Rear-Facing Until 2 Years Old: Why Not?
Any time a new recommendation from anything resembling an “authority” is released regarding the welfare of children, critics come out in droves to decry the advice. Sometimes, they have a legitimate concern. Other times, their reasoning is inherently flawed or purely emotional. For a background, be sure to read about the new AAP recommendations and check out the Rear Facing Link Guide for references. In this blog, Heather, Kecia and I put together some answers to fourteen popular questions:
1.) Won’t my toddler be uncomfortable facing the back? No, he or she will be just fine. Most toddlers are actually more comfortable rear-facing because the carseat is reclined and it’s much more comfortable to sleep that way than sitting upright in the forward-facing position. Plus they can prop up their feet instead of having them dangle unsupported.
2.) Won’t their feet or legs be injured because they are bent or crossed or touching the back of the seat? No, but this is a very big misconception among parents. In reality, during a frontal crash (the most common type of crash), the legs will fly up and away from the back seat. It’s also much more important to protect the head, neck and spinal cord in a crash which is exactly what rear-facing carseats do so well. If you’re still not convinced – there is this study by CHOP (Children’s Hospital of Philadelphia) that looked at injuries to children ages 1 – 4 who were hurt in crashes and leg injuries were rare for those kids in rear-facing seats. However, injuries to the lower extremity region were the second most common type of injury for the kids in forward-facing seats. That’s because the legs of a child in a forward-facing seat are thrown forward and can hit the console or the back of the front seat. Study quote: “Injuries below the knee were the most common, particularly to the tibia/fibula, and they most often occurred due to interaction with the vehicle seatback in front of the child’s seating position.”
3.) Isn’t a child going to get carsick when they are rear-facing? Keep in mind it’s all they know from day one. And while some children (and adults too) seem to be more susceptible to motion sickness in general – the direction the seat faces rarely has an impact on the frequency or severity of this occurance.
4.) But my child is already forward-facing, there’s no way she’ll tolerate going backwards again! Another popular misconception. In reality you don’t know how a child is going to react until you try it. And if you’re positive about it that greatly increases the chances that they will be too. Thousands of parents over the last decade have turned their children back after learning of the safety benefits of rear-facing (this knowledge that rear-facing is the safest way to travel isn’t new, by any means). The vast majority of these parents and caregivers receive little or no resistance from the child. So put on your happy face and give it your best try!
5.) My child fights me when I put her in the carseat rear facing. Wouldn’t it be easier to turn her seat forward? Probably not. Around 12-18 months of age, most children go through an “independent” phase where they just want to be free of restraint of any kind. It’s just a phase—ask any experienced parent about it and repeat the phrase “this too shall pass, this too shall pass.”
6.) I can’t see my child, what if they are choking or have a medical issue while I am driving? You can’t watch your child 24 hours a day–as much as you try to be SuperMom or SuperDad, you’re not. If you must feed your child in the car, feed him/her Cheerios or other such food that “melts” in their mouth. If the child has a medical issue, try to travel with someone who can sit in the back seat with her to monitor her condition.
7.) This is so intrusive, do you want me to put my child in a plastic bubble too? For the vast majority of kids, facing the rear of the vehicle for an extra year really isn’t taking anything at all away from their development or well-being. Even if the reduction in risk seems relatively small to you, the disadvantages for the child and parent are generally only those of perception. If a child spends so many hours per day restrained in a vehicle that this seems like a restriction of a child’s freedom in some way, then perhaps these other issues should be resolved first.
8.) Isn’t this just another law telling parents how to raise their kids? This is simply a guideline from a certifying body for pediatricians in the USA. Just as you don’t have to accept the advice of your child’s doctor regarding a diagnosis or treatment or vaccine, you also don’t have to take their advice regarding injury prevention. The AAP doesn’t make laws, they only give doctors guidelines regarding safest practice, based on research and statistics. Legislatures make laws. While states can and do make many laws to protect children from harm, citizens who have legitimate concerns can be a part of the process if they are genuinely interested, beyond simply complaining online about the woes of living in such a restrictive nanny-state.
