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Safety Archive

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

 

Distracted Driving

textingdrivingI had to run some errands today, the first of which involved getting on the freeway. I don’t particularly like merging onto this freeway because it’s a two-lane feeder and I either get blown off the road by someone going well over the speed limit or stuck behind poke-along-Stanley. Today it was poke-along-Stanley going 10 mph under the speed limit, made extra frustrating because he had his cell phone butt 4” away from his mouth talking speaker-phone style, selfishly oblivious to the fact there were cars around him.

My state has had a hands-free law for a year and a half now that is widely ignored. With a first offense penalty of $50, why not? The real cost comes from the time lost it takes to actually be pulled over to receive the ticket. Only after the third offense does the fine become $250, a bit more painful. According to authorities, ticket-writing has gone up 93% this year over the same time period last year. Ninety-three percent! And I still don’t go through an intersection without seeing at the very least 3 drivers using their cell phones in some manner. No one can say why drivers are still ignoring the hands-free law, other than they simply don’t see it as a deterrent. Apparently it’s easy to gripe about how poorly everyone drives while using their cell phones, yet still continue to practice the bad habit.

It’s been shown that using a cell phone while driving reduces concentration on driving by 37%. That’s a little over a third for those of us who aren’t mathematically inclined. Imagine taking a test in school and having a third of your score chopped off. That’s an automatic D on your test right there. Is anyone really satisfied with a D on a test?

Twelve states and the District of Columbia have primary enforcement hand-held cell phone bans. Thirty-seven states and D.C. ban all cell use by beginning drivers, though only 20 states and D.C. ban it for school bus drivers. Shouldn’t all states ban school bus drivers from using cell phones? That’s a pretty scary statistic. The picture of a school bus driver chatting away on her cell phone while pandemonium breaks out behind her isn’t a pleasant one. And hang out on a corner next to a high school when it gets out for the day and you know that new drivers aren’t staying off their phones: 71% of teens have typed text messages while driving and 78% of them have read one while driving. Now those are scary statistics!

How many of us have seen what we thought for sure was a drunk driver, weaving in and out of a lane, only to catch up toCell-Stop-Sign-10x15 see it was a texting driver? Forty-three states and D.C prohibit texting by drivers. That doesn’t seem to matter much to the texter, though. They just have to get that message sent, regardless of how many lanes they take up or how many lives they take in the process. Someone who is texting is 23 times more likely to be in a crash than someone who is not distracted by texting.

We can preach all we want about not using our cell phones and not texting and driving, but it’s time to get real and own up to it.  One option is a portable hands-free device, like the one Darren reviewed recently.  My Acura MDX has a Bluetooth feature that I make use of so I don’t need to touch my phone while I drive, but it’s still clunky trying to find someone in my phonebook to make a call.  If I have to make a call, I pull over. It’s that simple. To answer a call, it’s a push of a button—much easier. I’m fortunate that I don’t get many calls on my cell, maybe one every other month when I’m in the car. I used to text only at red lights while my brakes were applied, but I decided I didn’t like that feeling of not knowing what was going on around me. They were always quick texts: “on my way,” “what do you want at store,” that kind of thing. But even though I was stationary, I was still distracted. A driver should always be scanning the roadway whenever the car is near others. Besides, the real point is to be a good example for my kids. They aren’t in the car with me much anymore, but when they are, I don’t want them seeing me using my phone. I’ve never been a “do as I say, not as I do” kind of parent and I’m not about to start with my cell phone. My rule-following son won’t be a problem; my daughter, on the other hand . . . We may have to invest in some in-vehicle cameras. That will no doubt be fodder for another blog in the future.

There are lots of resources I plan on sharing with my kids when they start to drive, and that’s coming sooner than I’d like to think. NHTSA has distraction.gov where you can find out your state law on cell phone use, research, a pledge you and your kids can take, and survivor videos. AT&T has the It Can Wait no texting and driving campaign. If you have an Android phone, AT&T offers 2 free apps called AT&T DriveMode and Safely Go. AT&T DriveMode sends a customizable response to incoming texts letting your friends know you’re driving. Safely Go auto-replies to texts and auto-sends your calls to voicemail. Let’s not forget that AT&T has the “From One Second to the Next” documentary that follows 4 survivors of texting-causes crashes that will change your view of “yeah, but it’s only a quick text” forever. Impatience has gotten the best of me at times, but this is definitely one area where I keep the phone down. It’s not worth it. Is it worth it to you?