What Parents Need To Know About Rear-Facing Car Seats

Over the weekend, car seats became a political issue when Texas Gov. Greg Abbott vetoed House Bill 448, which would have required children under 2 years old to be secured in a rear-facing car seat while in a moving vehicle and it would have penalized drivers who fail to follow the new guidelines.

In his veto statement, Gov. Abbott called the bill “an unnecessary invasion of parental rights and an unfortunate example of over-criminalization.”

Texas law already requires children younger than 8 years old or shorter than 57 inches to be secured in a car seat and that the car seat be installed according to the manufacturer's instructions. The current law does not specifically mention car safety guidelines for children under 2 years old.

Following the veto, Chris Turner, D-Grand Prairie, who authored the bill said to The Dallas Morning News: “The governor’s veto sends the irresponsible message that it doesn’t matter if a child under age 2 is rear-facing. It does matter, because it is proven to save young lives.”

In much of the medical community, the talk among experts has shifted away from the age of the children to simply keeping them safely in a rear-facing car seat as long as possible. In 2018, the American Academy Of Pediatrics updated its recommendations on car seats for children. The AAP recommends children remain in a rear-facing car safety seat until they reach the highest weight or height allowed.

Benjamin Hoffman, M.D., FAA, the lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention, said newer car seats allow children to remain rear-facing until they weigh 40 pounds or more, meaning most kids can remain rear-facing past their second birthday.

“It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride,” Dr. Hoffman said. “Car seats are awesome at protecting children in a crash, and they are the reason deaths and injuries to children in motor vehicle crashes have decreased. But that also means we just don’t have a large enough set of data to determine with certainty at what age it is safest to turn children to be forward-facing. If you have a choice, keeping your child rear-facing as long as possible is the best way to keep safe.”

Nationally, car crashes remain a leading cause of death for children. The American Academy of Pediatrics states that over the last 10 years, 4 children under 14 died each day.

Last year at Cook Children’s, 37 kids, who were 2 years of age and under, were involved in motor vehicle crashes, including five deaths (the most in at least five years). According to Cook Children's Trauma team, there have been 205 children in that age range invovled in wrecks and 12 deaths since 2014.

Spinal cord injury is a major concern for children who have transitioned from rear-facing to forward-facing or booster seat too soon. Melodie Davis, director of the Pediatric ICU, Transitional Care Unit and Rehabilitation Care Unit at Cook Children’s, said a young child’s head is so heavy as a toddler that it whips and causes damage.

“Properly used car seats protect children from injury and death,” Davis said. “Infants and toddlers are at risk for head, neck, and spine injuries during car crashes because their heads are large and heavy compared to their bodies. When placed rear-facing, the car seat can better support these high-risk areas because the seat is able to absorb the force of the crash. Unfortunately, we see significant neck injuries with cord damage in incorrectly used car seats. Another common injury includes traumatic brain injuries because of the force of the crash. Following proper car seat use guidelines can significantly decrease injuries and death in children.”

Using the right car safety seat or booster seat lowers the risk of death or serious injury by more than 70 percent, according to the AAP. Parents are suggested to check the instruction manual and the labels on a car safety seat to find the manufacturer’s weight and height limits. When a child is approaching the limit, it’s time to think about transitioning to the next stage.

“We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies,” said Dr. Hoffman.