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Why Rear-Facing Is Better: Your RF Link Guide

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Evidence-based justification for extended rear-facing

It’s all the rage among parents nowadays: extended rear-facing. If you’re turning your child to face forward before age 2, then you’re old-schooling it and increasing your child’s risk of injury in a crash. Many pediatricians still hold onto the now ancient recommendation of turning kids forward-facing at age 1 and 20 lbs., even though their own professional organization, the American Academy of Pediatrics, hasn’t recommended that since before 2002. You were probably in grade school then.

Why is it so critical for kids to stay rear-facing?

When you use the carseat right, it protects them and you from potentially being forever changed if you get into a crash.

Simple Physics Lesson

A carseat will always move toward the point of impact (Newton’s 1st Law). In a frontal collision—statistically the most common type of crash—the entire back of a rear-facing carseat will protect the head, neck, and spine of a child as it rotates down toward the front of the vehicle. Even in a side impact, which is a more serious type of crash due to its proximity to passengers, there is usually an element of frontal movement, such as a vehicle moving forward through an intersection, as it’s hit from the side. So a rear-facing carseat will rotate down and forward, then toward the side where the impact occurs.

Click each graphic to see the motion:

rf-physics-animation ff-physics-animation

Compare this to a forward-facing child in a harnessed carseat. In a frontal crash, the carseat still rotates down and forward toward the front of the vehicle, and the child will be flung forward into the harness and forward of the carseat shell. In a side impact, again the carseat rotates down and forward toward the front of the vehicle; the child comes forward into the harness and out of the carseat shell and there is rotation toward the vehicle door where the impact occurs. Because the harness is holding only the shoulders and hips, the head, arms, and legs are flung violently forward. If the harness is loose, which is one of the most common mistakes a caregiver makes, there’s a high likelihood of the child hitting the vehicle seat in front or the side pillar. According to this study, rear-facing children 12-23 months are 5.53 times safer in a side impact than forward-facing children and there’s no indication that safety magically disappears at 24 months.

Anatomy 101

The folklore is that a child’s neck muscles aren’t developed enough to keep a baby’s neck safe in a car crash, which is why they have to face the rear of the vehicle. I suppose that’s true in a way: it does take babies time to develop their musculature so they can hold their heads up to keep their airways open. But the muscles don’t protect the fragile spinal cord, which is the bundle of nerve fibers that forms the central nervous system and is connected to the brainstem. No amount of baby push-ups will strengthen your child’s muscles to the point of protecting his spinal cord.

The bones of the spinal column are what actually protect the spinal cord and in infants and young children; they aren’t completely fused together for years. One of the most important cervical bones, the Atlas (C1), is what attaches the head to the spinal column. Drawings show where it ossifies, or fuses, at varying times: the anterior arch fuses around age 7, while the posterior neural arches fuse around age 3. Before it fuses, the Atlas and Axis (C2), the 2nd vertebra that the Atlas nestles into, are made of bone and cartilage, which is very pliable. These two vertebrae are held in place by ligaments, which are very elastic (lax) to allow the child to grow.

atlas-side-view axis-side-view simplified-upper-cervical-spine

Studies of infant cadavers have shown that vertebral columns can stretch up to 2” but that the spinal cord is damaged after only ¼”. Given that a baby’s head accounts for ¼ of its total body size versus 1/7 an adult’s size, plus the immaturity of its vertebrae and laxity of the ligaments holding those vertebrae together, rear-facing seems the obvious choice.

The child’s large head shifts the fulcrum of movement, where the head swings forward, higher, elongating the spinal column and potentially causing catastrophic damage to the spinal cord. Before age 8, this fulcrum is in the upper cervical spine, at C2-C3. After age 8, the fulcrum shifts down to C5-C6, where it stays into adulthood. When you hear the term “internal decapitation,” it encompasses this movement of the upper cervical spine since the head swinging forward must happen in order for the ligaments to stretch and pull the head from the Atlas.

Another devastating injury that doesn’t show up on x-ray is called Spinal Cord Injury without Radiographic Abnormality (SCIWORA). This is when the spinal cord stretches because of the elasticity of the ligaments and cartilage in the spinal column. An x-ray will show normal bone alignment and no fractures, but the spinal cord may be irreversibly damaged. Remember that this bundle of fibers can only stretch up to ¼” before having catastrophic damage.

