Study: Older Children Should be in Rear-Facing Car Seats
I have been doing some moderate research into the car seat vs. booster seat issue. Just when I thought I could move my three-year old to a booster seat, a report in the British Medical Journal announced that children would be better protected in rear-facing car seats through the age of four. So, not only should I not move her out of a convertible car seat, she should face backwards. (Normally, children are switched to forward-facing car seats around the age of one year or twenty pounds.)
The study looked at U.S. NHTSA data of children involved in crashes between 1998 and 2003. The reason for the recommendation:
Watson and Monteiro note that in contrast to forward-facing seats, rear-facing seats provide full alignment of the head, neck, and spine, so that crash forces are dispersed over these areas rather than centered on one site.
Most convertible rear-facing car seats have a weight limit of thirty-five pounds. This would offer additional protection for most kids until they reach the age of two. Beyond that, I’m not sure how many manufacturers offer a rear-facing option for bigger kids. I couldn’t find any in a quick Web search.
I’m interested to hear what other parents think about this report. My oldest daughter hated facing backwards. And, she can make a lot more noise now then she could then. But, there’s no question kids are safer in rear-facing seats. I do plan on keeping my youngest daughter facing backwards at least until two. But four?! How practical is that, especially when you can’t find a seat to accommodate your child?
Kim Said,
June 14, 2009 @ 6:56 pm
We moved our children to forward facing right at one. Our decision was based on the our small car. We could barely fit with our children rear facing.
I don’t know what is the best nor do I have opinions. I am torn. I am curious about how comfortable it would be for 4 years olds rear facing. Wouldn’t their legs be awful squished.
Julie Said,
June 14, 2009 @ 6:57 pm
Okay, this is very timely for me, because Zack just turned one, so I can turn him forward facing. He already weighs almost 30 pounds. I’d love to keep him rear facing for a bit longer, but I drive a VW Beetle, and I actually cannot get him into the rear facing convertible car seat. The roof of the Beetle slopes downward so abruptly that there actually is no room to put the child in a convertible seat, when it’s rear facing. I tried it when he hit 22 pounds and had to come out of his Graco SnugRide. I had to upgrade to a Graco SafeSeat, which goes up to 30 pounds rear facing and allowed me to actually get him in and out of the car.
So I have to transfer him to the convertible, since he’s out of the SnugRide weight limit completely. But I can’t keep him rear facing.
And if you don’t have a baby, I’m sure none of that made any sense to you. But the moral of the story is: the New Beetle is cute but not a family car.
Brendan Said,
June 14, 2009 @ 7:03 pm
Seems like a mis-aligned of priorities when the car you like to drive becomes the deciding factor in a child’s vehicle safety.
Another piece of trivia, military air transports have rear facing seats, it is safer for people of every age.
Scott Said,
June 14, 2009 @ 7:51 pm
I have no doubt that rear facing seats are superior at any age, for the reasons Watson and Montiero note. The reality is that larger/taller kids will have their legs pushed up against the seat back, sometimes even before the recommended “switch” age.
The link doesn’t give the relative risk so I have no context in which to interpret this data. For example, given that the risk of auto accident death is likely directly correlated with distance driven, a more feasible option may be just to drive less with your child if possible. Alternatively, what is the relative risk reduction of middle seat vs. closest-to-door? Or side-impact air bags? My personal feeling here is that there are a lot of factors to consider, so I’m not going to worry about one that I cannot control.
Stacy Said,
June 14, 2009 @ 8:16 pm
I concur with “won’t their legs be squished” and “my car won’t accommodate it” – we can’t all afford to drive our kids around in Expeditions just so we have enough space between rows to seat them backwards. Perhaps we should all be acquiring minivans like the Town & Country that have swivel seats built in so passengers of any size could always be facing backwards? http://www.chrysler.com/en/2008/town_country/interior/storage/ That costs twice as much as my Scion did, and would get half the gas mileage, not to mention being harder to park. Regardless of what I’d like to drive, what I can afford to drive does play a significant part in my decision, especially if the difference could pay for preschool…
Dash Said,
June 14, 2009 @ 9:07 pm
We agonised about this one. It is safer, BUT …
We live in a small town 5 hours from the next town and airport. So we do very little driving around here, but then do a couple of 5 hour drives every 3 months. The screaming and hysterics at facing backwards and the stress caused to everyone, including the distraction to the driver, just aren’t worth it so they got turned around.
I think this is a good example of needing to be careful when interpreting data. It is safer to face backwards, all else being equal. But having them facing backwards may stop things from being equal.
Laura Said,
June 14, 2009 @ 10:43 pm
I agree with Dash. I have ADD, too, so just trying to focus on the road when my daughter is front facing is hard enough. So for me, I might as well just crash my car into a tree! She was in a rear facing seat for over a year because she is so petite, and I about went mad.
Plus: rear facing seats for older kids are just plain expensive. Worth it if it saves my child’s life, but the number of lives one of these seats will save is relatively few compared to the general population. I am trying to figure out how to pay my rent next month, let alone buy another car seat.
Julie Said,
June 14, 2009 @ 11:14 pm
“Seems like a mis-aligned of priorities when the car you like to drive becomes the deciding factor in a child’s vehicle safety.”
It’s not mis-aligned priorities. It’s my husband being out of a job. Stupid economy.
I bought my little car when I was single, and I bought it because it had a tether for a car seat and was considered the safest compact car.
However, the child doesn’t fit rear facing, and I can’t take on another car payment.
Unfortunately, I didn’t know anything about actually being a parent when I got the dang thing, and I knew zero about car seats, how big they are, etc. Also had no idea how big my baby would be. (Big.)
