I have recently seen an increase in the number of my patient families who are not following the recommendation to keep kids in the back seat until 13 years of age. When I ask the parents of my 8-12 year old patients where they sit in the car, I commonly hear the following:
> “He is bigger than me! So, I let him sit in the front seat.”
> “She weighs 115 pounds. That is the size of a teenager, isn’t it?”
> “Frankly, I don’t have space in my car. My kid hates to be in the back seat, and all of her friends ride in front. I don’t see what’s the big deal.”
Now, I completely understand why families may ignore this recommendation. It seems like this is just another rule to follow! And YES – all tweens want to sit in front. However, as with other car travel recommendations, there really is good reason to keep kids in the back seat as long as possible.
In my opinion, most parents are allowing their children to sit in the front seat because they don’t understand why the back-seat-until-13 recommendation exists.
Why is the back seat safer for kids who otherwise are the same size as their older siblings and peers? Let me try to explain.
Most child passenger safety recommendations are based on 2 very simple principles:
- Vehicle restraint systems are designed for adults.
- Children are not little adults.
Seat belts are designed to keep an adult person safe during a motor vehicle collision (MVC). The position of the lap belt is specifically designed to ride over the lower part of an adult hip bone. The shoulder belt is designed to securely cover the breast bone. The combination of these 2 belts protects us during a MVC by keeping our bodies in the car (not getting ejected), and by slowing the rate that our bodies come to a complete stop. The belts use two of the strongest areas of our skeleton to do this – the rib cage and hips.
Although some children under the age of 13 may seem as big as an adult on the outside, they are not an adult on the inside.
The hip bones are not fully developed (all the way to the pointy top part) until 12-13 years of age. It is the pointy, angled area on the front of developed hips that keeps a lap belt low and snug. On a child with rounded, relatively soft hips, the belt will “ride up” onto the abdominal cavity during an MVC – even if the belt starts in the right place! This shift of the lap belt’s proper position increases the risk of injury to abdominal organs.
The development of the breast bone (sternum) is even more inconsistent. Mature, stable breast bones can be seen as early as 11 years old. Full development, however, can be seen as late as 17 years old. Without a mature skeleton, a child is at increased risk of injury and death in the event of a MVC.
Until a child has a mature skeleton, the protection provided by seat belt restraint is not as optimal as an adult. Period.
So, how is a seat belt in back, better than a seat belt in front?
The back seat position provides additional protection because it is furthest away from three things responsible for most injuries: the windshield, the dashboard, and the airbag.
The data clearly shows this is a safer way to travel:
- Buckling up in the back seat decreases the risk of death by one-third.
- Passengers in the front seat are at greatest risk of injuries.
- Rear-seated passengers have 60% better protection in side impact collisions.
- Studies repeatedly suggest the risk of injury becomes equal to those of an adult person after the age of 13 years.
When you know the physiology and you see the statistics, the recommendation becomes easier to understand. It is for the greatest safety of our children.
I want all of us, as parents, to be able to use this information to make the best decisions for our own children’s car travel. And, hopefully, encourage parents to give the tweens the back seat for awhile longer.
These recommendations are based on population studies, and not always applicable for each individual or vehicle. It is strongly recommended by AAP, and yours truly, to keep your kids in the back seat until they turn 13 years old. Specific situations, however, are best discussed with an individual specifically trained incar passenger safety.
About Dr. Natasha Burgert
Dr. Natasha is a Board-Certified general pediatrician in Kansas City, MO. Her primary focus is direct patient care in a dynamic suburban private practice.
She was born and raised in Omaha, Nebraska. After completing an undergraduate degree in Biology at the University of Nebraska – Lincoln, she completed medical school at the University of Nebraska Medical Center. Following medical school, her pediatric training was at Cincinnati Children’s Hospital Medical Center in Ohio. She is Board Certified by the American Board of Pediatrics and a Fellow of the American Academy of Pediatrics. For the AAP, she serves as a National Spokesperson. Her husband is also a pediatrician, and they both joined private practice in Kansas City in 2006.
When at home, Dr. Natasha enjoys reading good books and cooking for family and friends. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband, son, and daughter. And, of course, she bleeds Husker red.