5 Times Safer



 *** American Academy of Pediatrics recommends rear-facing until age 2 (at least) ***


3y 36lbs & 10m 20lbs Rear-Facing

In April 2011 the American Academy of Pediatrics (AAP) published new guidelines on children in car seats, recommending that children ride rear-facing until at least age 2. 1

Surprised?  We’re not; the evidence is there. A 2007 article in Injury Prevention showed that 2 year-olds were FIVE TIMES SAFER riding rear-facing than forward facing.2 A 2008 article Pediatrics urged pediatricians to “implement what we know to be best practice: children should ride in a rear-facing seat to the highest weight or height allowed for use rear-facing by the manufacturer of the seat.”3 In June 2009 the British Medical Journal published “Advise use of rear facing child car seats for children under 4 years old.”4


Convertible seats are ones that start rear-facing and then convert to forward-facing for older kids; kids typically start using a convertible seat rear-facing after out-growing the infant seat.  The weight limit for rear-facing is typically 35-40 pounds for most convertible seats, with a few seats going to 45 pounds and one to 50 pounds rear-facing. The height limit is the same for any rear-facing seat – the child’s head must be at least 1 inch below the top of the car seat.


3-year-old happily rear-facing

As kids get older, their feet will touch the back of the vehicle seat; this is both comfortable & safe. Ever wonder why a 5-year-old can sleep comfortably with his chin on his chest & never wake up complaining of a stiff neck?  It’s because kids’ joints aren’t fully formed, which lets them sit comfortably in positions that would be painful for even a yoga master.  For this reason, a 3-year-old can sit comfortably rear-facing with her legs crossed or in the “frog leg” position. Other parents worry about leg injuries; studies show that forward-facing kids suffer many more leg injuries than rear-facing kids.5


Rear-facing does not have to be boring! Older kids can ride quite upright so they can see out the side and rear windows. If there is a head rest blocking your child’s view out the back window, you can usually remove it. By 9-12 months your baby knows you’re there when you talk to them from the front – even though they can’t see you. You can calm and entertain your child with songs & stories – and for older children games of “I spy” – all while they are rear-facing.


Volvo looked at several thousand pre-schoolers and found the same rates of motion sickness in those riding rear-facing as those riding forward-facing. Regardless of the direction your child rides, placing them in the center seat with an unobstructed view out the front/back window (and limited visibility out the side windows) will help keep the nausea away.


It’s not coincidence that flight attendants sit rear-facing.  Rear-facing is the safest way for everyone to travel, not just babies.  Therefore, it is my recommendation as a pediatrician and nationally certified child passenger safety instructor that children ride rear-facing until at least age 2 – and ideally longer, until reaching the maximum height or weight for rear-facing in their convertible car seat, which for most kids is around 2-4 years old.

Alisa Baer, MD www.thecarseatlady.com  (last updated 01/14)

1. American Academy of Pediatrics, Committee on Injury, Violence & Poison Prevention. Child Passenger Safety. Pediatrics. 2011; 127: 788-793.
2. Henary B, et al. Car Safety Seats for Children: Rear Facing for Best Protection. Injury Prevention. 2007; 13 (6): 398-402.
3. Bull M, Durbin D. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics. 2008; 121 (3): 619-20.
4. Watson E, Monteiro M. Advise Use of Rear Facing Child Car Seats for Children Under 4 Years Old. BMJ. 2009; 338: b1994.
5. Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annu Proc Assoc Adv Automot Med. 2002; 46: 213-30.

9 Responses to “5 Times Safer”
  1. Vanessa says:

    What’s the car seat shown on Slide #9?

  2. Corinne says:

    What are your thoughts on the RF tether that is available on some seats? I need to purchase a second seat for the nanny’s car, and I’m wondering if it’s really necessary.

    • It is not necessary, BUT I think it is a nice feature and if you have a seat that allows for it I would definitely use the rear-facing tether. It will become more and more important as we are putting heavier & taller kids rear-facing.

  3. Michelle says:

    I loved the article until the comment about flight attendants being rear facing. Are you serious?? If a plane goes down, it doesn’t matter what way you’re facing. I’m pretty sure that they’re forward facing because there’s no other place to put their folding seat other than on that wall. That silly comment pretty much ruined your crediblity to me.

    • Michelle – I respectfully disagree with your statement “if a plane goes down, it doesn’t matter what way you’re facing” – as there is evidence that contradicts it. Please see this article – http://www.airspacemag.com/need-to-know/Need-to-Know-Aft-Facing-Seats.html

      • Rachelle says:

        sooo,,, you just gather information on what you believe to be true? Im sure that I can find evidence of any idea that I might have true, or not. Here is some good advise. ASK YOUR PEDIATRICIAN WHAT CHILD SEAT IS APPROPRIATE !!!!!!!!! THEY are the experts.

      • Rachelle – First, I am a board certified pediatrician. Second, did you not notice the references at the bottom of this article… this is not information that “I believe to be true” – this is information that I KNOW to be true – and have given you the medical journal articles to read further if you would like. Also, I can tell you that most pediatricians are not the experts in this as few receive appropriate training in medical school or residency – and having checked the car seats for the children of many of my pediatrician colleagues I can tell you that the same 90% misuse rate that is seen in the general population is seen amongst pediatricians and what they do for their own children.

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  1. […] children are 5 times safer than forward facing?  Children should be kept rear-facing to the limits of their car seat, and not […]

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