Parenting Archive

Rear-facing is no longer 5x safer. Really?

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You may have heard that the American Academy of Pediatrics (AAP) recently updated their recommendations on rear-facing. As usual, there’s some good news and some bad news. As with our carseat reviews, we will discuss both the good and the not-so-good and try to offer some perspective lacking in national news coverage of this update.

The Good News: The basic recommendation for rear-facing has NOT changed. “The Academy continues to recommend that all children ride in a rear-facing car safety seat as long as possible, up to the manufacturer’s stated weight and length limits.” This updated guidance from the AAP now better matches NHTSA’s policy for consistency in messaging. The authors of CarseatBlog have strongly supported Extended Rear-Facing (ERF) for over 15 years and continue to support this practice.

ERF in 2003 – now off to college!

The Bad News: As we reported a year ago, a major study from 2007 was found to be flawed. This study was the main source of injury data to compare rear-facing child restraint systems (RFCRS) to forward-facing child restraints (FFCRS) in the USA, for children up to 23 months old. It was also the basis for the erroneous ‘Rear-facing is 5x safer’ statistic. Newer research found some contradictory data, causing the original study to be retracted. A revised study, by some of the authors of the original 2007 study, concluded, “Non-US field data and laboratory tests support the recommendation that children be kept in RFCRS for as long as possible, but the US NASS-CDS field data are too limited to serve as a strong statistical basis for these recommendations.” This led to the evolving AAP advice that, “…while the trend was for rear-facing to be superior to forward-facing for children under 2 years, the numbers were too low to reach statistical significance.” Definitely not as compelling as 5x safer.

More Good News:  The reason there is no significant real-world information is because the sample size of injuries to children in car seats is so low during the 22 year study period that there simply isn’t enough data to compare rear-facing to forward-facing conclusively. In fact, all these studies included less than severe injuries just to do an analysis, because there are so few data points for severe/fatal injuries to kids in child restraints. According to the revised study, “NASS-CDS data indicate an extremely low injury rate in children up to 2 years of age in both RFCRS and FFCRS. It turns out that both rear-facing and forward-facing car seats do a very good job of protecting children within the relevant age/weight/height limits!

Because the real-world injury data in the USA no longer supports that rear-facing is significantly safer for kids up to 23 months old, the AAP removed the portion of their policy statement recommending that kids remain rear-facing until at least 2 years old. Also, since the original study is retracted, we have to pretend that it never existed. Therefore, we can no longer claim that rear-facing is proven to be five times safer than forward-facing. We can’t even say that statistics prove that rear-facing reduces the real-world risk of serious injury for kids up to 2 years old [or to any age] in the USA.  On the plus side, the 2011 AAP policy on rear-facing to at least age 2 led to a lot of awareness about the safety advantages of rear-facing.

Let’s take a step back and examine the most recent AAP policy statements to put these minimum age recommendations in perspective. Fundamentally, the policies on rear-facing haven’t changed, except for the inclusion of minimums. For over 15 years, the AAP has continued to recommend that kids remain rear-facing to the limits of their car safety seat. In essence, “as long as possible.”

AAP 2018: All infants and toddlers should ride in a rear-facing car safety seat (CSS) as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer. Most convertible seats have limits that will permit children to ride rear-facing for 2 years or more.

AAP 2011: All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their CSS.

AAP 2002: Children should face the rear of the vehicle until they are at least one year of age and weigh at least 20 lb. Infants younger than one year who weigh 20 lb should still face the back of the car in a convertible seat or one that is approved for higher weights. For optimal protection, the child should remain facing the rear of the car until reaching the maximum weight for the car safety seat, as long as the top of the child’s head is below the top of the seat back.

Clearly, this is not the end for extended rear-facing. The retraction of the main study supporting ERF in the USA is indeed a big loss, but not a total surprise because this study had known flaws long before this retraction. Again, the fundamental guidance HAS NOT CHANGED. We still recommend kids remain rear-facing, preferably for 2 years or longer if they are within the rear-facing height and weight limits of their carseat. In particular, parents should pay close attention to the seated torso height limit of the rear-facing seat (which typically requires 1″ or more of shell above the head).

