by Aimee Keenan-Greene

Auto fatalities are the leading cause of death for children ages 4 and older. More than 5,000 people under 21 are killed annually.

It is not enough to merely buckle up for safety anymore, now The American Academy of Pediatrics (AAP) says kids should remain buckled rear-facing longer.

The new policy recommendation appears in the latest April 2011 issue of Pediatrics, published online today.

The AAP says toddlers are safer in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat.

Since 2002 the AAP had been advising infants ride rear-facing until 12 months of age and 20 pounds. But many parents turned the seat to face front when the child celebrated their first birthday.

“Parents often look forward to transitioning from one stage to the next, but these transitions should generally be delayed until they’re necessary, when the child fully outgrows the limits for his or her current stage,” said Dennis Durbin, MD, FAAP, lead author of the new policy.

A 2007 study in the journal Injury Prevention showed children under age 2 are 75 percent less likely to die or be severely injured in a crash if they are riding rear-facing.

“The ‘age 2’ recommendation is not a deadline, but rather a guideline to help parents decide when to make the transition,” Dr. Durbin said. “Smaller children will benefit from remaining rear-facing longer, while other children may reach the maximum height or weight before 2 years of age.”

The AAP also now advises children ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall usually between the ages of 8 and 12.

“A rear-facing child safety seat does a better job of supporting the head, neck and spine of infants and toddlers in a crash, because it distributes the force of the collision over the entire body,” Dr. Durbin said. “For larger children, a forward-facing seat with a harness is safer than a booster, and a belt-positioning booster seat provides better protection than a seat belt alone until the seat belt fits correctly.”

Children should transition from a rear-facing seat to a forward-facing seat with a harness, until they reach the maximum weight or height for that seat. 

A booster will make sure the vehicle’s lap-and-shoulder belt fit properly. The shoulder belt should lie across the middle of the chest and shoulder, not near the neck or face. 

The lap belt should fit low and snug on the hips and upper thighs, not across the belly. 

Motor vehicle crashes involving children under age 16 has dropped 45 percent between 1997 and 2009.

For every death, approximately 18 children are hospitalized.  More than 400 are injured seriously and require medical treatment.

Also very important, children should ride in the backseat until they are 13 years old because of the dangers of airbags.

And if you are flying with your child, the Federal Aviation Administration permits children under age 2 to ride on an adult’s lap on an airplane, however the AAP says they are best protected by riding in an age- and size-appropriate restraint.

“Children should ride properly restrained on every trip in every type of transportation, on the road or in the air,” Dr. Durbin added.

A complete car seat guide for children can be found on  www.healthychildren.org/carseatguide