For many parents, their child's first birthday is about more than a cake and a party. It's commonly the moment they replace a rear-facing infant car seat with a more "grown-up" forward-facing seat.
Now, in a move that may be repeated by their Canadian counterparts, an influential group of U.S. pediatricians is calling for parents to keep their toddlers in rear-facing car seats a year longer, until the age of 2 - or until they reach the maximum height and weight according to the manufacturer's instructions.
The American Academy of Pediatrics also advises that most older children will need to ride in a booster seat longer - until they are between 8 and 12.
Sherbrooke pediatrician Claude Cyr says the philosophy behind the current Canadian Paediatric Society guidelines is similar to the new AAP policy. But the Canadian version still includes a mention of the age of 1 as a general milestone for moving to a forward-facing seat.
"The main difference is that the AAP stressed there is no urgency to graduate to one position from another," he says. "What they did is make it clearer and stronger as a recommendation."
The change to the AAP policy is largely based on a 2007 study that showed that children under the age of 2 are 75 per cent less likely to die or be severely injured in a crash if they are riding in a rear-facing seat.
"For younger kids, the main thing is control of the head," Dr. Cyr says. "Even in a low-speed impact, you can have injuries because the head will move forward and there will be stress on the spinal cord."
He says the CPS's injury prevention committee, of which he is a member, will be discussing a possible update to their guidelines at a meeting in April. "The only change we'd have to do is get rid of the one-year-old limit and suggest that parents should be encouraged to keep their baby rear-facing as long as the weight and height limitation of the manufacturer is there," he says.
In Canada, there are rear-facing car seats available for children up to about 45 pounds. Another issue is the possible harmonization of recommendations between various bodies including the AAP, CPS, Transport Canada and the provinces. One goal would be to standardize the phrasing of the guidelines across groups to avoid confusion among parents and pediatricians alike.
For instance, a parent looking for recommendations on the proper use of booster seats will find one group using sitting height, another using total height and a third using age as a milestone.
Ultimately, many child-safety experts are also hoping that updating car-safety guidelines may be an opportunity to lobby for booster-seat laws in provinces that do not currently have them, including Alberta and Saskatchewan.
"It's a silent epidemic, the injuries. Car accidents are the most frequent cause of death in Canadian children by far," Dr. Cyr says. "We talk about death, but most of these kids remain paraplegic."