9.) Isn’t this just the car seat makers forcing us to buy new seats? No. Best we can tell, these guidelines are being issued by researchers, physicians and experts at the American Academy of Pediatrics, the National Highway Traffic Safety Administration and other agencies invovled in injury prevention. We are not aware of a powerful, super-secret child seat manufacturer’s lobby or any other conspiracy behind these new guidelines! Plus, the fact is that all these agencies have encouraged rear-facing beyond 12 months for many years. That means that most convertible child seats in use today can accomodate most toddlers rear-facing up to 2 years old. There will be some exceptions for the smallest convertible carseats or the largest children, but for many parents, there is no need to buy a new seat unless yours is too old or unsafe for some other reason.
10.) I didn’t have a carseat and I survived. What’s the big deal? Consider yourself lucky! A relatively large number of your peers died in crashes because they didn’t have a carseat when they were young. In fact, child passenger fatalities from motor vehicle crashes have steadily declined since the early 1970s, even though we travel far more miles today than 30 or 40 years ago. Today, the number of kids who die each year as occupants in motor vehicles is roughly half what it was 35 years ago, even though we drive more than double the total miles as a nation today. According to the IIHS, “… passenger vehicle child occupant deaths in 2009 were 46 percent lower than in 1975.”
11.) What if I am rear-ended. Won’t my toddler be less safe if he is rear-facing? The majority of rear-end crashes occur when both vehicles are traveling in the same direction; one car is usually stopped or in the process of stopping. Crash forces are lessened which means a lower chance of injury. For severe crashes, especially those involving a fatality, rear-enders are quite rare. Frontal and side impacts account for the great majority of severe crashes, while rear-enders account for less than 10%. So, while we don’t have any data to compare injuries to kids in rear-facing seats involved in a rear end crash, these guidelines are intended to maximize protection in the most common and most severe types of crashes.
12.) My husband is Mayor/Chief of Police/State Senator and he says I’m not breaking the law and I can’t be ticketed for having our 13 month old son forward-facing. I’m not breaking any laws so why should I turn him backwards again? You’re right, you’re not breaking the law by having your 13 month old forward-facing as long as he is within the forward-facing weight and height range for his carseat. But in certain states you’re also not breaking the law if you sign him out of school on his 16th birthday so he can marry his first cousin.
13.) My husband is an engineer/scientist/mechanic/know-it-all and says race car drivers are perfectly safe forward facing in a 5-point harness. Can you prove that my baby is safer rear facing? Yes. For years, injury prevention researchers have known that the physics and kinematics of a crash prove that rear-facing is safer for everyone, when an appropriate seat is available. Young children gain a much greater benefit from rear-facing because their skeleton, connective tissues and their bodies in general are not as strong or developed as an adult body. The only other question is if real world statistics support the theory. The main study used to support the new guideline is from 2007. While it has some limitations, it does conclude that, “RFCSs (Rear Facing Car Seats) are more effective than FFCSs (Forward Facing Car Seats) in protecting restrained children aged 0–23 months. The same findings apply when 1 year olds are analyzed separately. Use of an RFCS, in accordance with restraint recommendations for child size and weight, is an excellent choice for optimum protection up to a child’s second birthday.” The full research behind the new guideline, along with more supporting evidence and references, can be found in Pediatrics. We do hope that more research will be done in the future to confirm the single 2007 study that is the only one to directly compare Rear Facing to Forward Facing for older babies in the USA. We would also like to see justification in terms of fatalities, not just for injuries. For now, the data available does seem to indicate that rear-facing is considerably safer than forward facing for children at least until their 2nd birthday and perhaps beyond!
14) The booster guideline is outrageous, too! I’m 50 years old and I’m not 4’9″ tall, so are you going to make me use a booster? No. The fundamental differences between a typical 9-year old and an adult are maturity and skeletal structure. If a seatbelt is uncomfortable for an adult, they can make a choice about their own well being and continue to use it, because they know doing otherwise could lead to a serious or fatal injury. Before the age of reason, kids simply don’t make good choices about their own well-being. If the shoulder belt is uncomfortable, they will simply put it behind their arm or back. If they can’t bend their knees, they will slouch, causing the lap belt to move off the bones of their hip into the soft tissue of the abdomen. Those choices will lead to very severe injuries in a crash. Boosters make the seatbelts fit better, making the kid more comfortable, making it less likely they will compromise their own safety.
