Safety Archive

Updated September 2017

There are so many confusing things about carseats for parents and tethers rank right up there with “do I use LATCH and the seatbelt together?” (the answer to that one is a wishy-washy no). We have a tether use rate of much less than 50% in the U.S., about the same as it was back in the mid-70s. Yes, you read that correctly! It’s gone up and down, but it’s still right around the same—pathetic. Even after teaching a child passenger safety technician class and going over tethers with them—when to use them, how important they are for safety—I still got the deer-in-headlights look from some of the new techs when I quizzed them about tether usage. So if my trained technicians are hesitant about when to use a top tether (how about all the time forward-facing!), I can only imagine the confusion parents are feeling. Without further ado, let’s get to it and learn about tethers.

So, I remember how what seemed like a few weeks ago I was jonesing for summer. It was still spring, and I *needed* to get over that season changeover hump and put myself solidly in flip-flop, beach, and waterpark weather. I am a mere shell of myself when it’s gray and dismal and 30 degrees but throw me in the sun with a blanket of 100% humidity around my shoulders and I’m solid.

Except yesterday I went back to school shopping. And a few minutes ago I was reading through the emails from school about teacher assignments and car rider line. What happened to my summer? It’s buried beneath the bags of pencils and expo markers and tissues and hand sanitizer. Can you feel my tears flowing through my fingers into this post? It’s not that I don’t enjoy structure and occupied kids. It’s just that I enjoy lack of structure and adventure more.

Anyway, back to my emails. Car rider line. I know most schools do this. It makes it a lot easier (supposedly) for drop off and pick up. Morning is always pretty smooth for us. We rush into the line while I simutaneously tell Liam to wipe the breakfast off his face-but not with your sleeve dangit!!!- while trying to avoid eye contact with the perfectly dressed at o-dark-thirty moms and wishing I had put a bra on. We roll right up, I shove, I mean lovingly wave, Liam out the car.

Afternoons are another story. I leave approximately 20 minutes after getting home from dropping him off in order to get a spot in the line that isn’t blocking traffic on the main road. I proceed to sit for 10 hours and overheat my car while my 3 year old cries from having to be woken up early from nap and then tells me he has to pee. Then once school is out we inch forward at about 1 mph for another hour until I reach my kid. Once my door is opened, after all that, I have approximately 0.00004 seconds to get him buckled and drive away.

So how does that work safely? Well, it depends.

Look, I know it stinks to sit. And sit. And sit some more. But I can’t even begin to tell you the sheer number of toddlers and babies I see on mom’s laps in the car line, even when the cars are moving. I see kids hanging out back windows and bopping around the backseat while the driver is browsing her/his phone. But guess what? Not only is that driver on her phone, so is the one behind her. And the one behind him. So what happens when that person is browsing Facebook and forgets they aren’t in park and lets up the brake a little bit when laughing at the meme about car rider lines? They roll into the person in front of them. Guess what happens to that lap baby or front seat monkey toddler? Hopefully just a tumble onto the floor, but you probably would want me to spare you the visual of a small body getting hit point blank with an air bag. Or the 4 year old falling head first onto the pavement from an SUV window when leaning out and mom lets off the brake a bit to inch forward. These aren’t freak accidents. These are situations that could easily happen. It might mean you need more wine later that night or you need to put the Moana soundtrack on repeat. Maybe you need to give into the no snacks in the car rule and bust out the Cheerios. Whatever it takes but PLEASE, keep your children buckled when in the car rider line. This includes your student until you have pulled up to the drop off point and they are ready to get out.

So what about the rush after you pick them up? I don’t know about your school but the pressure IS ON after Liam’s feet hit the floorboards. He’s in a booster this year and can get buckled quickly. Earlier this year I had to get out and run (all the more reason to wear a bra!) over to his side to buckle him. Fortunately his school supports “no one moves till everyone is buckled” but it doesn’t mean it’s not stressful, especially if you have more than one kid to buckle up. But I think we can all agree that we love each others’ kids and want whats best for all of them, even if that means waiting an extra minute for the mom in front of us to buckle her twins. Solidarity ya’ll. It’ll get us through.

So please buckle those kids. Even when it’s annoying and inconvenient. You’ll feel frazzled but I promise you will feel grateful if you’re on the receiving end of a Facebook meme fender bender. That booger and Cheerio covered little face will be peering back at you in your rear view mirror, right where it’s supposed to be.

Now here’s to a few more weeks of summer. May they go quick for you all who are longing for school, and may they be filled with last minute adventures for the summer lovers. Stay safe in all you do!

Has the time come to reverse our stance on extended rear-facing and turn children forward-facing at age 1 like we used to in the olden days?

The simple answer, for the moment is, NO.

What’s going on?

Dorel Juvenile Group, the parent company of Safety 1^st, Maxi-Cosi, Cosco and other juvenile brands recently issued a position statement on their website explaining why they’ve stepped away from their recent age 2 minimum mandate for forward-facing in their convertible carseats. The short story is that they hired a statistician, Jeya Padmanaban, to replicate the original 2007 study upon which all our assumptions of rear-facing (RF) safety statistics in the USA are based. Not only was Padmanaban unable to replicate the results using the same data set as the original authors of the study, her conclusions actually led to opposite findings. She presented her findings to NHTSA and to the journal Injury Prevention. This prompted some of the original authors of the 2007 study to re-examine their analyses. When their attempts to replicate the analysis also fell short, it became apparent that there were real flaws in the study. Recently, the journal Injury Prevention issued an “Expression of Concern” regarding the original study. From the statement: “Specifically, they believe that survey weights were improperly handled in the initial analysis, which caused the apparent sample size to be larger than the actual sample size. This resulted in inflated statistical significance.” We are currently waiting for the revised study analysis and results to be reviewed and released. We will update this article when that information becomes available.

