Why Your Kid Should Be In A Rear-Facing Car Seat As Long As Possible

by Alisa Baer, MD & CPSTI
Originally Published: 
Three kids, two girls and a little boy sitting next to each other in their car seats.
Car Seat Lady

Got a toddler and confused about the whole rear-facing vs forward-facing thing? How long should you do it? Is it really safer? What about their legs? But my kid is off the charts! And my kid pukes! And I certainly don’t have $500 to spend on a car seat for every car!

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Here’s what the experts say: The American Academy of Pediatrics recommends that kids ride rear-facing in their convertible car seat (not the infant seat) until they reach that seat’s maximum rear-facing weight or height, whichever comes first.

What’s that? Rear-facing until their middle school prom?

First, let’s define a convertible seat. Convertibles are seats that convert from rear-facing to forward facing. They are NOT the infant seat with the handle that you carried your baby in out of the hospital.

Second, no one is asking you to buy a new seat. The experts are recommending that you use the convertible seat you almost certainly already have rear-facing (RF) until your preschooler reaches the max rear-facing height or weight before turning it forward. For most kids, this means rear-facing until around 4 years old.

Max RF Height: For most seats, the RF child’s head must be at least 1 inch below the top of the seat — so that as a RF child slides up their car seat their head stays within the protective shell. Convertibles with taller seated heights will last longer RF. Legs that are bent, or feet that touch the vehicle seat, are NOT an indication that the child is too big for rear-facing… more on that below.

Max RF Weight: Typically 40-50 pounds for seats sold now. Any seat new enough to still be used will go to at least 30+ pounds rear-facing. 95th% boy is 40lbs at 3.5 years old.

Pro Tip: Convertible seats almost always have different height and weight limits for rear-facing than they do for forward-facing, so check your seat’s labels and instructions carefully!

Is rear-facing really safer?

Car crashes are the leading cause of preventable injury and death to kids of all ages in the US. Rear-facing is the safest way to ride (yes, its safe in a rear-end crash too!) — see “what’s the evidence” references at end of this article.

Instead of having your head pull violently away from your chest, as happens when you are forward-facing in a frontal crash, the rear-facing child is cradled in their seat with very little movement of the head and neck. Younger kids are most at risk riding forward-facing — where the head pulls forcibly on the neck, which can cause the spinal cord to stretch so far that it breaks — because younger kids have heavier heads in proportion to the rest of their body and stretchier neck bones (muscles strength doesn’t matter here) compared to older kids & adults.

Keeping toddlers and preschoolers rear-facing is our best way of preventing healthy kids from getting injured.

What about their legs?

Safety: In a frontal crash, a rear-facing child tucks into a cannonball position, meaning that their legs become super scrunched in the moment of the crash – and this does not cause injury. Studies show that forward-facing kids suffer many more leg injuries than rear-facing kids. The leg injuries to forward-facing children occur because the legs fly up and hit the back of the front seat and as the child + car seat all move forward with the force of the crash there is tremendous pressure into the leg bones and the bones break.

Serious question: Can you put your toe in your mouth? Betcha you couldn’t even if your life depended on it. Can your preschooler put his toe in his mouth? Most certainly yes (see hilarious picture from last weekend as evidence).

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Comfort: A newborn’s body is the most flexible it will ever be; as we age our joints develop, our ligaments get tighter, and we become stiffer. Your child’s body can move in ways that yours can’t, so it makes sense why your preschooler can sit comfortably rear-facing with their legs in positions that you couldn’t even fathom imitating. Whatever your rear-facing child wants to do with their legs is perfectly fine; most kids will sit frog-legged.

Unexpected Twist: Ever notice how forward-facing kids are constantly kicking the front seat? It’s for the same reason that you squirm when sitting on a bar stool that has no foot rest! It is not comfortable for kids or adults to sit with their feet dangling. Ironically, the rear-facing child’s feet touching the back of the vehicle seat — what parents often perceive as the child looking scrunched — is actually making the child more comfortable!

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But my kid is off the charts!

