How long child in rear facing car seat

Car Seats: Information for Families

​One of the most important jobs you have as a parent is keeping your child safe when your child is riding in a vehicle.

Each year, thousands of young children are killed or injured in car crashes. Proper use of car safety seats helps keep children safe. But, because so many different seats are on the market, many parents find this overwhelming. If you are expectant parents, consider working with a certified passenger safety technician (CPST or CPS technician), before your baby is born, to ensure a safe ride home from the hospital.

The type of seat your child needs depends on several things, including your child's age, size, and developmental needs. Here is more information from the American Academy of Pediatrics (AAP) about choosing the most appropriate car safety seat for your child.

Visit here for a listing of car seats & car seat manufacturers.

Types of car seats at a glance:

This chart is a quick guide on where to start your search. It's important to continue your research to learn about each seat you use.

Car safety seats may be installed with either the vehicle's seat belt or its LATCH (lower anchors and tethers for children) system. LATCH is an attachment system for car safety seats. Lower anchors can be used instead of the seat belt to install the seat, and many parents find them easier to use in some cars. The top tether should always be used with a forward-facing seat, whether you use the seat belt or lower anchors to secure it. The seat belt and LATCH systems are equally safe, so caregivers should use one or the other, whichever works best for them, for their car safety seat, and their vehicle. In general, caregivers should only use 1 of the 2 options unless the car safety seat and vehicle manufacturers say it is OK to use 2 systems at the same time.

Vehicles with the LATCH system have lower anchors located in the back seat, where the seat cushions meet. Tether anchors are located behind the seat, either on the panel behind the seat (in sedans) or on the back of the seat, ceiling, or floor (in most minivans, SUVs, hatchbacks, and pickup trucks). All forward-facing car safety seats have tethers or tether connectors that fasten to these anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, are equipped to use LATCH. See vehicle owner's manual for highest weight of child allowed to use top tether.

All lower anchors are rated for a maximum weight of 65 pounds (total weight includes car safety seat and child). Parents should check the car safety seat manufacturer's recommendations for maximum weight a child can be to use lower anchors. New car safety seats have the maximum weight printed on their label.

NOTE: Seat belts—If you install a car safety seat by using your vehicle's seat belt, you must make sure the seat belt locks to hold the seat tightly. In most newer cars, you can lock the seat belt by pulling it all the way out and then allowing it to retract to keep the seat belt tight around the car safety seat. In addition, many car safety seats have built-in lock-offs so you can lock the belt without having to lock the seat belt separately as well. Refer to the vehicle owner's manual for details about how your seat belt locks.

Middle of the back seat—The safest place to ride for all children younger than 13 years is the back seat. If possible, it may be best for the child to ride in the middle of the back seat. However, it is sometimes difficult to install a car safety seat tightly in the middle if the vehicle seat is narrow or uneven. Also, many vehicles do not have lower anchors for the middle seating position. It is safest to put the car safety seat in a position where you can install it tightly with either the lower anchor system or the seat belt; in some cases, this position may be on either side of the back seat rather than in the middle. A child passenger safety technician (CPST or CPS technician) can help you decide which place is best to install your child's car safety seat in your vehicle.

The AAP recommends that all infants ride rear facing starting with their first ride home from the hospital. All infants and toddlers should ride in a rear-facing seat as long as possible until they reach the highest weight or height allowed by their car safety seat manufacturer. Most convertible seats have limits that will allow children to ride rear facing for 2 years or more. When infants outgrow their rear-facing–only seat, a convertible seat installed rear facing is needed. All parents can benefit from getting installation help from a CPST to ensure that their child's seat is properly installed.

Types of rear-facing seats

Three types of rear-facing seats are available: rear-facing–only, convertible, and all-in-one. When children reach the highest weight or length allowed by the manufacturer of their rear-facing–only seat, they should continue to ride rear facing in a convertible or all-in-one seat.

Rear-facing–only seats

• Are used for infants up to 22 to 35 pounds and 26 to 35 inches, depending on the model.

• Are small and have carrying handles.

• Usually come with a base that can be left in the car. The seat clicks into and out of the base so you don't have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.

• Should be used only for a child's travel (not sleeping, feeding, or any other use outside the vehicle).

