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We’ve recently returned from the Kidz in Motion (KIM) Conference, which is the National Child Passenger Safety Conference, where we had a chance to talk with the very experts who help to shape policy on rear-facing. An open forum was added to the conference schedule at the last minute to address the current status of research on which the American Academy of Pediatrics’ rear-facing to age 2 policy is based. The original study from 2007 claims that rear-facing to age 2 is five times safer; however, Dorel commissioned a review of the study that shows those statistics to be in error. We now have a better idea of what’s going on with the recent Dorel policy statement, where they removed language from their labels and instruction manuals requiring children to remain rear-facing in their convertible seats until age 2.

Dr. Ben Hoffman MD FAAP CPST-I, Chair of the AAP’s Committee on Injury, Violence, and Poison Prevention, led the session and stated that the AAP is not making any changes to their rear-facing policy right now. Jeya Padmanaban, the author of the new research, who found the errors in the original study, has submitted her research to an unknown journal and we are all waiting for it to be peer-reviewed and published. Dr. Hoffman said the AAP is closely monitoring the situation but has no inside information on when, or even if, publication may happen. And he’s the guy who would know.

There was a discussion of research currently being done in the area of child passenger safety and it’s pretty slim. As we all know, money has dried up. Years ago, State Farm had an excellent partnership with the Children’s Hospital of Philadelphia (CHOP) where they pulled data from State Farm’s customers. That program, Partners for Child Passenger Safety, ended a decade ago. CIREN is another network where data from level one trauma centers was analyzed in conjunction with biomechanical engineering teams. The last data set from that program is dated 2015. That’s not to say there aren’t currently any studies being made and progress being made in CPS. It’s just that data to focus on injuries to RF children exclusively isn’t being collected.

The panel did discuss Sweden, since it’s a popular comparison country because of its low crash injury rates for children. All agreed that because of the way their carseats are engineered and installed, we can’t compare the U.S. to Sweden. Their vehicle fleet is newer and different, their roads are different as are the miles driven. They also don’t use forward-facing carseats with a harness so there is no way to compare the effectiveness of RF seats to FF seats in that country. From a pediatrician’s perspective, Dr. Hoffman contributed that their entire healthcare system sets them up for different crash outcomes because they may start out healthier.

The big take-home message of the session was that when used and installed properly, carseats are doing an amazing job of keeping children safe, no matter which direction they face.

What to Do

  • Keep your child rear-facing until age 2
    • Stay the course until/unless it’s proven to change
    • There’s no evidence currently that RF until 2 is harmful
    • Some carseats and some state laws require it
  • Don’t say “It’s 5 times safer to RF to age 2”
    • That’s the statistic that’s being called into question
  • After 24 months, it’s a parental choice when to turn
    • We simply don’t know if it’s safer to RF after age 2. Yes, it seems logical that it should be safer, but there are other variables in the vehicle crash environment.
    • If you choose to RF after age 2, make sure to snug up the harness so you can’t pinch any webbing above the chest clip and put the seat in its most upright angle as the manufacturer allows

At this point in the research, there are more unknowns than knowns and we’re definitely in a holding pattern waiting for that revised journal article to come out. There’s no doubt that Dorel’s statement came at a damaging time when states are passing laws requiring rear-facing to age 2 based on what turned out to be a flawed study. We’re in shock as much as the original authors are, as they didn’t set out to mislead anyone. They are all highly qualified researchers in their fields with professional reputations to uphold.

Just as I say to all my child passenger safety technician candidates in tech class: “Never say never in CPS. It’s an ever-changing field with no absolutes.”