title: Are parents following the recommendations for keeping children younger than 2 years rear facing during motor vehicle travel?
abstract: OBJECTIVE
  Between 2007 and 2012 there have been several recommendations that infants and toddlers ride in a car safety seat (CSS) rear facing until 2 years of age. This study reports the effect of these recommendations on the observed direction of travel for infants and toddlers transported in motor vehicles between 2007 and 2012.
  
  
  METHODS
  This is an observational, cross-sectional survey of drivers transporting children collected at 25 convenience locations selected in Indiana during summer 2007 through 2012. Observations were conducted by Certified Child Passenger Safety Technicians. As drivers completed a written survey, the Certified Child Passenger Safety Technician recorded the vehicle seating location, type of restraint, CSS direction and use of the CSS harness or safety belt as appropriate, and demographic data. The infant and toddler's age and weight were collected. Data from 2007 through 2012 for ages birth through 23 months were compared in order to determine if recommendations impacted observed direction of travel.
  
  
  RESULTS
  During the study period, the percent of infants and toddlers (birth through 23 months) observed rear facing in a motor vehicle varied from 44.2% (2007) to 59.1% (2012). For infants (birth through 11 months) observed rear facing, it was 85.1% (2009) to 91.6% (2012). The percent of toddlers (12 months through 23 months) observed rear facing ranged from 3.3% (2008) to 18.2% (2012).
  
  
  CONCLUSIONS
  During the study period, the proportion of toddlers rear facing increased approximately 15% (p=0.03). Counselling by primary care providers should continue and be strengthened to increase parent and caregiver awareness of the latest child passenger safety recommendations.
authors.affiliation: Section of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: O'Neil
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Slaven
authors.affiliation: Section of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA Automotive Safety Program, Riley Hospital for Children, Indianapolis, Indiana, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Talty
authors.affiliation: Section of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, Indiana, USA Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Bull
mesh_terms: D000328:Adult; D001334:Automobile Driving; D057207:Child Restraint Systems / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D007196:Indiana; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D012449:Safety / Q000592:standards*; D012622:Seat Belts / Q000592:standards*