SAN DIEGO – Three years after the American Academy of Pediatrics recommended that children ride in rear-facing car seats until 2 years of age, almost 90% of pediatricians in Michigan were in compliance, an electronic survey found.
The study, the first of its type in Michigan, highlights “effective messaging, dissemination, and uptake of AAP guidelines,” reported lead researcher Dr. Sneha Rao of Hurley Medical Center, Flint, Mich., and her associates.
Dr. Sneha Rao
In 2011, the AAP upped its age recommendation for use of rear-facing car seats from 12 months (or 20 pounds of body weight) to 2 years of age (Pediatrics 2011;127:788-93), Dr. Rao noted. “Scientifically, the reason for the change is the reduction in impact,” she said in an interview at the annual meeting of the AAP. “It’s easier to treat a broken leg than a broken neck.”
Research shows rear-facing car seats are safer than front-facing seats for young children, including in side-on collisions. In one study, children under 24 months old who were seriously injured in side-on crashes were five times more likely to have been in a front-facing than a rear-facing seat (odds ratio, 5.53; 95% confidence interval, 3.74-8.18) (Inj. Prev. 2007;13:398-402). Side-on collisions often have a frontal component, which causes the child’s head to move further into the seat if rear facing, but away from the seat if front facing, the researchers said.Michigan and many other states also recommend or require that children ride in rear-facing safety seats until about age 2 years. But parents do not necessarily follow the recommendation, studies indicate. Earlier this year, authors of a direct-observation study carried out in Indiana reported that only about 60% of infants and toddlers up to 2 years old rode in rear-facing seats (Inj. Prev. 2014;20:226-31). And in Michigan, another direct-observation study found that 20%-25% of children were riding in a type of seat meant for an older child. Dr. Rao and associates found that only 39% of clinicians thought it was “very effective” to counsel parents of young children about automobile safety, although 73%-82% reported “always” doing so with newborns up to age 2 years, the researchers reported.
For their study, Dr. Rao and her associates sent an electronic survey to all pediatric care providers listed in the directory of the Michigan chapter of the AAP. The 146 respondents included pediatricians and generalists who mostly worked in outpatient settings, the investigators reported. More than 95% of physicians surveyed said they discussed automobile safety with parents of infants and toddlers, Dr. Rao and associates reported. Among 134 respondents to the question about rear-facing seats, 89.6% said they counseled parents to keep children in rear-facing seats until at least 2 years of age, the researchers found.
The AAP guidelines call for 2-year-olds to switch to a front-facing safety seat in the back seat. From ages 4-8 years, they are to use a booster seat and a safety belt. Older children should use lap and shoulder belts and should not ride in the front seat until at least age 13 years, the guidelines state.
The survey’s response rate was only 20%, and questions were not worded so that age categories were necessarily interpreted as mutually exclusive, Dr. Rao acknowledged. She reported no external funding sources of conflicts of interest.