The American Academy of Pediatrics recommends rear facing until a minimum of age two, based in part on findings published by BMJ Injury Prevention. Decades of data from Sweden also support this recommendation: "children have ridden in rear-facing seats up to 4 years of age for many years, and very low death and injury rates have been documented" (Bull & Durbin, 2008) .
At age three there is still only a 50% probability that the C3 vertebra has finished ossification. The older a child gets, the more time their spinal column has to strengthen. Most car seats on the market will rear face even above average height and weight kids until 3-4 years of age. Without a CT scan, there is no way to know what stage of development a child's spinal column is in, so the safest option is to rear face to the maximum weight or height of a convertible car seat. As time goes on and more older children are rear facing, there will be more scientific data to compare the benefits of a rear facing car seat for preventing spinal injury.
Quantitative Analyses of Pediatric Cervical Spine Ossification Patterns Using Computed Tomography
PhD Narayan Yoganandan, PhD Narayan Yoganandan, PhD Frank A Pintar, MD Sean M Lew, MD Raj D Rao, PhD Nagarajan Rangarajan
Rear-Facing Car Safety Seats: Getting the Message Right
M J Bull, D R Durbin
Traumatic Fracture of the Pediatric Cervical Spine: Etiology, Epidemiology, Concurrent Injuries, and an Analysis of Perioperative Outcomes Using the Kids' Inpatient Database
BA Gregory W Poorman, BS Frank A Segreto, Bryan M Beaubrun, Cyrus M Jalai, BA Samantha R Horn, Cole A Bortz, MD Bassel G Diebo, MD Shaleen Vira, BA Olivia J Bono, Rafael De La Garza-Ramos, BS John Y Moon, MD Charles Wang, MD Brandon P Hirsch, Jared C Tishelman, BA Peter L Zhou, MD Michael Gerling, MD Peter G Passias
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Car Seats for the Littles