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Safety Archive

Rear-Facing As Long As Possible: Mixed Messages. Part I

In 2011, the AAP issued a new policy statement. To summarize, it says:

All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age OR until they reach the highest weight or height allowed by the manufacturer of their CSS.

This wording is duplicated in their frequently updated Information for Families at HealthyChildren.org. The basis of this recommendation is primarily one study that surveyed injury data for children 0 to 23 months of age. Despite some acknowledged limitations, the study has been a benchmark in promoting rear-facing for older kids and we all applaud the results.

Meanwhile the curriculum for certified child passenger safety technicians in the USA states, A child should remain in a rear-facing car seat AS LONG AS POSSIBLE. The child should remain in a rear-facing car seat until he or she reaches the top height or weight limit allowed by the car seat manufacturer. Once a child outgrows a rear-facing only seat, they can transfer to a rear-facing convertible until they reach the maximum height or weight for that seat.”

Other agencies, like NHTSA, have similar wording, “Keep your child rear-facing as long as possible. It’s the best way to keep him or her safe. Your child should remain in a rear-facing car seat until he or she reaches the top height or weight limit allowed by your car seat’s manufacturer.”  CarseatBlog does as well, and we encourage parents to keep their kids rear-facing to the limits of their convertible seat. Many of our Recommended Rear-Facing Carseats have sufficient rear-facing weight and/or height limits to keep the majority of children rear-facing until age 3 or 4, or even beyond in some cases.

Evenflo Triumph ProComfort - RF Toddler

Although the messages are similar, they use slightly different wording. They all fail to specifically address child restraint instructions that permit a child to be forward-facing after one year of age. What if your child outgrows your convertible carseat’s rear-facing limits before their second birthday? Most convertibles on the market today can fit children rear-facing until at least 24 months, with some exceptions. For example, the Combi Coccoro is a great seat that fits in small spaces. However, its short shell and relatively low rear-facing weight limit make it more likely that some toddlers may outgrow it rear-facing before 24 months. Its manual states, Toddlers 20-33 lbs., over one year of age, and who are capable of sitting upright unassisted may be forward-facing. Toddlers 33 to 40 lbs. and up to 40 inches tall MUST  be forward-facing.”  Many other carseats also have one year and 20-22 pound minimum limits for forward-facing.

Witness the chart from NHTSA:

Image Courtesy of NHTSA (Safercar.gov)

As you can see from the chart, it is not prohibited to have a child ride forward-facing after age 1. To my knowledge, no auto manufacturer or major traffic safety agency in USA or Canada prohibits using a carseat as permitted by its instruction manual. Provided that the child is correctly restrained within the limits stated on the labels or in the manual, their carseat will still be very effective in reducing injuries. There is no doubt, based on both crash physics and real world data, that rear-facing is safest for babies, toddlers and kids of all ages if an appropriate restraint system can be used. With that said, there is some misinformation on this topic that we’d like to address:

  1.  The AAP policy statement and NHTSA Guidelines do NOT prohibit using a child restraint according to the owner’s manual instructions. Many convertible carseats still have minimum forward-facing limits as low as 1 year AND 20-22 pounds. While we don’t recommend forward-facing for any child younger than 24 months, we do recognize that it is acceptable to do so according to some instructions.
  2. The AAP policy statement and the NHTSA guidelines do NOT dictate rear-facing until a minimum of 3 years old or 4 years old. The AAP recommendation is to keep kids rear-facing until their second birthday as a minimum. If the parent owns a carseat that permits rear-facing longer, that is the safest option.
  3. Neither the AAP policy statement nor the NHTSA guidelines instruct parents to only purchase carseats that potentially allow a child to remain rear-facing until age 3 or 4.
  4. Nor do either statement tell parents to buy a new rear-facing convertible if their child outgrows their current convertible’s rear-facing limit before a certain age.

While rear-facing limits are certainly important, they are only one aspect of finding the “best” carseat. The “best” carseat is one that fits the child and vehicle properly, and is easy to use correctly on each and every trip.  These factors are the critical ones for most parents when considering the purchase of a new carseat.

What does this all mean for parents and advocates?  Stay tuned for Part II tomorrow!

Rear-Facing vs. Forward-Facing Risk of Fatal Injury?

We have a study about rear-facing in the USA. It’s a great paper. It was also a major factor in promoting policy to rear-face until age two as a minimum. One main conclusion: “Effectiveness estimates for Rear Facing Car Seats (93%) were found to be 15% higher than those for Forward Facing Car Seats (78%)” [in preventing injuries of ISS9+ severity*]. Very impressive.

The study has some admitted weaknesses, though. Small sample sizes for one. No quantification in terms of child’s age by month is another, combined with the data being limited to 23 months of age. Looking for data to find the exact benefit to rear-facing for a 12-month old child? Forget it. Due to the complexity of child passenger safety issues, the authors suggest that the, “findings cannot be analyzed in a vacuum.” Yet, many of us do. We throw out a five times safer mantra flippantly from its results, without having read the study or knowing when that number might even apply. All too often, that mantra seems to imply that 5x more kids die or suffer permanent injuries because they were not kept rear-facing as long as possible, something totally unsupported by the study.

