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In a new policy statement published in the April 2011 issue of Pediatrics, the American Academy of Pediatrics now advises parents to keep toddlers in rear-facing car seats until age 2, or until they exceed the height or weight limit for the car seat, which can be found on the back of the seat.

Previously, the AAP advised parents to keep kids rear-facing as long as possible, up to the maximum limit of the car seat, and this has not changed.

But it also cited one year and 20 pounds as the minimum for flipping the seat, which many parents and pediatricians interpreted as conventional wisdom on the best time to make the switch.

The new policy clarifies the AAP’s recommendation, making age 2 the new guideline — a real game-changer for parents of toddlers.

A 2007 study in the journal Injury Prevention found that children under age 2 are 75 percent less likely to die or to be severely injured in a crash if they are rear-facing. Another study found riding rear-facing to be five times safer than forward-facing.

“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,” said Dennis Durbin, M.D., F.A.A.P., a pediatric emergency physician and co-scientific director of the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia and lead author of the policy statement and accompanying technical report.

Recall Finder: Check if your child’s car seat has been recalled

Parenting talked to Ben Hoffman, M.D., associate professor of pediatrics at the University of New Mexico in Albuquerque and a child passenger safety technician, to get answers to parents’ most pressing questions about the new policy.

Although the new baseline is now age 2, the AAP has advised parents since 2002 to keep kids rear-facing until they reach the height or weight limit of their car seat. Why are parents so eager to turn their car seats?

“Parents are interested in milestones, and the minimum of one year and 20 pounds has been interpreted as gold standard instead of the minimum,” says Hoffman. “Parents are always looking for the next stage of development because in every other scenario, that’s a good thing. With car safety seats, however, that’s often not the case.”

But isn’t forward-facing easier for everyone?

Yes, it’s easier to interact with your child when she is facing forward, and less awkward to get her into the seat. But safety should be the main concern. “I would ask parents to consider the protection of the child in addition to comfort,” says Hoffman. “It’s minimally acceptable to change to forward-facing at a year, but parents can do better than that.”

What about squished legs?

Kids who have been only rear-faced will most likely not be bothered, since they don’t know anything else. And it’s completely fine for their feet to touch the seat back, or for their legs to bend. “Once you make the switch, it’s hard to go back, so try not to ever switch them before they are ready,” says Hoffman.

Why are so few parents aware of even the older guidelines that say kids should stay rear-facing as long as possible?

There may have been some confusion with the message, with many parents mistaking the minimum for the ideal age to make the switch. The AAP hopes that by making age 2 the new guideline, the message will be less confusing for parents and for pediatricians.

If my child turns 2 before he reaches the height or weight limit for the seat, should I keep him rear-facing?

Yes. The safest decision is to keep him rear-facing until he reaches the height or weight limit for the seat.

If my child reaches the height or weight limit for my seat before age 2, what should I do?

Once your child exceeds the height and weight limit of his infant car seat, purchase a convertible car seat with a higher height or weight limit (most go to 35 pounds rear-facing) and continue to use it rear-facing until age two, or until your child hits the height or weight limit for rear-facing use. At that point you can make the switch to forward-facing– or you can purchase a convertible car seat with a higher weight limit for rear-facing (some go up to 45 pounds). “That’s a very personal decision for the parent,” says Hoffman, one that may also be influenced by the size of your car, the arrival of a younger sibling, or your budget.

What should I do if I’ve already switched my under-2 child for forward-facing?

The best advice is for parents to consider switching their child back to rear-facing. But the next best thing is to, at a minimum, make sure you correctly use the seat you have: Make sure the seat is harnessed tightly to the vehicle, that the harness is snug over the child and the chest clip is in the correct position, and that the seatbelt or LATCH system are installed correctly.

Why didn’t my pediatrician tell me about this?

“Pediatricians should be talking about this,” says Hoffman. “But given everything else that needs to happen in a well-child visit, sometimes this message gets left behind. I would love to see a day where every family-care health provider knew the best possible advice and shared it with their patients.”

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Why it happens? What to do? Here are some answers.  See if you find it usefull. 