Ultimately, these guidelines are not asking parents to do something different. They are only suggesting that parents use their convertible carseats in the rear-facing position longer to extend the protective benefits provided by the rear-facing position. Babies and toddlers won’t know anything different – they will simply be doing what they had already been doing since their first ride in the car.
Reader Comments
I get a lot of grief for having my child in a forward-facing car seat, even now that she’s over two. However, no-one has addressed the issue that I couldn’t find a rear-facing car seat that would fit safely in my car once my daughter outgrew her bucket seat. If I hadn’t had my seat professionally fitted, I might have assumed she was safer rear fitting and bought one anyway.
Is she safer in a front seat that fits properly or a non-fitting rear facing seat? I’m going with the former, and that’s what the fitters recommended.
Of course, these are only guidelines. There are clearly circumstances where a child could ride forward-facing once they are above 1 year and 20 pounds, but before they are 2 years old. Not being able to find a model that will fit the vehicle is one such circumstance. Sub-compacts and very narrow rear seats can cause such a problem, though there are models like the Combi Coccoro and Cosco Scenera that do fit many smaller cars. Beyond 2 years old, I would generally say it is fine for a child to be forward facing, unless they are below 20 pounds or have some other medical or behavioral issue that would require rear-facing. It is still slightly safer for kids to remain rear-facing beyond 2 years old, up to the limits of their convertible carseat.
GHOTI – I realize it’s a little late now but what do you drive and what convertible seats did you try? Not every carseat fits well in every vehicle (rear-facing or forward-facing) but you often *gain* space when you move from the infant seat to a rf convertible because the convertible can be installed a bit more upright for an older baby or toddler.
CPSDarren – Thankyou for saying that! It might be obvious to you, but it seems like it’s not to a lot of people.
It’s a Ford Mondeo. We tried every convertible seat in the shop (Kiddicare). The issue is not of space as such, it’s that the seatbelts aren’t long enough, so in the event of an accident, the weight would be taken by the buckle, not the webbing.
I didn’t really find the answer on small adults satisfactory. Sounds like the only difference is that it’s more tolerable to say a 12 y.o. should be in the back seat than that it’s unsafe for a small adult to drive. I looked at the original article with the recommendations and didn’t see any rationale for the age 12, either. What’s going on?
I hear parents often saying that their child will, and always has, been very upset while rear facing- so much so that they are distracting to the driver. What would be your response to this?
Great post! Nice to see my kiddos on there too
Elizabeth- Adults have stronger and more developed bodies and are presumably more mature than kids, even if they are around the same height. An adult should know well enough to wear a seatbelt even if it is uncomfortable. Plus, if it doesn’t fit well, their bodies are better able to withstand the forces. There is no magic at exactly 12 years old, execpt that kids that age are more mature, better developed and statistically, a larger percentage are tall enough to fit in a typical seatbelt (taller kids will fit in some seatbelts many years sooner). Some kids and adults will never be mature enough to make the best choice. On the flip side, older kids could continue to use a booster if they still don’t fit correctly in a seatbelt.
Tami- One thing that helps is that babies are already rear-facing to age 1, they simply won’t know any different if they keep going to age 2. There’s not much for peer pressure at that age! I have three kids. They get upset over a lot of things, though facing the rear was never one of them. Try telling a pre-teen girl to use a booster after she is age 8, when few of her friends use one! I managed for over a year. Fortunately, her fit in our seatbelts isn’t too bad and she knows not to slouch or put the shoulder belt behind her back. Anyway, like with anything, you choose your battles. If you can fight the tantrum over candy at the checkout aisle, you can probably deal with getting them to accept rear-facing. If you can’t, then make sure their front-facing seat is correctly installed and used. It should still provide a reasonable degree of safety for kids over 1 year and 20 pounds.
