Son's Pediatrician Misinformed on Extended Rear Facing

karcer

New member
I brought my son to his 2 year well child visit yesterday and his pediatrician told me I could turn his seat forward facing now. I said I planned to continue keeping him rear-facing and to buy a bigger seat to allow me to do that. She looked at me like I had three heads. She seemed to have the idea that it may be unsafe to do this, and she said she didn't think there are even any seats made that allow for RFing much past age 2. I had already researched seats and knew this was incorrect, but I was so taken aback I don't think I responded clearly. Then she wrote on his orders that I should turn his car seat forward facing!

I think this is a matter of her taking the AAP's new general recommendation of RFing until age 2 too literally. The recommendation is actually until AT LEAST age 2, and she seemed to have no understanding of that.

Can anyone share any good, concise info on the benefits of continuing to rear-face a child even AFTER age 2, and car seats that allow one to do that? When I googled for this, everything talks about UNTIL age 2. Because so many people are still flipping their kids right away at age 1 the information is mainly aimed at preventing that.
 
Last edited:
ADS

Stelvis

New member
The AAP actually does say that kids should turn FF at age 2. It's very clearly worded. I don't agree with it, but they were following the letter of the recommendations.
 

Brianna

New member
Yes, she was following the AAP recommendations. The NHTSA recommends rear facing through age 3 if the child still fits in their rear facing convertible seat. http://www.safercar.gov/parents/RightSeat.htm

There are several seats that will get most children past their 2nd birthday rear facing, but there will always be a few children that are off the charts and will outgrow seats sooner than average sized children.
A few seats off the top of my head: Graco MyRide 65, Graco Size4Me70, Evenflo Triumph, Evenflo Momentum, Maxi Cosi Pria, Safety 1st Complete Air, Diono Radian, Peg convertible, First Years True Fit and the Britax convertibles.
 

cantabdad

New member
Perhaps this has been re-hashed many times over in other discussions, but the new AAP guidelines do seem ambiguous in places. At one point it says that children "should continue to ride rear-facing ... for as long as possible" which is consistent with the NHTSA position and certainly seems to be the consensus view of most frequent contributors here on c-s.o.

However, another part of the document says, "All children 2 years or older, or those younger than 2 years who have outgrown the RF weight or height limit for their CSS, should use a forward-facing CSS." And likewise in the flow chart accompanying the text, for children 2+, there is no path to a recommendation for RF use.

Physicians are still accorded tremendous respect in the community and people give extra deference to the information they receive from their pediatrician. Keeping current with best practice is always a challenge and, unfortunately, this seems to be particularly the case for child passenger safety. Educating pediatricians may be one of the most effective things we could do to reduce the rates of CRS mis-use. I know I certainly plan to bring it up at our next checkup.
 

RubysGirl

New member
That sounds like our last visit! 'Cept I think he might have got it when I explained it to him.
He said he'd look up more about it as he'd never knew that it was okay to keep doing it as long as the kid fits, but it sounded like I knew what I was doing.
 

karcer

New member
The AAP actually does say that kids should turn FF at age 2. It's very clearly worded. I don't agree with it, but they were following the letter of the recommendations.

Yes, my ped seems to be very by the book when it comes to AAP recs. Does anyone have a link to the revised recommendation? I was not aware they say young children should be turned FFing at age 2. Everything I've read indicates the AAP says until age 2 OR the rear-facing limits of the seat. Does the AAP believe it isn't safe to continue RFing for longer? Is it a matter of disagreement on the evidence, or whoever wrote the rec just not knowing the evidence well enough?
 

Brianna

New member

karcer

New member
I am looking at the Marathon, which rear-faces to 40 lbs. My son is currently 30 lbs 11 oz (80th percentile), so above average, but growth rates typically slow between 2 and 3, and he's unlikely to gain more than 10 lbs before his 3rd birthday. I feel I should at least make this ped's office aware there are in fact seats that can rear face for longer.
 

karcer

New member
I don't see where the link you gave says they should be turned FFing at age 2, even if they still fit RFing. That seems to imply there would be some danger to continuing to RF beyond age 2 in a seat that allows it, and I'm not familiar with any evidence of that.
 

swtgi1982

New member
Yes, my ped seems to be very by the book when it comes to AAP recs. Does anyone have a link to the revised recommendation? I was not aware they say young children should be turned FFing at age 2. Everything I've read indicates the AAP says until age 2 OR the rear-facing limits of the seat. Does the AAP believe it isn't safe to continue RFing for longer? Is it a matter of disagreement on the evidence, or whoever wrote the rec just not knowing the evidence well enough?

Many pediatricians (Mine included) take the or to the limits of the seat part to mean if they max it out before 2yr old, not applied to the after 2yr old. And yes my Pediatrician said the same thing at my sons 2yr check last December.

Technically like others have said NHTSA says otherwise, thus including three year olds if they fit, they range FF for 4-8yrs of age in harness. I took this with me and informed them of this which they did not know and were shocked.
 

HEVY

New member
At least she will recommend babies be turned at two instead of one. Of course I am for the limit of the seat but a little progress is better than none ;)

One step at a time.
 
G

guest1

Guest
I'm glad your doctors are recommending 2!

