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.
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?