As always, we like to remind parents that these recommendations from the AAP are safest practice guidelinesThey aren’t rules or laws. The rules a parent must follow are those printed in their car seat and vehicle owners manuals, on the car seat labels and in any relevant state law. CarseatBlog endorses the AAP guidelines for added safety. We also like to offer perspective by looking at the BIG picture. The biggest reductions in risk come from the following simple steps:

  1. Drive unimpaired and undistracted
  2. Keep all passengers properly restrained according to the instruction manuals and state law
  3. Kids under 13 years in an appropriate rear seating position

So please, buckle up and drive safely!

See our Rear-Facing Links Guide for additional information.

How far is too far?

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I understand that we’re all passionate about safety. And at some point or another, most of us have had to deal with criticism from friends or family members who think we’ve taken this whole car safety thing too far and just gone right off the deep end. Usually, we just brush off these ignorant remarks because deep in our hearts we know that we’re right and obviously they just don’t get it. We’re aware of the fact that MVC’s are a leading cause of death to children in the U.S. and we’re all determined to protect our children to the best of our abilities. That’s our job as parents and caregivers and we all take that responsibility very seriously. I understand that, I really do – because I’m right there with ya.

But how are we to know if we’ve really gone too far? Certainly, our safety-addicted friends at the car-seat.org forum would never stage an intervention on our behalf. And our spouse would probably rather walk across hot coals than incur our wrath by suggesting that maybe, just maybe, we’re being a bit too extreme.

So, who’s gonna give it to ya straight and tell you when it’s time to chillax? Who’s going to remind you that you can’t save the world and completely eradicate all injuries to all children in MVCs – no matter how desperately you want to? Who’s gonna tell you when it’s time to step away from that vehicle in the Walmart parking lot because clearly you’re not dealing with an appreciative and open-minded victim?

I will.

However, the first step to getting help is to admit that you have a problem. Don’t think you have a problem? Get in line. And while you’re there – take our short survey:

1. Do you find yourself repeatedly trying to talk your sister-in-law into buying a Graco Extend2Fit to rear-face your tiny 7-year-old niece?

2. When you go grocery shopping do you spend 20 minutes thinking about the most appropriate way to secure those projectiles for the ride home?

3.  Have you purchased more carseats for other people’s kids than you have for your own children?

4.  Have you ever considered gluing sheets of EPS foam to the rear windows of a vehicle that doesn’t have side curtain airbags?

5.  Do you lose sleep thinking about your neighbor’s child who is 5 years old and rides in a backless booster?

6.  Do you respond “ABSOLUTELY”, when someone posts an online poll asking whether you would put a small, immature 13-year-old back into a 5-point harness?

7.  Have you ever refused to ride the monorail at WDW because you considered it too risky?

8.  Do you have anxiety attacks when you see properly restrained forward-facing 2-year-olds?

9.  Do you always remember to secure your purse with an available safety belt?

10.  On Halloween, do you hand out copies of the 5-Step Test flyer instead of candy? (If you hand out the flyer WITH candy – that doesn’t count as a yes.)

If you answered yes to more than 1 question above – please do yourself a favor and go volunteer some of your time at carseat check events in the lowest, low-income inner-city area you can find within driving distance.  If you don’t have any impoverished inner-city areas within driving distance, then a rural, migrant farm worker community will suffice.  All kidding aside, these are the types of places where your knowledge, passion, and dedication to Child Passenger Safety are desperately needed.  And seeing the frightening reality of how these children ride around every day will really help you to appreciate the beautiful sight of a properly restrained, albeit forward-facing, 2-year-old.  Everything in life is relative and a healthy perspective will keep you focused on the bigger picture – and help you avoid going off the deep end in the process.

~Kecia

Jack of all trades, but master of none.