Whatever your budget, you can keep even an “off the charts” kid rear-facing until at least 2 as even the least expensive convertible seats (~$40) go rear-facing to 40 pounds and have sufficient seated heights to fit kids rear-facing until at least 2. While many seats suggest that they fit big kids rear-facing, some offer more room for the child’s legs and torso than others — see here for advice on picking a seat to keep a big kid rear-facing as long as possible.

But my kid pukes!

They’ll most likely get motion sick forward facing too. Many adults get motion sick in cars… and all of them are forward facing. See here for more on motion sickness, why it happens, ways to try and prevent it, and ways to minimize the mess when they do vomit.

I don’t have $500 to spend on a car seat!

You don’t need to spend $500 to keep a big kid rear-facing. The Graco Extend2Fit will fit even the tallest kids rear-facing until 50 pounds and is often on sale for under $150. If space is at a premium (you’re trying to do 2-together or 3-across) you may need to spend more as the narrower seats tend to be more expensive (but not every expensive seat is narrow).

My kid will be bored riding rear-facing — they want to see what’s going on!

Of course they want to see what is going on — and rear-facing kids can see just as much (if not more) than their forward facing peers… albeit they’re seeing where they’ve been instead of where they’re going but they won’t know or care!

Once your child can sit upright unsupported, many convertible car seats allow you to sit the child more upright — which will give them a better view out the back and side windows. If the vehicle head restraint is removable where your kid is sitting, you can consider taking it out to give the child a better view (leave it in if you are packing stuff up high in the cargo area behind the child — it may help keep the stuff from flying into the child).

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My convertible seat only goes to 20 pounds rear-facing!

The government requires this confusing sentence on the label of every convertible car seat: “Use only in a rear-facing position when using it with an infant weighing less than 20 lbs.” It’s trying to say that for kids under 20 pounds that forward-facing is not an option — rather, the seat must be rear-facing. However, many people read the sentence and think that after 20 pounds the car seat must go forward-facing, which is NOT the case. It can — and should — be used rear-facing until the limit, which is 30-50 pounds depending on the seat.

What’s the law?

The laws of physics don’t care about the laws of the state… but with that said, it is now law in 12 states that children ride rear-facing until at least age 2.

– California

– Connecticut

– Illinois

– Nebraska

– New Jersey

– New York [effective 11/01/2019]

– Oklahoma

– Oregon

– Pennsylvania

– Rhode Island

– South Carolina

– Virginia [effective 07/01/2019]

What’s the evidence?

It is critically important to understand that the recommendation to keep children rear-facing as long as possible is not based on a single study, but rather on a broad body of research from the US and Sweden.

1. Sherwood CP, Crandall JR. Frontal sled tests comparing rear and forward facing child restraints with 1-3 year old dummies. Annual Proceedings of the Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine, 2007,51: 169-80.

2. Planath I, Rygaard C, Nilsson S. Synthesis of data towards neck protection criteria for children. Proceedings of the 1992 International IRCOBI Conference on the Biomechanics of Impacts. Verona, Italy:155-66.

3. Kamren B, Koch M, Kullgren A, et al. The protective effects of rearward facing CRS: an overview of possibilities and problems associated with child restraints for children aged 0-3 years. Child Occupant Protection Symposium: SAE International, 1993.

4. Klinich KD, Manary MA, Weber KB. Crash protection for child passengers: rationale for best practice. UMTRI Res Rev2012;43:1-35.

5. Isaksson-Hellman I, Jakobsson L, Gustafsson C, et al. Trends and effects of child restraint systems based on Volvo’s Swedish accident database.41st Stapp Car Crash Conference: SAE International, 1997.

6. Jakobsson L, Isaksson-Hellman I, Lundell B. Safety for the growing child: experiences from Swedish accident data. Proceedings of the 17th ESV Conference, 2005.

7. American Academy of Pediatrics, Committee on Injury, Violence & Poison Prevention. Child Passenger Safety. Pediatrics. 2018; 127: 788-793.

8. Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annual Proceedings Association for the Advancement of Automotive Medicine. 2002; 46: 213-30.

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