I am a proponent of extended rear facing and a there is an issue for many resistant parents that I wish you would adress in your articles. They think they need to keep the seat reclined as it would be for a small infant. Sometimes this causes space issues in the car and some children prefer sitting upright. So you get parents saying. ‘I was sick of not having room to push my seat back’ or ‘I turned my 12 month face-forward because she hated facing back and was much happierafter being turned’. Both of these issues may have been solved simply by placing the rear-facing seat at a more upright angle!
That is a great point. Older kids can be more upright, even as much as 30 degrees or so. That means less legroom taken from an adult in front, too!
Thanks for your reply. Whilst I get what you’re saying I also know of a few families whose babies have cried and cried constantly in a rear facing seat from newborn. Once they’re old enough at 12 months to cry and start kicking etc this can cause quite a bit more distraction to the driver than the newborn-12 month cry. I have read (untrained) people talk about how parents should just try and ignore the crying or not drive (which clearly isn’t always achievable). I’m not sure if this is the best advice as an accident is more likely to happen if the parent is distracted so.
In regards to the question from Cindy about not reclining the seat when rear facing… I believe our car seat (which can be rear or forward facing) has to be reclined in its rear facing position, according to the manufacturers instructions. I would have to check that though!
Tami- I have friends and family who rear face because they would much rather have their child kick the back seat than kick their seat. I’ve been cars with children who throw tantrums in their seat (which happened to be behind my chair) and it’s more uncomfortable and distracting to ride with a child kicking and pushing on your seat than it is to have them kicking the backseat. If a parent is having an issue with this they need to possibly discipline their child, not being a parent yet, I don’t know what it’s like to have to punish a child, but if they are throwing a tantrum over nothing, then it needs to be dealt with and not just left alone or given into because they learn that they can get what they want that way.
Issue #6 is a valid concern most parents (including myself) have – and the solution is simple: a mirror.
I understand that as car seat advocates, we do not encourage aftermarket products or anything that could post a hazard or as a projectile in the car, however, a properly installed (tethered to itself around a headrest or to the to tether point rather than using velcro) would post less of a danger than forward facing that child.
With the mirror, my child can communicate with me and can see me wave and talk to me more easily. Also – I know when he is asleep or kicking the kid beside him. In fact, when he is forward facing (he is 4 years old now, and rides forward facing when I have his 3 year old cousin on board) I find it a strain to look in my mirror to see him at all.
Kat
Canadian CRST
Race car drivers ARE forward-facing in a 5-pt harness, but keep in mind that it was internal decapitation that killed Dale Earnhardt. (Look up basilar skull fracture.) Race car drivers have the option of wearing a HANS device to prevent violent, extreme head movement in a sudden stop (crash). It is this same type of sudden, extreme head movement that can kill forward-facing infants and toddlers in a car crash. It literally snaps their necks or spinal cords, resulting in paralysis and death. Older children (age 4 and up) and adults have stronger, fused spine bones, which helps prevent internal decapitation in car crashes. A HANS device is impractical for an infant or toddler, which is why rear-facing is so important. It’s a simple way to prevent that violent, potentially fatal strain on the neck and spinal cord.
Kat, did you say “properly installed around a headrest”
Headrests are not child seat anchors and are not designed to be. They’re designed to take impact from the passenger’s head and that is it.
This article is long on straw-man arguments and spurious arguments and short on practical realities.
To Gustav: Apparently your reading skills are lacking. It was obvious that Kat was referring to tethering a MIRROR to the headrest as a solution for those who want to see their child while rear facing. Do you really think that someone who took the time to read this article on rear facing toddlers and make a helpful comment would tether a carseat to a headrest…come on!
@Gustav- As it turns out, I have three kids, two of which were rear-facing beyond 2 years old. I’m pretty familiar with the practical realities, as are hundreds, if not thousands of parents and advocates who have been keeping their older toddlers rear-facing for the better part of the last decade. Of course, not every solution works for every child or parent, but that doesn’t make any of our points disingenuous.
@mcmackme- the race car driver comment is one we see from time to time to justify how safe a forward facing harness must be. Of course, we agree with you. There are so many differences between a toddler and an adult, a family sedan and a race car, that the comparison is simply not valid.