The evidence is clear. Rear-facing carseats protect the most fragile part of a developing child’s body: the head and spinal column. The American Academy of Pediatrics recommends rear-facing to a minimum of age 2 and instructs their pediatricians to counsel parents about rear-facing to age 2 and longer as the carseat allows. The National Highway Traffic Safety Administration (NHTSA) recommends rear-facing  as long as possible.

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The American Academy of Pediatrics (AAP) has recommended since 2002 that after age 1 and 20 lbs., children should ride in a rear-facing convertible seat until reaching the weight limit of that carseat. They amended that policy in March 2011 to recommend rear-facing to age 2 or until they reach the “highest weight or height allowed” by that convertible carseat.

 

Note how the legs fly away from the back of the vehicle seat during the test. In the forward-facing seat, the properly secured dummy bends nearly in half during the crash test. Photo courtesy Kathy Weber, ret., UMTRI, and SafetyBeltSafe USA.

Note how the legs fly away from the back of the vehicle seat during the rear-facing test on the left. In the forward-facing seat, the properly secured dummy bends nearly in half during the crash test.  Photo courtesy Kathy Weber, ret., UMTRI, and SafetyBeltSafe USA.

Forward-facing children under the age of 2 are 75% more likely to be injured.  (Car Safety Seats for Children: Rear Facing for Best Protection

Here’s an article showing why children up to the age of 2 are more than 5 times safer riding rear-facing.  (Rear-Facing Car Safety Seats Getting the Message Right)

SafetyBeltSafe USA’s opinion on how long children should ride rear-facing. (How Long Should Children Ride Facing the Back of the Car?)

After reviewing studies from the U.S. and Sweden, a study published in the highly regarded British Medical Journal advises keeping children rear-facing until age 4.  (www.bmj.com/cgi/content/full/338/jun11_2/b1994?view=long&pmid=19520728)

Leg injuries account for 28% of significant injuries faced by forward-facing children in crashes  (Jermakian, J.S., et al. “Lower Extremity Injuries in Children Seated in Forward Facing Child Restraint Systems.” Traffic Injury Prevention 8 (2007): 171-179.)

This analysis shows how leg injuries are common among forward-facing children (Bennett, T.D., et al. “Crash Analysis of Lower Extremity Injuries in Children Restrained in Forward-facing Car Seats During Front and Rear Impacts.” Journal of TRAUMA® Injury, Infection, and Critical Care 2006;61:592-597

A tightly installed rear-facing carseat allows the vehicle and carseat to absorb crash forces and increases “ride down,” the amount of time it takes a body to come to a stop in a crash.  The longer the ride down time, the less chance of injury.  (http://www.car-safety.org/rearface.html)

Rear-facing carseats provide excellent protection in side impacts as well.  Because there’s usually a vehicle moving forward, as through an intersection, that element of forward motion can easily throw a child’s head clear of the carseat if he’s forward-facing.  If rear-facing, his head will stay protected inside the carseat.  (http://www.carseatsite.com/rf.htm)

Infants and young toddlers have spines made of soft bone and cartilage that doesn’t begin to harden until around age 3.  As a result, the spinal column can stretch up to 2 inches; however, the spinal cord will rupture after being stretched after only ¼ inch.  This damage cannot be repaired.  (http://www.carseat.org/Technical/tech_update.htm#rearfacFF)

Evenflo is now requiring that children be age 2 before forward-facing in their convertible and combination carseats.
 

Approximately 75% of kids in Sweden rear-face until at least age 4.  From 1999-2006, only 4 rear-facing children under age 4 were killed in crashes and their deaths were due to circumstances unrelated to the direction the carseat was facing (fire, drowning, excessive intrusion).  During that same timeframe, 6 kids under age 4 facing forward in booster seats were killed; 3 of these crashes were potentially survivable crashes had the children been in rear-facing carseats.  (http://www.bmj.com/cgi/content/full/338/jun11_2/b1994)

Anecdotal evidence suggests that infants around ages 10 mos.-18 mos. enter a fussy stage that makes it difficult to put them into any carseat, rear- or forward-facing.  Many parents prematurely switch the rear-facing carseat forward-facing thinking that the child is objecting to riding rear-facing, when the child is objecting to being restrained at all.  Visit the Car Seat Safety forums at www.car-seat.org and you’ll hear from other experienced parents regarding this phase.

