Boogers & Bows

The AAP (American Academy of Pediatrics) updated their recommendations in April to state that children should ride rear-facing until 2-years-old (or until they reach the maximum height and weight for their seat), and remain in a booster seat until the age of 8.
Alisa Baer, M.D., also known as “The Car Seat Lady,” explains the new recommendations in the following video, and why it’s so important to follow them. Dr. Baer also took the time to talk to us about the Top 5 Myths associated with rear-facing car seats in the article, below.

Top 5 Myths about Rear-Facing

Myth #1: My baby’s legs are too long for rear-facing – he’s uncomfortable & if we’re in a crash he’ll break his legs!
Fact: Rear-facing kids can ride safely and comfortably with limited room for their legs.

Your 6-month-old happily sucks his toes, your 18-month-old plays happily sitting on the floor with his legs in a “W”, but you, however, couldn’t even imagine getting your legs into either of these positions (let alone doing it comfortably), even if you are a yoga master! Having installed rear-facing car seats for many 3 & 4 year-olds I can tell you from experience that these older kids, who have far less leg room than your 18-month-old does, do not complain of their legs hurting. Still not convinced? Ever watch a 5 year old sleep in the car with his chin down on his chest and wake up several hours later without a care in the world? If you did this, you wouldn’t move your neck for a week! Kids are more flexible than we are because their joint spaces are not fully formed.

What about a broken leg? Surprisingly, studies show that forward-facing kids break their legs more often in crashes than rear-facing kids. A broken leg, however, is easy to fix; brain and spinal cord injuries are typically unfixable. Rear-facing virtually eliminates any chance of your child suffering a brain or spinal cord injury.

Myth #2: My 14-month-old hates riding rear-facing – and wants to ride forward facing
Fact: Your 14-month-old hates being strapped down – she doesn’t care about the direction she is facing

As a pediatrician, I can tell you that it is not developmentally appropriate for your 14-month-old to be happy about being strapped down. She is curious, newly mobile (crawling, cruising, walking) and wants to explore her world; car seat straps take away her independence and she is likely to protest. Like other phases (remember how much fun colic was) she will outgrow this also. In my experience helping families over the past 14 years, I find that the age of hating the car seat is worst from 12-15 months of age, and gets a lot better by 18 months of age.

If your 14-month-old found a book of matches and wanted to play with them, you wouldn’t let her no matter how much she tantrumed because you knew that the risks were too great. So too with the car seat; riding forward facing is 5 times more dangerous than riding rear-facing, and increases her chance of injuries we don’t know how to fix, namely those to the brain and spinal cord.

Myth #3: My baby gets motion sick riding rear-facing and needs to turn forward-facing
Fact: Forward-facing kids get motion sick just as often as rear-facing kids

Motion sickness happens when the brain gets mixed messages about motion and can’t reconcile them – your body feels stationary as you sit in the car but your eyes tell your brain that your body is actually moving. When the brain can’t figure out how to make sense of these seemingly contradictory messages, the body feels sick. Volvo did a large survey of several thousand toddlers and found no difference in the rates of motion sickness between those riding rear-facing and those forward-facing. But statistics don’t help when it is your child who is throwing up! Here are some suggestions.

The most important thing is to make sure your child has the best view possible out the BACK window. Kids and adults who get motion sick will tell you that looking out the side windows is a quick and easy way to feel very sick, very fast because things move very quickly out the side windows – which confuses the brain even more. Looking out the back window (for rear-facing kids) or the front window (for forward-facing kids or adults) makes it seem like you are moving slower than the side windows make it seem. For rear-facing kids, sit their car seat as upright as the manufacturer allows and, when possible, remove the vehicle’s head rest to give the child the best possible view out the back window. If possible, have the child ride in the center of the back seat as this spot typically gives the best view out the back window. You may want to consider trying to block your child’s view out the side windows – since you can’t really tell a 2-year-old not to look out the side window! This sunshade will do just that.

Make sure you aren’t inadvertently making your child feel sick – if you are giving him toys or books that require looking down and concentrating, this will likely make him feel sick. Try occupying your child with songs and games that require looking out the window. If you can, travel at naptime or bedtime as your child will not feel sick while sleeping.

Many parents use food as an activity during long car rides – but for a child who gets motion sick, this will only make matters worse. Feed your child something starchy like bagel or crackers about 1-2 hours before the car ride – and then try to not feed him in the car.

If you have to take a long trip, talk to your pediatrician about using an anti-nausea medication. You can also try some natural, homeopathic remedies including accupressure wrist bands (but make sure the one you get is not a choking hazard for a young child!) and ginger.

Some kids are going to get motion sick regardless of the direction they are facing – and the worst part, besides watching your child feel ill, is having to clean the car seat when it is full of vomit. To decrease the clean-up, have your child wear a “puking poncho” – this way their clothes and the car seat stay clean, and all you have to wash is the poncho. Here are two different examples of products that can work well as “puking ponchos” (I’m sure my mother wished she had these when I was a kid!)

- Bibbitec
- Terry Cloth Cape (wear it in front, instead of in back)
- The Car Seat Poncho (for winter time)
- FlipOverMe Poncho (for winter time)

Myth #4: My 20-month-old is in the 95th% – he’s too big for rear-facing!
Fact: Nearly every convertible car seat (including the inexpensive ones) can accommodate even very big toddlers rear-facing until at least the age of 2.

One of the key reasons that the American Academy of Pediatrics chose the age of 2 for their recommended minimum age to go forward facing is that the 95th% 24-month-old weighs 35 pounds – and since nearly every convertible seat goes rear-facing until at least 35 pounds, every parent can follow the new recommendations and keep their child rear-facing until at 2.

When we talk about older kids riding rear-facing, we are talking about in a convertible seat – the one that starts rear-facing and then goes forward facing – not in an infant seat. While many infant seats now have weight limits as high as 35 pounds, we are not suggesting that your toddler ride in an infant seat as even if they are within the height requirements they are almost certainly too tall (their head is closer than 1 inch from the top of the seat) and definitely don’t like riding as reclined as they are forced to in the infant seat.

Myth #5: But my pediatrician said it is OK for my under-2-year-old to ride forward-facing, therefore it must be safe
Fact: The American Academy of Pediatrics recommends that ALL kids stay rear-facing until at least age 2 – and ideally longer, until reaching the maximum height or weight for rear-facing in their convertible seat

As a pediatrician myself, I can tell you that it is humanly impossible for us to stay current on all the topics we are required to know. Not only that, but many pediatricians never received ANY training on car seat safety either in medical school or residency. Here are the links to several medical journal articles on the topic of older kids riding rear-facing – so you can read the evidence for yourself.