Convertible seats (used rear facing)

• Can be used rear facing and, later, "converted" to forward facing for older children when they outgrow either the weight limit or the length limit for rear facing. This means the seat can be used longer by your child. Convertible seats are bulkier than infant seats, however, and they do not come with carrying handles or separate bases and are designed to stay in the car.

• Many have higher limits in rear-facing weight (up to 40–50 pounds) and height than those of rear-facing– only seats, a feature that makes convertible seats ideal for bigger babies and toddlers.

• Have a 5-point harness that attaches at the shoulders, at the hips, and between the legs.

• Should be used only for a child's travel (not sleeping, feeding, or any other use outside the vehicle).

All-in-one seats (used rear facing)

• Can be used rear facing, forward facing, or as a belt- positioning booster. This means the seat may be used longer by your child as your child grows.

• Are often bigger in size, so it is important to check that they fit in the vehicle while they are rear facing.

• Do not have the convenience of a carrying handle or separate base; however, they may have higher limits in rear-facing weight (up to 40–50 pounds) and height than those of rear-facing–only seats, a feature that makes all-in-one seats ideal for bigger babies and toddlers.

Installation tips for rear-facing seats

Always read the vehicle owner's manual and the car safety seat manual before installing the seat.

When using a rear-facing seat, keep the following tips in mind:

• Place the harnesses in your rear-facing seat in slots that are at or below your child's shoulders.

• Ensure that the harness is snug (you cannot pinch any slack between your fingers when testing the harness straps over the child's shoulders) and that the chest clip is placed at the center of the chest, even with your child's armpits.

• Make sure the car safety seat is installed tightly in the vehicle with either lower anchors or a locked seat belt. Many car safety seats have an integrated lock-off system to keep the seat belt locked. If your seat has one, follow the manufacturer's recommendations on how to use it. If you can move the seat at the belt path more than an inch side to side or front to back, it's not tight enough.

• Never place a rear-facing seat in the front seat of a vehicle that has an active front passenger airbag. If the airbag inflates, it will hit the back of the car safety seat, right against your child's head, and could cause serious injury or death.

• If you are using a convertible or all-in-one seat in the rear-facing position, make sure the seat belt or lower anchor webbing is routed through the correct belt path. Check the instructions that came with the car safety seat to be sure.

• Make sure the seat is at the correct angle so your child's head does not flop forward. Check the instructions to find out the correct angle for your seat and how to adjust the angle if needed. All rear-facing seats have built-in recline indicators.

• Check the car safety seat instructions and vehicle owner's manual about whether the car safety seat may contact the back of the vehicle seat in front of it.

• Still having trouble? Check with a certified CPST in your area who can help.
  

Common questions

What if my child's feet touch the back of the vehicle seat?

What do I do if my child slouches down or to the side in the car seat?

• You can try placing a tightly rolled receiving blanket on both sides of your child. Many manufacturers allow the use of a tightly rolled small diaper or cloth between the crotch strap and your child, if necessary, to prevent slouching. Do not place padding under or behind your child or use any sort of car safety seat insert unless it came with the seat or was made by the manufacturer for use with that specific seat.
  

Why should I dress my child in thinner layers of clothing before strapping them into a car safety seat?

• Bulky clothing, including winter coats and snowsuits, can compress in a crash and leave the straps too loose to restrain your child, leading to increased risk of injury. Ideally, dress your baby in thinner layers and wrap a coat or blanket around your baby over the buckled harness straps if needed. See Winter Car Seat Safety Tips from the AAP.

Do preemies need a special car seat?

A car safety seat should be approved for a baby's weight. Very small babies who can sit safely in a semi-reclined position usually fit better in rear-facing–only seats. Babies born preterm should be screened while still in the hospital to make sure they can sit safely in a semi-reclined position. Babies who need to lie flat during travel may be able to ride in a car bed that meets Federal Motor Vehicle Safety Standard 213. They should be screened again while in the hospital to make sure they can lie safely in the car bed.

Always read the vehicle owner's manual and the car safety seat manual before installing the seat.

Any child who has outgrown the rear-facing weight or height limit for her convertible seat should use a forward- facing seat with a harness for as long as possible, up to the highest weight or height allowed by her car safety seat manufacturer. It is best for children to ride in a seat with a harness as long as possible, at least to 4 years of age. If your child outgrows a seat before reaching 4 years of age, consider using a seat with a harness approved for higher weights and heights.