Why it happens

You put your toddler to bed at 8:30 at night. You hug him, kiss him, and wish him sweet dreams. It’s been a long day. The dinner dishes await you, your spouse has to pay the bills, the dog needs to be walked, the cat needs to be fed, and you haven’t had a moment to sit down and put your feet up. But nope — instead of spending the rest of the night catching up on your chores and spending some precious time with your partner, you’re in and out of your child’s room, cajoling him to go to sleep. He finally does — three hours later. Sound familiar? You’d be surprised at just how many of your fellow parents face this scenario night after night.

Sometimes you can tell your toddler’s fighting sleep — he rubs his eyes, yawns repeatedly, and falls apart at the merest hint of frustration. Other times he may seem wide awake, even hyper, but this can be another form of exhaustion. What’s happening is the toddler version of “so much to do, so little time”; there’s so much going on around him — Daddy’s in the living room poring over the mail, the pets are scuttling about, and you’re moving from room to room — that he wants to be part of the action. Also, just like other toddlers, your child is beginning to understand that he’s separate from you and is his own person, so he wants to assert his independence. Refusing to go to bed at night is one way he asserts control.

What to do

Teach your child to fall asleep alone. If your child will to go to bed only if you’re around, he’s forming bad habits that will be hard to break later. The best lesson you can teach him is how to soothe himself to sleep. Follow a nightly bedtime ritual (bath, books, and bed, for example) so he knows what’s expected of him and what to expect at night. You can tell him that if he stays in bed you’ll come back in five minutes to check on him. Let him know that he’s safe and that you’ll be nearby.

Don’t let him dawdle. Toddlers are great negotiators, and they’re no different when it comes to bedtime. And because they so enjoy the time they spend with you, they’ll do what they can to prolong the time they have with you. Your child may take his time doing his usual nightly routine, ask repeatedly for a glass of water, or keep requesting that you come to his room because he needs something. If you suspect he’s stalling, don’t let him. Tell him it’s time for bed and that he can finish working on his art project the next day or find the stuffed bunny the following morning.

You may want to anticipate all of your child’s usual (and reasonable) requests and make them part of the bedtime routine. Fill up a glass of water before bed and have him put it on his night table, remind him to use the potty one more time, and give him lots of extra hugs to last him the whole night. Then allow your child one extra request — but make it clear that one is the limit. He’ll feel like he’s getting his way, but you’ll know you’re really getting yours.

Offer him acceptable choices at bedtime. These days your toddler is beginning to test the limits of his newfound independence. To help him feel empowered, let your child make choices whenever possible at bedtime, from which story he wants to hear to what pajamas he’d like to wear. The trick is to offer only two or three alternatives and to make sure you’re happy with every choice. For example, don’t ask, “Do you want to go to bed now?” He could very well say no, which isn’t acceptable. Instead, try, “Do you want to go to bed now or in five minutes?” He still gets to make the choice, but you win no matter which option he picks.

Be calm but firm. Stand your ground even if your child cries or pleads for an exception to the going-to-bed rule. If you’re frustrated, try not to engage in a power struggle. Speak calmly and quietly but insist that when time’s up, time’s up. If you give into his request for “five minutes more, please” once, you’ll hear it again and again. If he throws a fit, ignore it as you do other tantrums. By paying attention to him — even if you’re displeased with him — you’ve reinforced his behavior.

Moving him to a big-kid bed. Between the ages of 2 1/2 and 4, your child has probably outgrown his crib and is ready to give it up. Moving from his crib to a bed signals to him that he’s becoming a big kid. You can tell him that part of getting older is learning how to go to bed when he needs to rest and doing so on his own. Once he’s using his new bed, be sure to praise your child when he stays in it at bedtime and overnight. After the confinement of his crib, your child may get out of his big-kid bed over and over just because he can. If your toddler gets up, temper your reaction. Simply take him back to bed, firmly tell him that it’s time to go to sleep, and leave.  (Ref: babycenter.com)

Although developmental change runs parallel with chronological age, age itself cannot cause development. The basic mechanisms or causes of developmental change are genetic factors and environmental factors. Genetic factors are responsible for cellular changes like overall growth, changes in proportion of body and brain parts, and the maturation of aspects of function such as vision and dietary needs. Because genes can be “turned off” and “turned on”, the individual’s initial genotype may change in function over time, giving rise to further developmental change. Environmental factors affecting development may include both diet and disease exposure, as well as social, emotional, and cognitive experiences. However, examination of environmental factors also shows that young human beings can survive within a fairly broad range of environmental experiences.^[17]