Among the other drawbacks to this study, the data is now well over 10 years old. It studied crashes from 1988-2003, meaning the vehicles and carseats involved in those crashes were mostly less safe models from the 1980s and 1990s. Another drawback was limited information on misuse. Also worth noting, it mostly discussed the risk of injuries* rather than being limited to fatalities or even critical/permanent injuries. Suppose you are an astute parent or advocate who has properly restrained your 24-month old child in the back of a newer minivan, according to the owner’s manual of a convertible carseat from our Recommended Carseats list. You actually read the instructions and discovered that it allows them to be either rear or forward-facing at their age, weight and height. You’d like to know the difference in risk of your child being killed or permanently injured. Sorry, that “5x safer” number doesn’t apply. Nope, not at all. We simply have no published and peer-reviewed research from recent years to provide useful statistics like this.

Rear-facing beyond 23 months old in 2002: Cool then and now!

Maybe Sweden is the answer, they have the data, right? After all, they keep kids rear-facing until around 4-years old and report nearly no fatalities to children of that age. Unfortunately, the nearly complete lack of children who are forward-facing in a 5-point harness system in Sweden means they also don’t have comparative statistics. Also, their environment is very different from North America, from the level of education about transporting children safely to the age and types of vehicles and carseats that are in use. Plus, their population as a whole does not travel nearly as many millions of miles on the roads as we do in the USA. So, it is essentially impossible to make valid comparisons of injury or fatality rates that can be attributed only to rear-facing.

We simply don’t know exactly how much safer rear-facing is in terms of critical injuries and/or fatalities for a properly restrained child in newer vehicles and carseats. We also don’t know at what age that the advantage of rear-facing starts to decrease for properly restrained children.

So, what do we know?  

Mythbusting: Legs bent or feet touching the backseat when rear-facing is dangerous

Welcome to our Mythbusters Series. Each week we will explore a new myth regarding kids and carseats.

Myth #2: My child’s legs will be injured in a crash if their feet are touching the back of the seat or if their legs are bent. 

This is a very common and very persistent myth.  Child Passenger Safety Technicians spend a lot of time talking to parents about this subject.

Diono Rainier - Clara  Kecia's DS2 rear-facing at 3 years old and 33 lbs

rxt-ds2-rf-2  Toddler rf close to 30* in 2008 Civic

CONFIRMED, PLAUSIBLE, or BUSTED?

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 often hit the hard center 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.”

This myth is definitely BUSTED.

Rear-facing for best protectionIMG_0798

RF in ETA  E rf side view

The video below is part of the curriculum for training new Child Passenger Safety Technicians. In the video, Dr. Marilyn J. Bull, MD, outlines the reasons why rear-facing is so important and also addresses the concerns many parents have about children with longer legs.

Last but not least, we should address the issue of comfort since that’s another big hang-up that adults seem to have with older kids.  The reality is that while *we* might not be happy if we had to sit this way for prolonged periods, kids will always find a way to make themselves comfortable. They might sit “criss-cross-applesauce”, or they might stretch their legs straight out and prop them up, or they might even dangle them over the sides of the carseat. Regardless of how they make themselves comfortable – they will find a way to be comfortable.

And remember – these kids didn’t wake up one morning with an extra 5″ of legs. Every day is the same as yesterday except maybe you’re a millimeter taller today. Kids don’t notice growing – and when they grow enough to warrant a shift in how they position their legs to sit rear-facing, they will make the adjustment without even thinking about it.

Do I look uncomfortable

 

 

Mythbusting: Once a 5-stepper, Always a 5-stepper.

While I may not be as intelligent as Jamie Hyneman, or as adorable as Kari Byron, I’ve been recruited back to CarseatBlog after a not-so-brief graduate school hiatus to do a little mythbusting—carseat style. So as a sort of geek-worship homage to Jamie, Adam, and the MythBusters crew—let’s get busting.

Myth #1: Once my child “passes” the 5-step test, they are done with boosters once and for all.

This myth comes straight out of my vast repertoire of personal experience as a mom of four.  This past Friday, I was recruited to drive my husband out of town for work.  While typically we would pile into the family minivan, it was a gorgeous Arizona day and I decided to take my 18 year old son’s little 5-speed Mazda.  Kyle’s little Mazda is great on gas and he has been safely transporting his 11 year old brother without a booster for the last few months, despite Aiden still needing a booster in our Odyssey.  As I reached the front door, I paused for a moment while Aiden’s old Paul Frank Clek Olli caught my eye over in the corner of the livingroom.  Should I…Should I not? It seems like just yesterday that Kecia outlined the 5-Step Test, using my oldest son Kyle as one of her models. Let’s do a quick review…

Kyle - 5-Step

Kyle – Passing the 5-Step Test, Circa 2009

Check…Check…Check…Check…Ut-oh.  While Aiden had been on some great adventures within our lakeside HOA community, his travels in the little Mazda had thus far been limited to a few miles here or there.  As I headed out the door for a two hour trek from Phoenix into Pinal County, I grabbed the trusty Clek Olli. In the minutes prior to arriving at our destination, a black cloud approached that would eventually result in one of the worst dust storms I have ever driven in.  Returning home with two sleeping kids, with highway visibility sometimes limited to 20 or 30 feet and in winds that were clocked at up to 60 miles per hour, I was confident in my decision to re-booster Aiden.  Because Aiden was never promoted to an adult seatbelt, returning to his booster didn’t seem like a demotion, either.

CONFIRMED, PLAUSIBLE, or BUSTED? I think that we can safely say that this myth is BUSTED. While your child may pass all five steps under certain conditions, longer drives, different cars, or other circumstances can change. And even though Aiden fits into the little Mazda seatbelt well, there’s no harm in him continuing to use an appropriately-fitting booster at this point. aidenprotegewm