The above video shows how the dummy stays contained in the seat during a rear-facing crash test.  The tape on the dummy’s head is for measurement and doesn’t affect its head during the test.

This video is the companion video to the one above and shows a side view of the crash test.  Note how little the head moves.

The above video shows a properly installed forward-facing seat.  Note the seat belt stretch and how far forward the dummy bends.

The above video from Norway shows the differences between rear- and forward-facing carseats in an animated crash.

The above video from the Buckle Up Brutus at Ohio State University demonstrates the difference between rear-facing and forward-facing in crash tests.

If you need more convincing, take it from Dr. Marilyn Bull, a noted pediatrician from one of the country’s best pediatric hospitals, Riley Children’s Hospital in Indiana. This video was produced for, and used in, the current Child Passenger Safety Technician course.

Vehicle crashes are the number 1 killer of children.  Protect your children to the best of your ability.  Follow best practice.

Britax Recalls B-Agile and BOB Motion Strollers

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Britax, in cooperation with the U.S. Consumer Product Safety Commission (CPSC), Health Canada, and Profeco (Mexico), is conducting a voluntary recall of all Britax B-Agile and BOB Motion stroller models listed below.

When used as a travel system with the Click & Go receivers to attach the carseat to the stroller frame, the receiver mount may be damaged and cause the carseat to disengage unexpectedly and fall. If the carseat falls to the ground, the child may be injured.

Model numbers for single strollers are located on the inside of the stroller frame near the right rear wheel. For double strollers, it’s located on the front middle underside of the frame. Models affected:

B-Agile

S01298600 S01298700 S01635200 S02063600
S02063700 S02063800 S02063900 S02064000
S03803400 S03803500 S03803700 S03803800
S03803900 S04144400 S04144500 S04144600
S04144700 S04144800 S04144900 S04145000
S04183700 S04183800 S04184000 S04281200
S04281300 S04402800 S04437700 S04628500
S04884200 S04884300 S04884400 S04884500
S04975600 S04978900 S05060600 S05260200
S05511600 S05511700 S865800 S865900
S874300 S874400 S874500 S877200
S890100 S896000 S896200 S896600
S907200 S907300 S907400 S907500
S907600 S910200 S910300 S910400
S910500 S912300 S914300 S914500
S914700 S914900 S915200 S915400
S917400 S921800 S921900 S923700
U341763 U341764 U341782 U341783
U341825 U341826 U341828 U341X82
U34X782 U361763 U361818 U361819
U361825 U391875 U451835 U451837
U451841 U461763 U461764 U461782
U461783 U461825 U461826 U461828
U471818 U471819 U491842 U491843
U491844 U491908 U491909 U491910
U511875 U511877 U551835 U551837
U551841 U551861 U551862 U551863
U551864 U551865 U551905 U551906
U691878 U691879 U691881 U691882
U691884 U691904 U691905 U721895
U721896

 

BOB Motion

S888600 S890200 S890300 S890400
S890500 S909700 S910600 S910700
S910800 S910900 S912600 U391820
U391821 U391822 U481820 U481821
U481822 U501820 U501821 U501822
U501907

What should you do:

  • Stop using the carseat on the stroller as a travel system IMMEDIATELY. It is completely SAFE to continue using your stroller in the recline mode for infants though.
  • Go to www.us.britax.com/recall or call 1-844-227-0300 to request a free repair kit that contains a new set of Click & Go receivers and instructions.

Manufacturers—It’s Time for You to Step Up

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Emma in NautilusIn 2011, the American Academy of Pediatrics changed their rear-facing recommendations to age 2 or until the highest rear-facing weight or height limit of the child restraint has been reached. Shortly after, the National Highway Traffic Safety Administration also changed their policy to show that rear-facing is safest for kids up to the limits of their rear-facing carseats. While the two policies aren’t quite in line with each other as far as limits go, what’s clear is that at the very least, kids should stay rear-facing to age 2.