Rather than acting as independent mechanisms, genetic and environmental factors often interact to cause developmental change. Some aspects of child development are notable for their plasticity, or the extent to which the direction of development is guided by environmental factors as well as initiated by genetic factors. For example, the development of allergic reactions appears to be caused by exposure to certain environmental factors relatively early in life, and protection from early exposure makes the child less likely to show later allergic reactions. When an aspect of development is strongly affected by early experience, it is said to show a high degree of plasticity; when the genetic make-up is the primary cause of development, plasticity is said to be low.^[18] Plasticity may involve guidance by endogenous factors like hormones as well as by exogenous factors like infection.

One kind of environmental guidance of development has been described as experience-dependent plasticity, in which behavior is altered as a result of learning from the environment. Plasticity of this type can occur throughout the lifespan and may involve many kinds of behavior, including some emotional reactions. A second type of plasticity, experience-expectant plasticity, involves the strong effect of specific experiences during limited sensitive periods of development. For example, the coordinated use of the two eyes, and the experience of a single three-dimensional image rather than the two-dimensional images created by light in each eye, depend on experiences with vision during the second half of the first year of life. Experience-expectant plasticity works to fine-tune aspects of development that cannot proceed to optimum outcomes as a result of genetic factors working alone.^[19]

In addition to the existence of plasticity in some aspects of development, genetic-environmental correlations may function in several ways to determine the mature characteristics of the individual. Genetic-environmental correlations are circumstances in which genetic factors make certain experiences more likely to occur. For example, in passive genetic-environmental correlation, a child is likely to experience a particular environment because his or her parents’ genetic make-up makes them likely to choose or create such an environment. in evocative genetic-environmental correlation, the child’s genetically-caused characteristics cause other people to respond in certain ways, providing a different environment than might occur for a genetically-different child; for instance, a child with Down syndrome may be treated more protectively and less challengingly than a non-Down child. Finally, an active genetic-environmental correlation is one in which the child chooses experiences that in turn have their effect; for instance, a muscular, active child may choose after-school sports experiences that create increased athletic skills, but perhaps preclude music lessons. In all of these cases, it becomes difficult to know whether child characteristics were shaped by genetic factors, by experiences, or by a combination of the two.^[20]

The perinatal period is immediately before to after birth. Depending on the definition, it starts between the 20th to 28th week of gestation and ends between 1 to 4 weeks after birth (the word “perinatal” is a hybrid of the Greek “peri-” meaning ‘around or about’ and “natal” from the Latin “natus” meaning “birth.”).

Infants cry as a form of basic instinctive communication. A crying infant may be trying to express a variety of feelings including hunger, discomfort, overstimulation, boredom, wanting something, or loneliness.

Breastfeeding is the recommended method of feeding by all major infant health organizations.^[4] If breastfeeding is not possible or desired, bottle feeding is done with expressed breast-milk or with infant formula. Infants are born with a sucking reflex allowing them to extract the milk from the nipples of the breasts or the nipple of the baby bottle, as well as an instinctive behavior known as rooting with which they seek out the nipple. Sometimes a wet nurse is hired to feed the infant, although this is rare, especially in developed countries.

As infants grow, food supplements are added. Many parents choose commercial, ready-made baby foods to supplement breast milk or formula for the child, while others adapt their usual meals for the dietary needs of their child. Whole cow’s milk can be used at one year, but lower-fat milk should not be provided until the child is 2 to 3 years old.^[5] Until they are toilet-trained, infants in industrialized countries wear diapers. Children need more sleep than adults—up to 18 hours for newborn babies, with a declining rate as the child ages. Until babies learn to walk, they are carried in the arms, held in slings or baby carriers, or transported in baby carriages or strollers. Most industrialized countries have laws requiring child safety seats for infants in motor vehicles.

Upon its entry to the air-breathing world, without the nutrition and oxygenation from the umbilical cord, the newborn must begin to adjust to life outside the uterus.

Alert infant interested in surrounding objects and people

Newborns can feel all different sensations, but respond most enthusiastically to soft stroking, cuddling and caressing. Gentle rocking back and forth often calms a crying infant, as do massages and warm baths. Newborns may comfort themselves by sucking their thumb, or a pacifier. The need to suckle is instinctive (see suction in biology) and allows newborns to feed.

