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Madonna Rehabilitation Hospitals

Madonna expert explains new rear-facing car safety seat recommendations

September 17, 2018

Physical Therapist Kirsten Demmel, of Madonna Rehabilitation Hospitals—Omaha Campus, helps explain some new guidelines from one of the nation’s largest medical associations and a new law in the state of Nebraska regarding car seats.

The American Academy of Pediatrics recently revised their recommendations to state that children should be rear-facing until they reach the upper height and weight requirements of their car seat manufacturer’s instructions. This update removes a previous recommendation that children could be safely moved forward facing once they reached the age of 2.

“Fortunately, car seat manufacturers have created seats that allow children to remain rear-facing until they weigh 40 pounds or more, which means most children can remain rear-facing past their second birthday,” said Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention. “It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride.”

In Nebraska, a new law goes into effect January 1, 2019, requiring children to be at least 2 years of age or reach the upper height and weight requirements of their car seats before they’re turned around to forward facing. Older children will also be required to ride in an appropriate seat, such as a booster, until they are 8. Children aged 8-18 are also required to be in an age-appropriate restraint, such as a safety belt.  

Kirsten Demmel, PT, one of Madonna’s 15 certified Child Passenger Safety Technicians, is encouraged by new guidelines and laws. She and her fellow CPSTs have undergone at least a two-day training to familiarize themselves with various car seat models, best practices for use and proper installations in order to provide counseling and education for parents and the community. Madonna clinicians have unique perspective on the importance of car seat safety, often providing therapeutic services for patients who have suffered traumatic brain injury and spinal cord injuries as a result of motor vehicle accidents.

“I take car seat passenger safety very seriously. I have two kids of my own who are still young. I would empower kids to know what keeps them safe.” said Demmel.

She details that one of the obstacles to proper car seat use is simple complacency and parents being in a hurry. Car seat usage should not be a “set it and forget it” operation.

“I think as a parent we get our car seat set, we put them in the car and we’re like they’re good to go and we just don’t think about them much.”, Demmel says, “Just get out there and just periodically check to make sure those seatbelts haven’t loosened, somebody hasn’t unbuckled the seat belt because that’s the thing that can happen.”

Another reason parents are sometimes hesitant to follow guidelines is that they are concerned about their child being uncomfortable rear facing as they grow taller, or that their legs may be at increased risk of injury in the event of an accident.

“When your kid is rear-facing, you can see that their feet may crisscross and then I hear parents tell me they’re going to be uncomfortable or their legs are going to be squished or maybe their legs are going to be injured.”, said Demmel. “There is no evidence to support that there is more risk of injury to their legs. Even if that happens it’s really important that we’re protecting the most vulnerable parts of their bodies.”

Another common misconception is that moving into another car seat is a child development milestone, not unlike learning to crawl or starting preschool. However, Demmel says it may not be a positive milestone, as the progression from rear-facing to forward-facing, then convertible seat, high-back booster and backless booster, only reduces the amount of protection the child receives.

“Car crashes remain a leading cause of death for children. Over the last 10 years, 4 children under 14 and younger died each day. We hope that by helping parents and caregivers use the right car safety seat for each and every ride that we can better protect kids, and prevent tragedies,” said Dr. Hoffman of the AAP.

At Madonna, we remain committed to our core value of Teaching, helping parents to understand the importance of proper car seat usage to prevent injuries and keep children safe. To learn more about the unique services we offer pediatric patients, visit