Types of Forward-Facing Car Seat Restraints

Four types of car safety restraints can be used forward facing:

• Convertible seats: Seats can "convert" from rear facing to forward facing. These include all-in-one seats.

• Combination seats with harness: Seats can be used forward facing with a harness for children who weigh up to 40 to 65 pounds (depending on the model) or without the harness as a booster (up to 100–120 pounds, depending on the model).

• Integrated seats: Some vehicles come with built-in forward-facing seats. Weight and height limits vary. Do not use a built-in seat until your child has reached the highest weight or height allowed for your rear-facing convertible car safety seat. Read your vehicle owner's manual for details about how to use these seats.

• Travel vests: Vests can be worn by children 22 to 168 pounds and can be an option to traditional forward- facing seats. They are useful for when a vehicle has lap-only seat belts in the rear, for children with certain special needs, or for children whose weight has exceeded that allowed by car safety seats. These vests usually require use of a top tether.

Installation tips for forward-facing seats

Always read the vehicle owner's manual and the car safety seat manual before installing the seat.

It is important that the car safety seat is installed tightly in the vehicle and that the harness fits your child snugly.

To switch a convertible or all-in-one seat from rear-facing to forward-facing:

• Move the harness shoulder straps to the slots or position that is at or just above your child's shoulders. Check the instructions that came with the seat to be sure you are positioning the shoulder straps correctly.

• You may have to adjust the recline angle of the seat so that it sits more upright in your vehicle. Check the instructions to be sure.

• If using a seat belt, make sure it runs through the forward-facing belt path (be sure to follow car safety seat instructions) and that the seat belt is locked and tightened. Many car safety seats have an integrated lock-off to keep the seat belt locked. If your seat has one, follow the manufacturer's recommendations on how to use it.
  

• If using the lower anchors, make sure that the weight of your child plus the weight of the seat does not exceed 65 pounds. Most seats now state in the manual and on the stickers on the side the maximum child weight to use the anchors. If the child weighs too much, caregivers must use the seat belt to install.

• Always use the tether when you can. A tether is a strap that is attached to the top part of a car safety seat and holds the seat tightly by connecting to an anchor point in your vehicle (often on the seat back or rear shelf; see your vehicle owner's manual to find where tether anchors are in your vehicle). Tethers give important extra protection by keeping the car safety seat and your child's head from moving too far forward in a crash or sudden stop. All new cars, minivans, and light trucks are required to have tether anchors as of September 2000. Forward-facing seats come with tether straps. A tether should always be used as long as your child has not reached the top weight limit for the tether anchor. Check the car safety seat instructions and vehicle owner's manual for information about the top weight limit and locations of tether anchors.

• Watch the Video: How to Install a Forward-Facing Car Seat

Common question

What if I drive more children than those who can be buckled safely in the back seat?

• It's best to avoid this, especially if your vehicle has airbags in the front seat. All children younger than 13 years should ride in the back seat. If absolutely necessary, a child in a forward-facing seat with a harness may be the best choice to ride in front. Just be sure the vehicle seat is moved as far back away from the dashboard (and airbag) as possible.
  

Booster seats are for older children who have outgrown their forward-facing seats. All children whose weight or height exceeds the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 to 12 years of age. Most children will not fit in most vehicle seat belts without a booster until 10 to 12 years of age. All children younger than 13 years should ride in the back seat. Instructions that come with your car safety seat will tell you the height and weight limits for the seat. As a general guideline, a child has outgrown a forward-facing seat when any of the following situations is true:

• They reach the top weight or height allowed for his seat with a harness. (These limits are listed on the seat and in the instruction manual.)

• Their shoulders are above the top harness slots.

• The tops of their ears have reached the top of the seat.

Types of booster seats

High-back and backless are 2 standard types of booster seats. They do not come with a harness but are used with lap and shoulder seat belts in your vehicle, the same way an adult rides. They are designed to raise a child up so that lap and shoulder seat belts fit properly over the strongest parts of the child's body.

Most booster seats are not secured to the vehicle seat with the seat belt or lower anchors and tether but simply rest on the vehicle seat and are held in place once the seat belt is fastened over a child. However, some models of booster seats can be secured to the vehicle seat and kept in place by using the lower anchors and tether along with lap and shoulder belts. (Currently, only a few vehicle manufacturers offer integrated booster seats.)

