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Child car seat advice questioned

There’s a growing body of evidence that toddlers in car seats should face the rear for longer than a year.
/ Source: contributor

Ask any parent about graduating their infant from a rear-facing car seat to a forward-facing one and you’ll likely hear this common refrain — at least 20 pounds and at least one year (although some estimates say a full 30 percent of parents go against this guideline and actually face their children forward earlier).

This advice is generally what our doctors tell us and it’s the car seat safety mantra that’s been drilled into our heads from organizations such as the American Academy of Pediatrics and the National Highway Traffic Safety Administration.

Two years ago, however, the American Academy of Pediatrics quietly added this wording to its guidelines: If a car safety seat accommodateschildren rear facing to higher weights, for optimal protection,the child should remain rear facing until reaching the maximumweight for the car safety seat, as long as the top of the headis below the top of the seat back.

There’s a growing body of evidence, however, that this lesser known guideline, which is considerably different from the well-known minimum guideline, will soon take center stage.

“In Scandinavian countries it’s common to keep children rear facing up to 3 or 4 years old and there’s some good data there that proves it’s effective,” says Chris Sherwood, a research scientist who is studying the issue at the University of Virginia Automobile Safety Laboratory. Yet, until recently, Sherwood says there was not U.S. data to prove that keeping an older child rear-facing would result in significantly less injuries.

As part of a project sponsored by the federal Centers for Disease Control and Prevention, Sherwood and colleagues recently completed a study looking at the benefits of keeping children in car seats that face rear. Sherwood’s research is now undergoing the necessary stage of being published and peer reviewed but the outcomes look intriguing.

His study, presented at a recent meeting of the American Academy of Pediatrics, involved 870 children under age 2 who had been in either rear-facing or forward-facing car seats at the time of an automobile accident. He found that the children in forward-facing seats were more than four times as likely to be injured in side crashes as opposed to the children in rear-facing seats. The study also found a small but not statistically significant benefit for facing rear in frontal crashes.

“The findings from the other countries and in Chris Sherwood’s work, although preliminary, should be considered carefully,” says Kristy Arbogast, associate director of field engineering with Traumalink at Children’s Hospital of Philadelphia and a leading researcher in the field. Arbogast notes that in general the newest evidence appears convincing that keeping children facing rear longer is probably the safest way to go.

Why is rear-facing safer?
Since the 1970s with the introduction of the first seat belt and child safety seat laws, there’s been an increased focus on how to make children safer in cars. In the last decade improvements have been made in computer modeling and child-size crash test dummies to give researchers a clearer understanding of what happens to children in car crashes.

What we know is that children aren’t just pint-sized adults. Their anatomy differs significantly from an adult’s and puts them more at risk for certain serious injuries. 

“The biomechanics of their necks facilitate the birth process — there’s a lot of flexibility in a child’s neck compared to an adult’s,” says Arbogast. “The youngest kids have a neck or cervical spine that doesn’t have the strength to withstand the forces they’d experience in many crashes.”

When a child is placed in a rear-facing seat there is less chance of trauma to the highly vulnerable neck and head areas during the most common crashes. Arbogast notes, too, that even older children — up to age 12 — still haven’t fully developed. They — along with adult passengers — would also probably be safer sitting rear-facing. Of course, this isn’t feasible. Adults and older children won’t do it or they can’t because the car seats won’t allow it. So the question safety experts are trying to answer now is how long we can get our very youngest children to do it.

The answer is a lot longer than many parents might think, says Kathleen Klinich, a senior research associate at the University of Michigan Transportation Research Institute.

Key safety period before age 2
Over the last few years U.S. car seats manufacturers have drastically improved the car seats. Besides making the seats much easier to use in general, they are making the seats safe to use rear-facing with older children.

“Unlike previously, now the majority of seats offered in the U.S. accommodate children up to 30 pounds rear-facing,” says Klinich. (In Scandinavian countries most seats accommodate even heavier and taller children.) “That means that most children can remain rear facing until at least around age 2 and some even beyond.” This 1- to 2-year-old gap is the most crucial time, according to Klinich.

“A comparison study of Scandinavian to German crash data seems to indicate that the safety benefit is particularly strong for kids from 1 year to 2 years,” she says.

Still, Klinich understands that some parents will resist keeping their children rear-facing. Forward-facing means parents are able to see their child. But also many parents claim their children are more content facing forward.

“I think there’s a notion out there that kids are somehow happier when they go forward-facing,” says Klinich. “But we haven’t found this to be true. Besides, safety shouldn’t be a choice. If your child cried and screamed because you wouldn’t let him play in middle of road, you still wouldn’t let him play in a the middle of the road.”

Parents also express concern that an older child’s longer legs will hit the back seat when rear-facing.

“When I talk to parents some feel that the bigger children are more at risk for leg injuries because their legs are bunched up. But that concern has never been borne out in the data,” says Arbogast. “Besides, remember, the risks you’re trying to prevent by keeping a child rear-facing are head and spinal injuries.” Broken legs are easy fixes compared to the other injuries, she notes.

The biggest obstacle to longer rear-facing rides, though, is simply changing a parent’s perception, says Miriam Manary, also a senior research associate at the University of Michigan.

Manary says parents need to realize that as a child moves through various car seat stages — from an infant seat, to a convertible to a booster seat to regular seat belts — each one offers less protection than the prior phase.

“Parents should be looking to prolong these stages rather than rushing through them,” advises Manary. “Remember, graduation to the next level isn’t progress. It’s a decrease in safety.”

Victoria Clayton is a freelance writer based in California and co-author of "Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom," published by Fair Winds Press.