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I hear the term “jack of all trades” used a lot. But people always leave off the “master of none” part which, at least when I’m applying it to myself, is the most accurate part. You’ve probably heard the term applied to the Alpha Omega car seat, or any of it’s clones. Tries to be a lot of things, and pretty much sucks at all of them. I’m like the Alpha Omega of the mom world.

Most days it feels next to impossible to have two jobs: mom and work out of home mom. Heck, being mom in general is next to impossible some days. Or most days. Or all of them. Really.

You literally spend your whole day giving yourself to someone else. Not just your care but your soul and emotions. Then on top of that, you attempt to maintain some sort of living environment while they ransack and destroy every futile attempt you put forth. It’s something you never really feel adequate at, even though you’re doing your best.

I work weekends as a nurse, and it’s basically déjà vu but with adults. I go to work and spend my whole day putting others’ needs before my own. I don’t eat, I don’t pee. I get yelled at, hit, things thrown at me, and spend lots of time teaching and bargaining. “Please stop smoking. If you stop smoking, maybe you won’t die!” sounds a lot like “Please stop jumping off the top of the playset. If you stop jumping off the playset, maybe you won’t break both your ankles!” There’s lots of poop and bodily fluids and tears involved. And hugs. The hugs that make you mind the other stuff a little less.

The problem is, I always feel like I can’t put my whole effort into both. At home, I’m constantly on the phone about work stuff, or counting down the days till I have to drag myself back there. I snap at my kids when I’m going through work emails (I work in management as well as bedside nursing so work often does come home with me) because I’m frustrated. I don’t see much of my older son as he’s in school all day and by the time we get home from school pick up at 4pm, we don’t have time to go do anything because I have to make dinner and my kids go to bed at 7pm. I miss their weekend ball games, all the fun family events, festivals, and time with my husband.

When I’m at work, I don’t put 100% because I just want to get home to my family. I think about my kids, wonder how their games are going, wish I could give my husband a hand in the yard. I snap at my coworkers because I’m frustrated at what I’m not doing. I don’t always finish the things I should finish because I just want to get home and relieve the guilt of ignoring the kids during the week because I was thinking about work.

It’s a catch 22 really, and I feel like I don’t do anything well. Sometimes I feel like I can’t make anyone happy, including myself. The guilt is overwhelming, especially when you see other moms holding down full time jobs and seemingly rocking it. Unfortunately in this day and age, it’s hard to get by on one income. We’ve done it for years but we felt like we weren’t giving our kids enough and with both of us working, we have opportunities to go do fun things instead of not being able to because we are living paycheck to paycheck. However, working opposite schedules, we don’t really have time to do those fun things. And then apparently on top of all that, I’m supposed to eat healthy, exercise, be involved in my kid’s school, have friends, and make time for myself.

So what’s the answer? I don’t know. It’s probably family specific, and what works for us won’t work for everyone and vice versa. But how do you make it work emotionally? How do you feel satisfied with what you’re doing? How do you not feel stretched thin and still not successful? If anyone has the answers, please let me know. Otherwise, I’ll chalk it up as one of those eternally unanswered mom questions. How do we do it all, and do it well?

You Asked: When is the right time to move to a booster?

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A few weeks ago, I wanted to write something but no matter how long I stared at my computer, I couldn’t come up with anything interesting to write about. After an embarrassing amount of time, I took to my social media channels and asked my friends what their top car seat question was. I found a lot of commonalities among the things people offered up because there are definitely some areas of car seating that are more difficult than others, but there was a wide variety of things people want to know more about. And after looking through the responses and sitting on it for a bit, I’m going to use those suggestions (and new ones that come along), to launch a new series of articles.

I decided my first “You Asked” post would be whichever topic came up the most from my friends, and the result ended up being one of the questions I get most often in person from friends and family, so it feels right to start here.

You Asked: When is it time to switch to a booster?

I think boosters are confusing because all the seats you’ve used up to this point have been sort of similar. They all install in a relatively similar pattern, the way you secure your child is consistent, but then you get to boosters and they don’t install the same way and they don’t work the same way and it’s just hard to know if you’re doing it right. As a parent who is starting to booster-train for the first time, I feel this confusion first hand.