Installation tips for booster seats

When using a booster seat, always read the vehicle owner's manual and the car safety seat manual before installing the seat. Booster seats often have a plastic clip or guide to correctly position vehicle lap and shoulder belts. See the booster seat instruction manual for directions on how to use the clip or guide. Booster seats must be used with lap and shoulder belts. When using a booster seat, make sure:

• The lap belt lies low and snug across your child's upper thighs.

• The shoulder belt crosses the middle of your child's chest and shoulder and is off the neck.

• Watch the video: How to Use a Booster Seat

If your booster seat has lower anchors or tether attachments, check its manual for installation instructions.

Common questions about booster seats

What if my car has only lap belts in the back seat?

Lap belts work fine with rear-facing–only, convertible, and forward-facing seats that h av e a harness but can never be used with a booster seat. If your car has only lap belts, use a forward-facing seat that has a harness and higher weight limits. You could also

• Check to see if shoulder belts can be installed in your vehicle.

• Use a travel vest (check the manufacturer's instructions about the use of lap belts only and about the use of lap and shoulder belts).

• Consider buying another car with lap and shoulder belts in the back seat.

What is the difference between high-back boosters and backless boosters?

• Both types of boosters are designed to raise your child so seat belts fit properly, and both will reduce your child's risk of injury in a crash. High-back boosters should be used in vehicles without headrests or with low seat backs. Many seats that look like high-back boosters are actually combination seats. They come with harnesses that can be used for smaller children and, later, removed for older children. Backless boosters are usually less expensive and are easier to move from one vehicle to another. Backless boosters can be used safely in vehicles with headrests and high seat backs.
  

Seat belts are made for adults. Children should stay in a booster seat until adult seat belts fit correctly, typically when children reach about 4 feet 9 inches in height and are 8 to 12 years of age. Most children will not fit in a seat belt alone until 10 to 12 years of age. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for the best protection. All children younger than 13 years should ride in the back seat.

Using a seat belt:

An adult seat belt fits correctly when:

• The shoulder belt lies across the middle of the chest and shoulder, not the neck or throat.

• The lap belt is low and snug across the upper thighs, not the belly.

• Your child is tall enough to sit against the vehicle seat back with her knees bent over the edge of the seat without slouching and can comfortably stay in this position throughout the trip.

Other points to keep in mind when using seat belts include:

• Make sure your child does not tuck the shoulder belt under her arm or behind her back. This leaves the upper body unprotected and adds extra slack to the seat belt system, putting your child at risk of severe injury in a crash or with sudden braking.

• Never allow anyone to "share" seat belts. All passengers must have their own car safety seats or seat belts.

Common question

I've seen products that say they can help make the seat belt fit better. Should we get one of these?

• No, these products are unapproved and should not be used. They may actually interfere with proper seat belt fit by causing the lap belt to ride too high on the stomach or making the shoulder belt too loose. They can even damage the seat belt. This rule applies to car safety seats too; do not use extra products unless they came with the seat or are specifically approved by the seat manufacturer. These products are not covered by any federal safety standards, and the AAP does not recommend they be used. As long as children are riding in the correct restraint for their size, they should not need to use additional devices.
  

When shopping for a car seat, keep the following tips in mind:

• No one seat is the "best" or "safest. " The best seat is the one that fits your child's size, is correctly installed, fits well in your vehicle, and is used properly every time you drive.

• Don't decide by price alone. A higher price does not mean the seat is safer or easier to use.

• Avoid used seats if you don't know the seat's history.

• Watch the Video: What to Look For When Purchasing a Car Seat

Never use a car seat that:

• Is too old. Look on the label for the date the seat was made. Check with the manufacturer to find out how long it recommends using the seat.

• Has any visible cracks on it.
  

• Does not have a label with the date of manufacture and model number. Without these, you cannot check to see if the seat has been recalled.

• Does not come with instructions. You need them to know how to use the seat. Instructions can be found on manufacturer websites or by contacting the manufacturer.

• Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.

• Was recalled. You can find out by calling the manufacturer or contacting the National Highway Traffic Safety Administration (NHTSA) Vehicle Safety Hotline at 888/327-4236. You can also visit the NHTSA Website.

• Do not use seats that have been in a moderate or severe crash. Seats that were in a minor crash may still be safe to use, but some car safety seat manufacturers recommend replacing the seat after any crash, even a minor one. The NHTSA considers a crash minor if all the following situations are true:

• The vehicle could be driven away from the crash.