It’s been 6 years now since those recommendations changed and I’d say most parents have heard of them. Some want to stick their heads in the sand and pretend like they didn’t hear them because they want their kids to see them eat their mom snacks or because they think their kids’ legs are twisted up and uncomfortable, and for others, it’s truly a new discovery. We have 4 states—New Jersey, Oklahoma, Pennsylvania, California—where it’s the law that children must stay rear-facing until at least age 2, and 5 other states where bills have been proposed in state legislatures to make it formal. This is real.

So, manufacturers, what’s the problem?

Caregivers are getting conflicting messages and it’s confusing the bejeezits out of them. I know—how could this possibly be confusing when we have a 6 year old recommendation and even laws coming out to enforce the safety aspect of rear-facing? It seems clear-cut.

First, I want to say manufacturers have been giving us great seats lately. Really awesome seats! I can’t think of a better time in the last 17 years that I’ve been in carseats that I’ve seen such a great selection and if I had a kid in a carseat, I’d probably be switching them out on a daily basis. The manuals have improved so much too! Sections have been reorganized, color-coded, and written at a lower grade level so you don’t need to have a graduate level college degree to understand it.

Let’s get into the confusion by talking about these awesome infant seats on the market (technically we’re supposed to call them rear-facing only seats). They go to 35 lbs. or 40 lbs. and can hold kids who are no longer infants (see why we’re supposed to call them rear-facing only seats?). A mom who has a 30 lbs. 32” 19 mo old may think that her son is big enough to go straight into a Graco Nautilus because the box on the forward-facing only Nautilus says it fits children in a harness from 20-65 lbs. (and, after all, it’s “the last car seat you’ll ever buy”). There’s no mention on the side of the box, or in the manual, that the Nautilus is not an appropriate carseat for a child under age 2. Besides, after a caregiver has gotten a carseat home and unboxed is not the time to read in the manual that the carseat is not an appropriate model for their child.

graco-nautilus-front-of-box graco-nautilus-bottom-of-box

Graco isn’t the only manufacturer. Dorel (Safety 1st, Cosco, Maxi-Cosi, Eddie Bauer), doesn’t put age recommendations on their packaging and in fact, rescinded their stance on rear-facing to age 2 that they had on several convertible models (it’s complicated). Evenflo is in the process of converting their line to an age 2 minimum for forward-facing, but that takes time to trickle down; they say it should be completed by this summer. Britax is the only manufacturer currently with text on the side of their combination seat (harness seat that converts to booster) boxes that says the seat has an age 2 minimum.

britax-pioneer-bottom-of-box graco-nautilus-80-elite-top-of-box baby-trend-hybrid-top-of-box evenflo-maestro-top-of-box

I’m not asking for much. A simple “Recommended for ages 2+” on the side of the box next to the weight limits on every combination seat would cover it. It doesn’t change the company’s overall philosophy or policy and would let caregivers clearly know the seat isn’t appropriate. Similarly, convertible seat packaging could have wording on the side next to the weight limits that says, “Recommended for ages 0-2+, 5-40 lbs.,” “Recommended for ages 2+, 20-65 lbs.,” and so on.

Labeling on the sides of restraints has improved so much in the past several years. Wording has been simplified and bright colors are being used. It’s time to make text on the boxes practical so parents aren’t stuck buying inappropriate carseats that could put their children at risk.

4moms Recalls Self-Installing Car Seat

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4moms4moms is issuing a recall on its self-installing carseat manufactured between July 1, 2016 and October 31, 2016. The recall affects about 2% of 1,622 carseats, or about 33 carseats, manufactured during this time. There have been no reported injuries at this time.

On some carriers, the coupling hooks that lock the carrier into the base have been improperly riveted, potentially causing them to stick and not attach to the base. The coupling hook failure has only been observed after extended use and testing. Again, there have been no reported injuries.

Fix: 4moms will send owners a new carrier starting January 13, 2017

What should you do: Visit the 4moms recall site to see if your carseat is affected. You can continue to use your affected carrier until you receive the new one.

  • Check to make sure the carrier is locked into the base by pulling up on the handle after the carrier is placed into the base. If it isn’t locked into the base, then . . .
  • Install the carrier without the base. The carrier can be installed “Euro style” as shown by Kecia in this video (demonstrating on a Nuna Pipa):

 

If you have other questions, you can call the 4moms Customer Care Team at 1-888-614-6667