So let’s start with a little terminology. A booster, or belt-positioning booster, is a car seat that does NOT use a built-in harness, but instead uses the vehicle seat belt to restrain the child. There are products that refer to themselves as a “Harnessed Booster” or “Harness-to-Booster” and we call those types of seats “combination seats” because they combine a forward-facing seat that has a 5-point harness with a booster seat. Those are 2 completely different modes of use. If you are using a combination seat with the 5-point harness for your preschool-age child, that’s perfectly fine. Technically, it’s not a booster (even if that’s what the product name implies) unless you are using it in booster mode without the harness.

Most booster seats (or combination seats used in booster mode) have either a 30 or 40-pound weight minimum, a height minimum and an age minimum of 3 to 4 years, generally speaking. Unlike a harnessed seat, which restrains the child with a built-in 5-point harness, the booster is used to literally boost the child up so that the adult seat belt fits properly on the strongest parts of their body – the pelvic bones and collar bone. A good belt fit means the shoulder belt lays flat across the middle of the collar bone and the lap belt lays across the thighs and off the belly.

Now, I realize I just said that 3-year-olds can use boosters, but I want to stop here and clarify something. While some boosters do not list a specific age minimum, and others list age 3 or 4 as the minimum, it is my opinion that dedicated booster seats are not appropriate for 3-year-old children. I am currently raising my second 3-year-old and I’ve spent a pretty extensive amount of time around 3-year-olds and let me let you in on a secret: they are not known for excellent decision making. They just aren’t. My first child was probably one of the most compliant and calm 3-year-olds and even he lacked the frontal lobe development to make the kind of choices that a booster requires a child to make. Putting your 3-year-old in a booster might be legal in some states and with certain products, but it’s not a great idea unless you don’t have any other options.

I put my current 3-year-old child in a booster for less than 2 minutes to take a picture of him and I told him to sit still. This is a progression of what took place in those 2 minutes and it perfectly illustrates the issue:

   

Here’s the thing: boosters require maturity in a way that a 5-point harness doesn’t. A 5-point harness holds your child in the safest position without any effort on your child’s part. In a 5-point harness, your child can fall asleep, can reach for something next to them, can do any number of attempted gymnastics and assuming you have installed the seat well and buckled them correctly, they will still be just as safe. A booster, on the other hand, allows the child a lot of freedom of movement. It allows slouching, it allows toppling over when asleep, it allows them to tuck the shoulder belt behind them and it allows them to lean forward to pick toys off the floor, all the things my 3-year-old did in a matter of 2 minutes. But unlike in a harness, all of these scenarios in a booster are seriously dangerous. A booster only works to keep your child safe in a crash when the seatbelt is positioned properly on the child. So, if you can’t trust your child to sit upright for an entire car ride, even when asleep, they shouldn’t be in a booster. Period.

You can safely keep your child in a 5-point harness until they outgrow it by height or by weight, so there’s not a rush, no matter what anyone else is telling you. There’s no evidence (trust me, I’ve looked for it), that keeping a 6 or 7-year-old in a harness (if they still fit) is more dangerous than using a booster. We do know that allowing a young child who lacks impulse control to move to a booster too soon can absolutely be extremely dangerous.

So, you asked when you should you move your child to a booster and the simplest answer is:

In order to ride in a booster, a child must meet the height, weight AND age minimums of their seat AND they must be able to sit upright through an entire car ride with a good belt fit. Provided that your child is still within the height and weight limits of their harnessed seat, keeping a child in a 5-point harness beyond age 4 or 5 is fine and many parents choose to do that. If your child does not have the impulse control to sit safely in a booster seat but they’ve outgrown all the harnessed seat options, there are medical car seats that will allow your child to remain seated safely for longer (see your physician, medical therapists or a CPST near you for more information).

  

Some other information on boosters can be found here:

IIHS Booster Seat Ratings Bonanza: Where does your booster seat rank?

CarseatBlog recommended high back booster seats

CarseatBlog recommended combination seats