What do we know at this point?

The anatomy of the developing pediatric cervical spine predisposes children to injury of the upper cervical spine. In general, the younger the child, the more likely an upper cervical spine injury will occur. The neural arches in the pediatric cervical spine fuse posteriorly by 2–3 years of age. Until that time, the vertebrae are made of cartilage and bone and held in place by ligaments; it’s all very pliable and elastic. Traveling in the rear-facing position is inherently safe and is critical for babies less than 1 year old. (Please also read Why Rear-Facing Is Better: Your RF Link Guide, an evidence-based justification for rear-facing.)

Even though the statistics from the 2007 study are being disputed, there is agreement that rear-facing carseats cradle the head, neck, and spine to protect them in frontal and side impact crashes. We know it’s safe from basic physics, an understanding of crash dynamics and results from other countries, like Sweden.

What’s in question?

Since 2007 when the Henary, Sherwood, Crandall, et. al. study was first published, child passenger safety advocates have been told that rear-facing is 500% (or 5 times) safer than forward-facing for children under age 2. Now that statistic appears not to be true, at least not based on the data used in this one study which analyzed injuries to fewer than 300 kids between 1988-2003. Having such a small sample size makes drawing broad conclusions very difficult. Large sample sizes generally result in more accurate and reliable conclusions. We have had our own concerns about the original study and how the “5x safer” figure is presented to parents. We still don’t know exactly how rear-facing compares quantitatively to forward-facing in most situations.

There are other methods, but it can also be difficult to draw broad conclusions from specific case studies or proprietary crash testing done by manufacturers. All of this underscores the need for a more modern crash test sled and better studies on the subject. Modern vehicles simply don’t have a back seat that’s a flat bench seat of a ’70s Chevy Impala with lap-only seat belts and no floor like the standard crash test bench does. Modern vehicles have very different back seat cushions, front seats that crowd the back seat, lap/shoulder seatbelts, and they all have floors too!

What are the risks to a rear-facing child?

You’ve heard Rear-Facing (RF) is safest. Maybe you’ve heard that RF car seats provide the best head protection. That’s probably true, in general. Maybe someone told you RF is “5x safer”. That statistic is based on only one study that used limited data and covers very specific circumstances, so it may or may not apply to your situation. What’s important is that rear-facing is very safe when the child is within the limits allowed by the carseat. In fact, simply using any age-appropriate carseat according to both instructions and state laws will be very effective at reducing the risk of severe injuries and fatalities.

Very safe in an upright convertible carseat!

So, what’s the deal? It turns out, that while rare, moderate and serious head injuries can happen in rear-facing carseats. There are typically 3 possible causes.

1.  The top of a baby’s head might move out of the protection of the carseat shell and strike a front vehicle seat, pillar or console. This may be more of a concern with rear-facing only infant carriers, especially when fully reclined with a baby near the height limit.
2.  The carseat shell strikes part of the vehicle interior, possibly resulting in the back or side of baby’s head hitting the inside of the carseat with enough force to cause a contusion or other injury.
3.  In unusually energetic frontal crashes, the carseat could rebound with enough energy that the front of baby’s head may strike part of the vehicle interior.

Don’t Panic! High speed and very energetic crashes are not common, but can result in serious injuries, especially when misuse or non-use of restraints are involved. The good news is that if you are using a carseat and have installed and adjusted it as best as you can, you probably have very little to worry about.

So what can you do to reduce the chance of injury? The same simple things we’ve always told you and that you’ve probably done:

• Install and use your carseat in the back seat, according to manufacturer instructions AND state law
• Drive unimpaired and undistracted

How can you further reduce the chance of head injury in rear-facing carseats?

1. In particular, make sure your carseat installation and harness are tight.
2. If your child is approaching the stated rear-facing height limit, or when the top of the head is 1″ from the top of the carseat shell, then a taller seat may be necessary.
3. For older babies and toddlers who have good head and neck control, install your carseat as upright as allowed by the instructions.
4. If your carseat offers a load leg or anti-rebound feature, use it.
5. Choose a Recommended Carseat that has a layer of energy-absorbing foam both behind and on the side of baby’s head.  Deep side wings and load legs (on certain infant seat bases) can also be advantageous.
6. When shopping for a newer vehicle, select one with good safety ratings made in 2011 or later, when side-impact airbags and stability control are usually standard features.

“Bracing”, or having the rear-facing carseat touching the front vehicle seat, is a very complex topic.  Some vehicles don’t allow this at all, due to passenger airbag sensors.  In other vehicles, there are various conflicting factors to consider.  If allowed by both the vehicle and carseat owners manuals, bracing could potentially reduce the risk of the carseat energetically striking the vehicle seat back and related head injury (point B above).  On the other hand, it could increase the risk of direct head contact for an older, taller baby ramping out of the infant seat and striking a part of the vehicle interior (point A above). This is especially a concern with rear-facing only infant carseats that have shorter shells, tend to sit lower in the vehicle and tend to be installed with more recline than a rear-facing convertible carseat.

Above all, try not to lose sleep over this!  Loose installations, loose harnesses, too much recline and exceeding the rear-facing height limits are always a potential concern, so just make sure you read the instructions and consult a child passenger safety technician if you have any questions about your installation and usage of child restraints.