• The vehicle door closest to the car safety seat was not damaged.

• No one in the vehicle was injured.

• The airbags did not go off.

• You can't see any damage to the car safety seat.

• If you have specific questions about the car seat, contact the manufacturer.

Front airbags are installed in all new cars. When used with seat belts, airbags work well to protect teenagers and adults; however, airbags can be very dangerous to children, particularly to those riding in rear-facing seats and to preschoolers and young school-aged children who are not properly restrained. If your vehicle has a front passenger airbag, infants in rear-facing seats must ride in the back seat. Even in a relatively low-speed crash, the airbag can inflate, strike the car safety seat, and cause serious brain injury and death.

Vehicles with no back seat or a back seat that is not made for passengers are not the best choice for traveling with small children; however, the airbag can be turned off in some of these vehicles if the front seat is needed for a child passenger. See your vehicle owner's manual for more information.

Side airbags are available in most new cars. Side airbags improve safety for adults in side-impact crashes. Read your vehicle owner's manual for more information about the airbags in your vehicle. Read your car safety seat instructions and the vehicle owner's manual for guidance on placing the seat next to a side airbag.

About carpooling

If your child is being driven by someone else, make sure:

• The car safety seat your child will be using fits properly in the vehicle used for transport.

• The car safety seat being used is appropriate for the age and size of your child.

• The person in charge of transporting your child knows how to install and use the car safety seat correctly.

Child care programs and schools should have written guidelines for transporting children, including

• All drivers must have a valid driver's license. In some states, school bus drivers need to have a special type of license.

• Staff to child ratios for transport should meet or exceed those required for the classroom.

• Every child should be supervised during transport, either by school staff or a parent volunteer, so the driver can focus on driving.

• School staff, teachers, and drivers should know what to do in an emergency, know how to properly use car safety seats and seat belts, and be aware of other safety requirements.

About car safety seats on airplanes

The Federal Aviation Administration (FAA) and the AAP recommend that children less than 40 pounds be securely fastened in certified child restraints when flying. This will help keep them safe during takeoff and landing or in case of turbulence. Most rear-facing, convertible, and forward-facing seats can be used on airplanes , but booster seats and travel vests cannot.

Read your seat's instruction manual and look for a label on the car safety seat that says, "This restraint is certified for use in motor vehicles and aircraft. " You can also consider using a restraint made only for use on airplanes and approved by the FAA. Larger children may use the airplane seat belt or continue to use their car safety seat on the airplane as long as it is labeled for use on aircraft and the child has not exceeded the seat's weight or height limit. Remember that your child will need an appropriate car safety seat to use at your destination. For more information, visit the FAA Website or the CARES (Airplane Safety Harness for Children) Website.

If you need installation help

If you have questions or need help with installing your car safety seat, find a certified child passenger safety technician (CPST or CPS technician). Lists of certified CPSTs and child seat–fitting stations are available on the following websites:

• National Child Passenger Safety Certification (Click on "Find a Tech" or call 877-366-8154.) – Includes list of CPSTs fluent in Spanish and other languages or with extra training in transportation of children with special needs.

• NHTSA Parents & Caregivers

Important reminders

Be a good role model. Make sure you always wear your seat belt. This will help your child form a lifelong habit of buckling up.

Make sure that everyone who transports your child uses the correct car safety seat or seat belt on every trip, every time. Being consistent with car safety seat use is good parenting, reduces fussing and complaints, and is safest for your child.

Never leave your child alone in or around cars, and lock your vehicle when it is not in use. Any of the following situations can happen when a child is left alone in or around a vehicle. A child can

• Die of heatstroke because temperatures can reach deadly levels in minutes.

• Be strangled by power windows, retracting seat belts, sunroofs, or accessories.

• Knock the vehicle into gear, setting it into motion.

• Be backed over when the vehicle backs up.

• Become trapped in the trunk of the vehicle.

Always read and follow the manufacturer's instructions for your car safety seat. If you do not have those, write or call the company's customer service department. Staff will ask you for the model number, name of seat, and date of manufacture. The manufacturer's address and phone number are on a label on the seat. Also, be sure to follow the instructions in your vehicle owner's manual about using car safety seats. Some manufacturers' instructions may be available on their websites.

