might be better protected from injury resulting from car accidents. The authors of this study said health care professionals should make a point of educating parents about proper car seat use.

"I would strongly recommend children rear face until age 2 because toddlers' necks are not as strong," said Hannah Chow-Johnson, MD, a pediatrician at Loyola University Health System and assistant professor at Loyola University Chicago Stritch School of Medicine.

"When facing forward, an infant's neck can snap with the force of a crash. When facing backwards, the carseat cushions the head and neck and prevents neck fractures. Parents get concerned about their children's comfort in the back seat, but a broken leg is better than a broken neck," said Dr. Chow-Johnson.

Michelle L. Macy, MD, an assistant professor in the Department of Emergency Medicine at the University of Michigan and a member of the Institute for Healthcare Policy and Innovation, led this study.

"Parents want to keep their children as safe as possible but can get confused by mixed messages that they receive about car seats," Dr. Macy told dailyRx News. "Many parents look to laws for child passenger safety for guidance but currently no state laws are completely in line with the latest national recommendations. Health care providers need to understand these gaps so that they are prepared to answer tough questions from parents."

The current AAP guidelines say children should be placed in a rear-facing car seat until age 2. A child who has outgrown the height or weight limits of a particular car seat can also be placed facing forward.

Researchers, however, found that, in 2013, 77 percent of parents had turned their children to face forward before the child reached the age of 2. Twenty-four percent of parents had turned their children to face forward before or at the age of 12 months.

Although these numbers are an improvement since the 2011 survey, Dr. Macy and team noted that there are still opportunities to improve children’s safety.

Dr. Macy and team obtained their information through an online survey of parents throughout the US. In 2013, 1,522 parents responded to this survey.

Parents might swap their children’s position early for a variety of reasons, Dr. Macy and team noted. Parents might want to see the child, or they may find it easier to get the child in and out of a forward-facing seat.

Dr, Macy noted that this is a community issue.

"Child passenger safety is a public health issue that needs to be addressed in the community," she said.

She added that "Families can find child safety seat inspection stations in their area using the online tool available at"

This study was published online Jan. 6 in Academic Pediatrics.

The Department of Pediatrics and Communicable Diseases at the University of Michigan and the University of Michigan Health System funded this research. Dr. Macy received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The authors disclosed no conflicts of interest.

Review Date: 
January 8, 2015
Last Updated:
January 11, 2015