By AP Medical Writer
updated 3/21/2011 7:37:09 PM ET 2011-03-21T23:37:09

Children should ride in rear-facing car seats longer, until they are 2 years old instead of 1, according to updated advice from a medical group and a federal agency.

The American Academy of Pediatrics and the National Highway Traffic Safety Administration issued separate but consistent new recommendations Monday.

Both organizations say older children who've outgrown front-facing car seats should ride in booster seats until the lap-shoulder belt fits them. Booster seats help position adult seat belts properly on children's smaller frames. Children usually can graduate from a booster seat when their height reaches 4 feet 9 inches.

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Children younger than 13 should ride in the back seat, the guidelines from both groups say.

The advice may seem extreme to some parents, who may imagine trouble convincing older elementary school kids — as old as 12 — to use booster seats.

But it's based on evidence from crashes. For older children, poorly fitting seat belts can cause abdominal and spine injuries in a crash.

One-year-olds are five times less likely to be injured in a crash if they are in a rear-facing car seat than a forward-facing seat, according to a 2007 analysis of five years of U.S. crash data.

Put another way, an estimated 1,000 children injured in forward-facing seats over 15 years might not have been hurt if they had been in a car seat facing the back, said Dr. Dennis Durbin, lead author of the recommendations and a pediatric emergency physician at Children's Hospital of Philadelphia.

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Toddlers have relatively large heads and small necks. In a front-facing car seat, the force of a crash can jerk the child's head causing spinal cord injuries.

Car seats have recommended weights printed on them. If a 1-year-old outweighs the recommendation of an infant seat, parents should switch to a different rear-facing car seat that accommodates the heavier weight until they turn 2, the pediatricians group says.

Discuss: Will you put your tween in a booster seat?

Luckily for parents, most car seat makers have increased the amount of weight the seats can hold. This year, about half of infant rear-facing seats accommodate up to 30 pounds, Durbin said. Ten years ago, rear-facing car seats topped out at children weighing 22 pounds.

"The good news is it's likely parents currently have a car seat that will accommodate the change," Durbin said.

The American Academy of Pediatrics recommendations appear Monday in the journal Pediatrics.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: New safety guidelines for kids in car seats

  1. Closed captioning of: New safety guidelines for kids in car seats

    >>> back now at 7:43 with new car seat recommendations for parents of young children. the american academy of pediatrics has revised the guidelines and you need to listen up. dr. levine is the spokesperson for the aap and from baby.com. nice to see you. we have three different kinds -- infant, convertible and booster seats. we start with the infant seats. any major changes here?

    >> no. the important thing to know is the infant cease is always rear facing. you never want your baby facing forward in this suit. from the moment you bring them home from the hospital they need to face backwards in the seat.

    >> generally speaking how long does a baby stay in an infant seat before moving on to the next seat, the convertible seat?

    >> babies can sit in the infant seat until they reach the limit of the car seat which is easily seen. this one says 5 to 35 pounds up to 32 inches. check with the specific car seat you have.

    >> then you will move your infant into a convertible seat and always at the beginning these are to face the rear.

    >> exactly. this probably represents the biggest change in the words of the policy. you want this seat to be rear facing until your child is 2 years old, within the limit of the seat.

    >> let's talk about what parents do now. at about a year it's almost a rite of passage . parents say the baby is a year old. we are going to turn the seat front-facing. that's no longer acceptable under the guidelines.

    >> exactly right. a lot of parents will say, well, my child has long legs but it's more important to keep their head, neck and back safe. children are comfortable knees bent. so keep it rear facing.

    >> a lot of parents switch them at a year because they want to look in the mirror and see the face of my baby. rear-facing i don't know what's going on.

    >> that's true. but safety is our number one priority. children are definitely safest rear facing.

    >> always rear facing until 2 years of age.

    >> as long as you are within the limits of the seat.

    >> also look at the height and weight requirements of a seat like this before deciding when to move into a booster seat.

    >> exactly. once you reach the limit of the seat then you can move your child into a booster seat.

    >> okay. when we talk about booster seats we are going to talk about probably the most important second guideline change. what is that?

    >> now the recommendation is to keep your child in a booster seat until your child is 4'9" which is roughly between 8 and 12 years of age. the reason is because the purpose of the booster seat is to make sure the car seat belt hits them in the right place.

    >> right. if the child is too small and you put them in a regular seat with a regular seat belt the seat belt rides up around the neck.

    >> it will be up around the neck. it will be uncomfortable for children. they will take the shoulder belt off which you don't want them to do. you want them to sit all the way back in the car, knees bent over the edge of the seat and the seat belt needs to go across the middle of the chest and the thighs.

    >> it's the combination of age and height. parents who say, wait, my child is 8, out of the booster seat he or she comes. no. only 4'9".

    >> you really want to be 4'4'9".

    >> and settle an argument. at what age should children be allowed to sit in the front seat of the car.

    >> children need to be in the rear of the car until they are 13.

    >> okay.

    >> i'm not making friends today.

    >> not at my house, but that's okay. it's important. we

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