Remember to fill out and mail in the registration card that comes with the car safety seat. You can also register your seat on the manufacturer's website. It will be important in case the seat is recalled.

Follow manufacturer directions for cleaning car seats. Cleaning but not disinfecting is usually permitted. That's because disinfectant products may decrease the protection provided by the seat and harness.

More information

• Ask the Pediatrician: Is it safe for my baby to travel in a car seat a few hours at a time?
  
• Car Seats: Product Listing
• Car Seat Checkup
• Car Seats and Obese Children: Suggestions for Parents
• Prevent Child Deaths in Hot Cars
• Travel Safety During COVID-1 9

_{Although the AAP is not a testing or standard-setting organization, this article sets forth the AAP recommendations based on the peer-reviewed literature available at the time of its publication and sets forth some of the factors that parents should consider before selecting and using a car seat.}

_{Figure 1 adapted from US Department of Transportation, National Highway Traffic Safety Administration (NHTSA). LATCH Makes Child Safety Seat Installation as Easy as 1-2-3. Washington, DC: NHTSA; 2011. DOT HS publication 809 489.}

_{Figure 4 from Bull MJ, Engle WA; American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009;123(5):1424–1429.}

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

How long should my child ride rear-facing?

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Tips & Tools

Tips & Tools

Question

Benjamin Hoffman, MD, FAAP

Answer

​Rear facing is not just for babies! The American Academy of Pediatrics (AAP) has long recommended that―infants ride in rear-facing car seats, and in 2018 the AAP updated that recommendation to encourage rear facing for as long as possible, until a child reaches the highest weight or height allowed by the manufacturer. Most convertible car safety seats have limits that will permit children to ride rear-facing past the second birthday.

Why the Change?

This recommendation was based not only on motor vehicle crashes in which children died or were injured, but also from what we know about the anatomy of young children. Young children have large heads compared to their body size, and a high center of gravity. The vertebrae in their spine are more shallow, and their ligaments are looser. All of these factors increase the risk of a spine injury in a crash. In a sudden, violent stop, a rear-facing seat will cradle a child's entire back and spread out the force of the crash, reducing the risk of serious injuries to the neck and spine.

More Evidence:

Children in other countries routinely ride rear-facing until age 4. Deaths and serious injuries to these children are extremely rare. While differences in car seats, vehicles, and driving conditions make it tricky to compare, data from those countries suggest that children in the U. S. are also best protected by riding rear-facing for as long as they can.

The Good News:

Over the years, car seat manufacturers have increased the weight and height limits on their rear-facing seats. This means that more children can ride rear-facing as they grow well into the toddler and preschool years.

No matter which direction your child faces in the car, though, it is important to read and follow the instructions from your car seat manufacturer. A certified child passenger safety technician can help you figure out what is best for your child and your vehicle. Find one online from the National Highway Traffic Safety Administration or Safe Kids Worldwide.

Additional Information from HealthyChildren.org:

• Rear-Facing Car Seats for Infants & Toddlers

• Car Seats: Product Listing

• Shopping for Car Seats: Tips for Parents

Benjamin Hoffman, MD, FAAP

​Benjamin Hoffman, MD, FAAP is a Professor of Pediatrics and the Director of the Tom Sargent Safety Center at Doernbecher Children's Hospital at Oregon Health and Science University in Portland, Oregon. In addition, he serves as Director of the Oregon Center for Children and Youth with Special Healthcare Needs. After graduating from Harvard Medical School and completing his pediatric training at Seattle Children's Hospital, Dr. Hoffman directed the pediatric residency program and served as assistant dean for graduate medical education at the University of New Mexico before moving to Oregon. He is a nationally recognized educator and expert in child passenger safety, and leader in the field of community health and advocacy training for pediatric residents. Within the American Academy of Pediatrics, Dr. Hoffman is a member of the Council on Injury, Violence, and Poison Prevention, as well as Associate Director of the Community Pediatrics Training Initiative. Follow him on Twitter @DrBenHoffman. ​

Last Updated

3/6/2020

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

How long should a child ride in a rear-facing car seat?

For safety reasons, it is best to keep your child facing backwards until they reach the maximum seat height or weight limit.