When I took my daughter for her one year appointment my doctor said something along the lines of "go ahead and put her car seat forward facing now if you haven't already."
 

sparkle3116

New member
My husband is in his last year of medical school and I am appalled at what he has NOT learned...not a single nutrition class...I could go on, but he's not going into peds, so :rolleyes:

Much of what pediatricians learn is through their years spent in residency...and a lot of that knowledge is passed down from the current generation of pediatricians, so new conventions (such as rear-facing beyond one year) can be slow to gain acceptance.

Perhaps you can bring your pediatrician some articles from peer-reviewed journals to explain why you are rear-facing your child? Obviously it will depend on your pediatrician whether this will go over well, but here are a couple of articles I pulled up quickly:

http://injuryprevention.bmj.com/content/13/6/398.abstract

http://www.ncbi.nlm.nih.gov/pubmed/18184491

I'm sure members who are more familiar with the literature can provide other sources.
 

karcer

New member
Many pediatricians (Mine included) take the or to the limits of the seat part to mean if they max it out before 2yr old, not applied to the after 2yr old. And yes my Pediatrician said the same thing at my sons 2yr check last December.

Technically like others have said NHTSA says otherwise, thus including three year olds if they fit, they range FF for 4-8yrs of age in harness. I took this with me and informed them of this which they did not know and were shocked.

Right. That's exactly what was happening. She thought I was talking about keeping him rear-facing in his current seat longer than it would be safe (even though he has another inch to go before his head is within an inch from the top of his current seat). Then when I said I planned to buy another seat to allow him to safely rear-face even longer, she did not seem to believe there are seats that can do this.

Yes, it's great as someone pointed out that more peds are now pushing the AAPs until age 2 recommendation, but if the recs are vague and misleading, it sounds like they need to be revised yet again. Pediatricians should know it is not only possible but safer to rear-face for longer if one has a seat that allows it.
 

ketchupqueen

CPST and ketchup snob
Staff member
Right. That's exactly what was happening. She thought I was talking about keeping him rear-facing in his current seat longer than it would be safe (even though he has another inch to go before his head is within an inch from the top of his current seat). Then when I said I planned to buy another seat to allow him to safely rear-face even longer, she did not seem to believe there are seats that can do this.

Yes, it's great as someone pointed out that more peds are now pushing the AAPs until age 2 recommendation, but if the recs are vague and misleading, it sounds like they need to be revised yet again. Pediatricians should know it is not only possible but safer to rear-face for longer if one has a seat that allows it.

I have it on fairly reliable authority that the wording and until 2 were actually a compromise. There were elements that very strongly objected to changing the minimum recommendation from 1 and this is the way they got 2 passed. :rolleyes: So, I think it will take quite a while before it changes again.
 

~*Jen*~

New member
When I took my LO in for her 2yr checkup last week, the cute little first-year resident said, "Okay, go ahead and turn her. Rear-facing isn't any safer than forward-facing."

Hmm...

And this is probably one of the largest pediatric practices in the state and my daughter is *barely* tall enough to meet the minimum requirements to face forward in Dorel seats and is supposedly in the 75th percentile for height so a LOT of kids wouldn't meet the height requirements at this age. That kind of blanket statement rubbed me the wrong way because not only does it not encourage best practice but could potentially promote BAD practices because a lot of people listen to their doctors and are not aware of the seat's requirements.

Needless to say, my LO is still RF.
 

BananaBoat

Well-known member
Unfortunately, I think peds are more concerned with preventing illness than accidents.

Our ped stopped mentioning car seats altogether when I told her my (then) 3 year old was still RF. She said "well, you can turn her now." My reply was "why would I if it's safer RF & she fits fine?" She knows I'm up on my car seat safety & doesn't even ask anymore.
 

VoodooChile

New member
Unfortunately, I think peds are more concerned with preventing illness than accidents.

Our ped stopped mentioning car seats altogether when I told her my (then) 3 year old was still RF. She said "well, you can turn her now." My reply was "why would I if it's safer RF & she fits fine?" She knows I'm up on my car seat safety & doesn't even ask anymore.

Mine said the same "You can turn him now." I know I "can", I just didn't want to. I remember starting a thread about this, and vaguely wondering if he thought I was stuffing a tall 2.5 year old into an infant carrier.
 

Car-Seat.Org Facebook Group

Forum statistics

Threads
219,654
Messages
2,196,889
Members
13,530
Latest member
onehitko860

You must read your carseat and vehicle owner’s manual and understand any relevant state laws. These are the rules you must follow to restrain your children safely. All opinions at Car-Seat.Org are those of the individual author for informational purposes only, and do not necessarily reflect any policy or position of Carseat Media LLC. Car-Seat.Org makes no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis. If you are unsure about information provided to you, please visit a local certified technician. Before posting or using our website you must read and agree to our TERMS.

Graco is a Proud Sponsor of Car-Seat.Org! Britax is a Proud Sponsor of Car-Seat.Org! Nuna Baby is a Proud Sponsor of Car-Seat.Org!

Please  Support Car-Seat.Org  with your purchases of infant, convertible, combination and boosters seats from our premier sponsors above.
Shop travel systems, strollers and baby gear from Britax, Chicco, Clek, Combi, Evenflo, First Years, Graco, Maxi-Cosi, Nuna, Safety 1st, Diono & more! ©2001-2022 Carseat Media LLC

Top