Whilst I appreciate the reply from NOTYETMOM I would like to hear what CPSDARREN has to say about my previous question. (And I’m not just talking about tantrums, after all newborn babies don’t tantrum and if a child has been inconsolably crying from newborn in a rear facing position then there’s likely to be more to them crying inconsolably as a 12 months old rear facing toddler than a tantrum. I understand that some people, as NOTYETMOM described, can put up with the noise and continue to drive carefully but other are more distractable and could cause a risk to the road if driving under such conditions.)
Tami, what we have to do with a child who cries continuously is find the reason behind the crying. Is it a medical issue, such as reflux or colic, or a comfort issue, such as padding in the carseat not fitting correctly? My ds had colic and cried and fussed constantly from the day we brought him home until about 5 minutes ago (he’s 11), lol. His magic number on the road was 45 mph–that’s when he’d settle down, so we did a lot of highway driving his first few months. Kids who have reflux can be treated with medicine or even put in different carseats that may put them at a different angle that will make them more comfortable. Some kids have sensory issues (touch or smell) and a different carseat may make all the difference in the world. It can be really frustrating to have to try different things to calm a baby who seems to cry for no reason.
Thanks Heather.
Is it possible to try a different angle with a baby in a bucket seat? I understood, from my training, that they all had to be at a 45 degree angle. If I’m right that means that you can’t change the angle, right?
I guess the child I’m thinking of would probably have a really chronic motion sickness. Many people suffer from motion sickness when traveling backwards, babies included. There’s not much you can do to help a child who is suffering from something like that.
What if the parents have tried everything suggested and there is still the inconsolable crying? WOuld you recommend a FF, tell them to ignore it and attempt to drive or tell them to just not drive anywhere? The reason I ask is not because I am trying to make excuses but because I have heard trained car seat techs give all of the above recommendations and as a car seat tech myself I wonder what the best advice would be. Of course I would want them to keep their child rear facing for as long as possible, perhaps until they no longer need a car safety restraint but I know I’m going to increasingly come across parents who will give me this story and I want to be able to offer the best advice. Cheers, Tami
Hi Tami-
The 45 degree angle is necessary for newborns and small infants. It is actually considered slightly safer for kids to be more upright, once they are able to suppport and move their head on their own. That’s usually by 4-6 months old, and allows baby to lift their head in the event their head flopped forward and resulted in a breathing obstruction. Of course, a few convertibles have recline angle indicators or requirements in the manual, much like infant seats. Those must be followed if present. Otherwise, it’s OK for a toddler to be upright, even 30 degrees or so from verticle.
If there was no possibility at all to keep a child rear-facing due to carsickness or a medical issue, then it would be acceptable for them to be forward facing once they are over both 1 year and 20 pounds. Make sure the seat is correctly installed and used, and they should be relatively safe! Of course, carsickness is often just something a parent perceives might be a problem, not something that is actually a repeated problem!
@mcmackme
I was talking about affixing the mirror to the headrest – not the seat.
Obviously, my main concern for my girls is safety…but I have a small 4 year old(maybe 33 lbs) and a 21 month old. We take 2-4 monthly trips to visit my parents who live a little over an hour away. When we do longer drives, the girls are allowed to watch a video in our van. Turning them around(I pretty much would not turn around my 4 year old until she hit 35lbs), would mean we would not be able to do the videos. That was a MASSIVE reason why we bought our van.
The problem is my youngest is already used to watching videos and she would be TICKED if she did not get to watch…and can you blame her?
So, I really do not know how I feel about this. If I had another baby…I would just leave them be and that would be easier. Turning them back once they are accustomed to the other and LOVE the other, makes it much more complicated.
KELLY – I have a van with a DVD player too (not really by choice – it came with one) and my boys are 7 yrs apart. DS2 was rear-facing until he hit the rf weight limit on his convertible carseat at 3 years old. My solution to the issue was that the oldest could not watch the DVD player unless it was a long trip (more than 1 hr) and even then not until his brother fell asleep – which was usually within 15 minutes since he had no reason to stay awake. LOL
Really, most kids under the age of 3 watch too much TV at home anyway (not saying yours do – just a general observation backed up by the AAP), and I personally preferred that my kids not watch more “TV” in the vehicle too.
