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.”
Thank you for the kind remarks, teeka! We agree, and don’t give up hope just yet:-)
These concerns about the 2007 Henary/Sherwood/et al. study on rear-facing are not new. Back in 2008, the study was presented at child passenger safety conferences. A few of us had concerns at the time, even extended rear-facing advocates like me. For one, the study wasn’t using the FARS fatal crash database that, at least at the time, had much better reporting than injury databases. Second, there was an unusual outcome that babies 0-12 months old were nearly as safe forward-facing as rear-facing. When we asked about inconsistencies, the response from the authors always had to do with small samples sizes, the inclusion of injury data sets and limited information on misuse.
Indeed, we covered this topic a few years ago when the prevalence of misused and out of context “5x safer” statements became so common on social media that it was impossible to explain correctly, even to technicians and advocates. See: https://carseatblog.com/28995/ . The fact is that in terms of fatalities or even “critical” or “severe” injuries, there just aren’t enough of them to provide any statistically significant real-world data.
As for head injuries, the types of injuries that can occur in rear-facing child restraints have been documented for decades. It was even presented along with the rear-facing study in conference sessions back in 2008. For example, take a close look at the chart derived from a presentation by Dr. Marilyn Bull from the American Academy of Pediatrics: https://carseatblog.com/34/
So, what does this all mean? We still know from physics and crash dynamics that rear-facing protects the head and spine from many types of injury that can occur to forward-facing children. What we didn’t fully grasp 10 years ago was how common other types of head injury are for rear-facing babies, especially those nearing the height limits of their seat or with other types of misuse. If you can mitigate those possible causes of head injury, you can still reap the proven benefits of rear-facing from potentially more serious types of head and spine injury. We tell you how here: https://carseatblog.com/43058/
And finally, the vehicle fleet used in a 10-year old study is nearly obsolete and the carseats lag behind today’s models as well. If you have a newer vehicle with the latest safety features and good crash test ratings, combined with a newer carseat with side impact protection features, you install it and use it correctly, and you drive unimpaired and undistracted, then these studies are *absolutely meaningless* in your situation. Your child will be extremely well protected and has a very, very low risk of severe or fatal injury in a crash if you take these steps.
As a side note to our readers, the editors here at CarseatBlog have considerable knowledge and experience in child passenger safety. Not only in practical terms as moms and dads, but we also understand the technical stuff and have a vast amount of information from conversations with crash testing experts and researchers, too. We do our best to relay our insight to readers without causing panic, but we do want to convey that sometimes even experts who publish these studies can get it wrong. If that turns out to be the case with the “5x safer” rear-facing statistic, we won’t be surprised. But we still think that rear-facing has proven benefits for parents and advocates who take the time to mitigate the risks!
Very interesting. Thanks for making this so accessible to the public. I am way past the rear-facing years so no horses in this race, but I do selfishly admit I will be sad if very extended rearfacing goes extinct. It was the best parenting hack! I could be a a car seat sanctimommy all while enjoying my oreos in peace since my kid couldn’t see to mooch. And the kids slept SO WELL on long drives. ERF felt like the only “me time” I got some days. But I know extended rearfacing has been considered a cause of hot car deaths, so this news combined with the HOT CARS legislation seems a bit like a changing of the guard in car seat best practices.