Newborn infants have unremarkable vision, being able to focus on objects only about 18 inches (45 cm) directly in front of their face. While this may not be much, it is all that is needed for the infant to look at the mother’s eyes or areola when breastfeeding. Depth perception does not develop until the infant is mobile. Generally, a newborn cries when wanting to feed. When a newborn is not sleeping, or feeding, or crying, he or she may spend a lot of time staring at random objects. Usually anything that is shiny, has sharp contrasting colors, or has complex patterns will catch an infant’s eye. However, the newborn has a preference for looking at other human faces above all else. (see also: infant metaphysics and infant vision)

While still inside the mother, the infant could hear many internal noises, such as the mother’s heartbeat, as well as many external noises including human voices, music and most other sounds. Therefore, although a newborn’s ears may have some catarrh and fluid, he or she can hear sound from before birth. Newborns usually respond to a female voice over a male voice. This may explain why people will unknowingly raise the pitch of their voice when talking to newborns (this voice change is called motherese). The sound of other human voices, especially the mother’s, can have a calming or soothing effect on the newborn. Conversely, loud or sudden noises will startle and scare a newborn. Newborns have been shown to prefer sounds that were a regular feature of their prenatal environment, for example, the theme tune of a television programme that their mother watched regularly.

Newborns can respond to different tastes, including sweet, sour, bitter, and salty substances, with a preference toward sweets. It has been shown that neonates show a preference for the smell of foods that their mother ate regularly.

Studies examining whether breastfeeding in infants is associated with higher intelligence later in life include:

1. Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of 280 low birthweight children at seven or eight years of age.[28] Those who were breastfed for more than eight months had verbal IQ scores 6 points higher (which was significantly higher) than comparable children breastfed for less time.[28] They concluded “These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development.”[28]

2. A 2005 study using data on 2,734 sibling pairs from the National Longitudinal Study of Adolescent Health “provide[d] persuasive evidence of a causal connection between breastfeeding and intelligence.” The same data “also suggests that nonexperimental studies of breastfeeding overstate some of [breastfeeding's] other long-term benefits, even if controls are included for race, ethnicity, income, and education.” [29]

3. In 2006, Der and colleagues, having performed a prospective cohort study, sibling pairs analysis, and meta-analysis, concluded that “Breast feeding has little or no effect on intelligence in children.”[30] The researchers found that “Most of the observed association between breast feeding and cognitive development is the result of confounding by maternal intelligence.”[30]

4. The 2007 review for the AHRQ found “no relationship between breastfeeding in term infants and cognitive performance.”[16]

5. The 2007 review for the WHO “suggests that breastfeeding is associated with increased cognitive development in childhood.” The review also states that “The issue remains of whether the association is related to the properties of breastmilk itself, or whether breastfeeding enhances the bonding between mother and child, and thus contributes to intellectual development.” [17]

6. Two initial cohort studies published in 2007 suggest babies with a specific version of the FADS2 gene demonstrated an IQ averaging 7 points higher if breastfed, compared with babies with a less common version of the gene who showed no improvement when breastfed.[31] FADS2 affects the metabolism of polyunsaturated fatty acids found in human breast milk, such as docosahexaenoic acid and arachidonic acid, which are known to be linked to early brain development.[31] The researchers were quoted as saying “Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ. But it’s not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant.”[32] The researchers wrote “further investigation to replicate and explain this specific gene–environment interaction is warranted.”[31]

7. In “the largest randomized trial ever conducted in the area of human lactation,” between 1996 and 1997 maternity hospitals and polyclinics in Belarus were randomized to receive or not receive breastfeeding promotion modeled on the Baby Friendly Hospital Initiative.[33] Of 13,889 infants born at these hospitals and polyclinics and followed up in 2002-2005, those who had been born in hospitals and polyclinics receiving breastfeeding promotion had IQs that were 2.9-7.5 points higher (which was significantly higher).[33] Since (among other reasons) a randomized trial should control for maternal IQ, the authors concluded in a 2008 paper that the data “provide strong evidence that prolonged and exclusive breastfeeding improves children’s cognitive development.”[33]

The postnatal period begins immediately after the birth of a child and then extends for about six weeks. During this period, the mother’s body returns to prepregnancy conditions as far as uterus size and hormone levels are concerned.