Many parents turn the seat face to face as soon as their child has celebrated their first birthday. But in 2011, the American Academy of Pediatrics (AAP) revised its policy, citing a study that found that children under 2 are 75% less likely to be killed or injured in a car crash if they are in a rear-facing car seat. nine0005

Both the AAP and the National Highway Traffic Safety Administration (NHTSA) now recommend keeping children in a rear-facing car seat until they outgrow it. This means that most children should remain in a rear-facing car seat until they are 4 years old.

Why the other side is better

Very young children are especially at risk for brain and spinal cord injuries because their bones and ligaments are still developing. Their heads are also proportionately larger than their necks, so the structural support system is still a bit wobbly. The rear-facing seats provide better support for your child's head, neck and spine, and also prevent the child's head from being ejected from their body in the event of a car accident. nine0005

When your child exceeds the height and weight limits of a rear-facing child seat, you must move them to a convertible seat with a higher height and weight limit. Most manufacturers make rear-facing seats that accommodate children over 40 pounds, allowing most children to use them up to age 4.

Is it safe to hold a child facing backwards if their legs seem too long?

Sitting in a rear-facing car seat, most babies have limited legroom. Their legs may even need to be bent or crossed to fit. nine0005

This may be of concern to some parents who are concerned that the child is uncomfortable. Or worse, the child's legs could be injured in an accident. But experts say it's not.

Rear-facing car seats are not only much more effective in preventing fatal injuries (and injuries that can permanently disable a child), but also protect your child's arms and legs much better.

“In a forward-facing car seat, during an accident, your child’s arms and legs will fly forward and are more likely to be injured,” says Ben Hoffman, nationally recognized trauma prevention specialist and pediatrician at Doernbecher Children’s Hospital, Oregon Health & Science University. “In a rear-facing car seat, there is less than a 1 in 10,000 chance of hand and foot injury in a crash.” nine0005

So this is still the safest position, even for children who look cramped in the rear-facing seat. As long as children are within the height and weight range for the seat, they are safe and likely to be quite comfortable.

Many rear-facing car seats now accommodate children weighing 40, 45 or even 50 pounds and up to 49 inches tall. (Many children exceed the height limit before the weight limit. ) Hoffman recommends keeping your child in the safest possible position for as long as possible, and moving on to the next step only when absolutely necessary. nine0005

Every year, AAP updates the car seat manual, which includes tips on how to install the car seat correctly. It also compares car seats by weight and height as well as price and lists the results.

Rear-facing child car seat: how long can you use it

Experts say it's best for your baby's safety to sit in a rear-facing car seat as long as the seat is suitable for their height and weight.

Many parents used to install a forward facing car seat as soon as the child was 1 year old. But in 2011, American experts revised their policy on this matter. Studies have shown that children under 2 years of age are 75% less likely to be killed or injured in car accidents if they are in a rear-facing seat. Therefore, it is now recommended for adults to transport the child facing the direction of the vehicle until he grows out of such a car seat. Most companies make rear-facing devices that are suitable for children even over 18 kg. This allows kids to safely ride in such a seat for at least 4 years. nine0005

Benefits of a rear-facing seat

Young children are particularly at risk for brain and spinal cord injuries because their bones and ligaments are still too fragile. Toddlers are not yet able to control head movements well due to the fact that it is proportionately larger than the neck. The rear-facing car seat secures the child's head in the event of an accident and also supports the child's neck and spine.

Once your little one is out of their first child seat, experts recommend buying a convertible model for their height and weight that can be rotated in the cabin for and against the vehicle. nine0005

Is it safe to carry a baby in a rear-facing car seat if his legs seem too long?

In a rear facing car seat, most children have limited leg room. The child may even have to keep the knees bent or crossed. Many parents worry about this - they worry that the baby is uncomfortable. Some adults even fear that the baby could injure his legs in the event of an accident. But experts say: don't worry! Not only do rear-facing car seats reduce the risk of serious or fatal injury, they say, but they also protect a child's arms and legs more effectively. nine0005

“In a car seat behind the movement of the car, during an accident, the baby's arms and legs are thrown forward with force, and they are more at risk of injury,” says American expert Ben Hoffman. “In a rear-facing seat, the chance of limb injury in a crash is less than 1 in 10,000.”

Therefore, the position of the body against the movement of the vehicle is the safest, even if the child looks too constrained. As long as the height and weight of the baby is within the normal range of a particular car seat model, it is considered reliable and quite comfortable. nine0005

Many rear-facing car units accommodate children weighing 18, 20 and even 22 kilograms and up to 125 cm tall.

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