From the Guidelines
Switching a 21-month-old child from a rear-facing to a front-facing car seat increases the risk of injury by approximately 5 times (or 500%). Children should remain in rear-facing car seats until at least age 2, preferably longer if they haven't exceeded the height and weight limits of their rear-facing seat. This recommendation exists because rear-facing seats provide crucial support to a young child's head, neck, and spine during a crash, as noted in the Pediatrics journal 1. When a collision occurs, the forces are distributed across the car seat's back rather than concentrated on the child's vulnerable neck and spinal cord. A 21-month-old child still has developing neck muscles and a relatively large head compared to their body, making them particularly susceptible to serious injuries in forward-facing positions during sudden stops or crashes.
The American Academy of Pediatrics (AAP) recommends that all infants and toddlers should ride in a rear-facing car safety seat (CSS) as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer, as stated in 1. The AAP also emphasizes the importance of delaying transitions to less protective seats for as long as possible, as each transition is associated with some decrease in protection 1.
Key points to consider:
- Rear-facing seats provide optimal support to the head and spine in the event of a crash
- Children should remain in rear-facing car seats until at least age 2, or longer if they haven't exceeded the height and weight limits of their rear-facing seat
- The 5-fold increase in injury risk is substantial and preventable simply by maintaining the rear-facing position for a few more months until the child is developmentally ready for the transition
- Parents should be encouraged to delay transitions to less protective seats for as long as possible, as recommended by the AAP 1.
From the Research
Risk of Injury from Front-Facing Car Seats
- There are no research papers provided to assist in answering this question about the increased risk of injury to a 21-month-old child when switching to a front-facing car seat.
- The available studies 2, 3, 4 do not address the topic of car seat safety or the risk of injury associated with front-facing car seats for children of this age group.
- These studies focus on different topics, including obesity treatment 2, COVID-19 drug treatments 3, and the metabolomic effects of COVID-19 vaccination on leukemic hematopoiesis 4.