You could probably get away with just telling them it’s broken for a few weeks while you make the adjustment back to rf and figure out what’s going to work best for your situation.
FWIW, I have heard of parents who rigged a mirror so the rear-facing kid(s) could see the video screen.
My brother, who is a police officer, has a response to the whole baby screaming in the car because htey don’t like being in their seats.
He said screaming babies are not nearly as bad as dead ones.
Kelly, I had the same dilemma as you. My family lives 2 hours away, and when we bought our van with dvd player, the older kids quickly got used to watching a movie on the way. That was fine when their baby sister was an infant, but around 15 months or so she started wanting to see the movie too. Against my better judgment, I turned her around to keep the peace. 6 months later, I felt guilty about putting her desire to watch a movie and my desire to not deal with whining ahead of her safety, and turned her back around. People said she would protest after being FF for so long, and I braced for the whining, but you know what – she didn’t mind at all! I just made a rule that movies could only be watched in the van if she was asleep or not along for the ride. Sure, the older kids (ages 9, 8, 7 and 4) protested at first. Like you think your 4 year old might be, mine was ticked. She got used to it though, and now plays her Leapster, or looks out the window, or sings, or talks to her siblings. The kids all converse more now, and with their little sister now facing them, she is included in the conversation. Why not give it a try and see how it goes? Leave the DVDs at home so you can honestly tell your 4 year old that there isn’t anything to watch, that helped me. Put on some kids music or play I Spy, you might be surprised, they may take it better than you think.
My daughter is 2 and still rear facing. I hope to keep her rear facing as long as possible, so I appreciate the recommendations on narrower infant seats that may allow this, as we are expecting another child next month. We have a Britax Marathon and Roundabout, which are pretty bulky, so may not have room to put a Chaperone in the middle, which is the seat I’d like to get for the baby. My other dilemma is which side of the car to move the toddler seat. Is one side of the car safer than the other? Has anyone seen statistics on whether driver or passenger side collisions are more common?
Can anyone reccomend a rear facing seat that will fit in a HONDA FIT? I currently own a Britax Roundabout and a Sunshine Kids Radian. Neither will fit. Bear in mind I am 5’1″ and already have the front seat scooted all the way up anyways and I still can’t get either of these to fit RF. Wish I could afford a different car!!!
@ Amy – how old is the child? Do you know about the new angle adjuster from Diono? Also, which RA model do you have? The original? RA50? RA55?
Why does it seem that rear-facing advocates don’t really address (satisfactorily) the fact that people are not going to buy another car, nor another (really expensive) car seat that might *still* not fit in a rear-facing position? The car seat we have is really basic. It was REALLY not safe in the rear-facing position and I turned our son as soon as he was 1 & 20. He out grew the infant seat by 10 mos. (And as a side note… no WAY was the seat going in backward and upright. There’s too much angle!) So, he’s about to turn 4 and has been foward-facing for almost 3 yrs. We are a 1 income family who will not spend $200 on a car seat. Oh, and I don’t agree with a lot of things people inflict on our society… child-lead parenting, co-sleeping, johnson & johnsons, store-bought milk…
Hi Karly,
The Cosco Scenera is $39 at Walmart and has been recognized as a very safe convertible carseat for a decade. It’s also shorter than average and can fit better in smaller cars. It won’t last kids much longer than 2 years rear-facing, but should work for most well past 1 year and 20 pounds. Whether you buy an inexpensive new seat or use the one you already have (see point #9), seek out a local CPS technician for a free inspection to help get it installed correctly in your vehicle in case you have problems with the angle or other issues.
There is also an easier way to protect your child from the #1 killer of kids. Simply avoid the most hazardous thing society has inflicted upon young people: don’t drive. Seriously, though, with the privilege of driving comes some major responsibility, especially in regard to those that are too young to protect themselves. We find this recent article sums up the issue with our modern society very well:
http://www.huffingtonpost.com/jennifer-mendelsohn/car-seat-safety_b_2830955.html