Julie Said,
June 14, 2009 @ 11:20 pm
On the other hand, here’s Steven Levitt on cars eats, and he says the data suggests it really makes no difference, after age two, if the kid is in a car seat or just wearing a seatbelt.
http://www.ted.com/index.php/talks/steven_levitt_on_child_carseats.html
Also, Brendan, CA law says we can turn our kids front facing after age one, if they’re over 20 pounds. So I’ve been looking forward to the first birthday for a while, and then I started hearing about the rear-facing thing. It’s not the greatest news for me, as you can imagine, since you know, I like to try to keep my kid alive and well.
Danni Said,
June 15, 2009 @ 4:31 am
I FOUND THIS – DON’T KNOW IF IT HELPS ANYONE.
REAR-FACING CHILD CAR SEATS:
RESPONSE FROM DOREL, MANUFACTURERS OF MAXI-COSI
London, England: 12 June 2009 – Dorel (UK) Ltd, the world’s biggest manufacturer of nursery and children’s products and makers of Maxi Cosi seats, has responded to today’s report – published in the British Medical Journal – which suggests that children should stay in a rear-facing child car seat until the age of four:
“There are some pure safety arguments for the benefit of travelling backwards in the event of an accident. This also applies to adults travelling by rail, for example.
“We recommend parents to keep their child in rear-facing infant carriers for as long as possible and not to switch to a more convenient forward facing seat at the earliest opportunity. However, most parents around the world eventually make the change because rearward facing child car seats are simply impractical in most situations. They take up a huge amount of room in the car, usually necessitating the front seats to be moved forward, and they don’t even fit in some smaller cars. Unless the child is given sufficient legroom, he or she will be cramped against the car’s seatback. It can be incredibly difficult for a parent to get a larger child into such a seat and the fitting system is often very complex, increasing the chance of incorrect fitting.
“The most effective way to improve child safety in car seats is to ensure that the child is correctly fitted into the seat and the seat is correctly fitted into the car. This is why publications such as Which? look at ease of fitting when assessing child car seats along with crash test performance. Maxi-Cosi car seats are consistently ranked in the top few by the European independent testing of car seats as reported in Which? and we strongly believe that real car safety is derived from the best combination of ease of use, ensuring correct fitting and excellent crash test results.
“In addition, although rearward facing is arguably the safest travelling position, most of us prefer not to travel that way. It reduces the growing child’s ability to interact with those in the front seats, to look around and see where they are going.”
Joanna Said,
June 15, 2009 @ 6:16 am
Hi, I love your site. So refreshing to see moms that are not defaulting to panic over every little headline. I analyze studies for a living, and as always, the devil is the details — even with such important issues such as child safety seats.
The bulk of the data supporting Watson and Monteiro’s call to keep kids rear-facing until age 4 come from the study you mentioned, the 1988-2003 review of NHTSA crash data. A link to that study is below. It discusses crashes up to 23 months, not 48 months. So already we are making a big leap with the headline.
fcs.tamu.edu/safety/passenger_safety/certified-tech/rear-facing2.pdf
The first thing to note is that a full 21% of injured kids were UNRESTRAINED. This is ridiculous to me, and suggests that perhaps most of our public health dollars with regards to car seats should be spent on reducing these incidents.
The second thing to note is that they are using a small sample of data to extrapolate to the general population. In the raw data, just 60 kids 1 year and older were rear-facing. Sixty kids! So we are generalizing from a pretty small sample when we are talking about the benefits of rear-facing seats after the age of one year.
So next, the really good news: when the authors generalize to the crash statistics as a whole, they find the car seats do a really excellent job at protecting kids, no matter which direction they are facing. Results showed that 89.9% of rear-facing kids and 84.8% of forward-facing kids were not injured at all (MAIS score = 0). Yay! The biggest gap between the rear and front facing in terms of raw percentages was for kids who sustained the mildest injuries (MAIS score = 1) — 9.6% for rear-facing versus 14.1% for forward facing. For the rest of the MAIS levels, the results also tended to favor the rear-facing models, but the raw percentages were much, much slimmer. And for the second-highest level of injury (MAIS score = 5), the data favored the forward-facing seats (0.16% versus 0.02%)!
Later, the authors switch things up with a different measurement of injury level, the ISS score of 9 or higher, which represents moderate to severe injuries. We never see any raw percentages for this measurement, but it would seem to translate into an MAIS score of 2 or higher. If we go back to the original breakdown of MAIS scores, how many kids actually sustained an injury of MAIS 2+? The answer is very, VERY few kids. Just 0.5% of kids in rear-facing seats and 1.1% of kids in front-facing seats experienced anything greater than a mild injury. Again, yay for car seats!
What this is telling me is that the vast majority of protection for your child comes from having him/her buckled in to a properly-installed car seat. Might you get some tiny extra percentage of safety by keeping your child rear-facing beyond 1 year? Sure, the data are reasonably convincing on this point. But let’s be clear: it’s a very tiny extra percentage (0.6% to be exact).
If one gets such a small benefit even in 1 year olds, I can only imagine there are diminishing returns for older children who have better neck/spine control. If parents want to keep kids rear-facing to mine that tiny extra percentage point of safety, my hat is off to them. When it’s your kid, you want every extra edge you can get. What I don’t see is enough convincing evidence that the difference is large enough that we should be legislating such a move or making snarky remarks to other parents — “I can’t believe you would prioritize your car over your kids’ safety”, etc.
molly Said,
June 15, 2009 @ 6:35 am
The car seats I’ve seen really aren’t designed for “extended rear facing” at this point. The Britax we have has a rear-facing limit of 33 lbs which is pretty generous BUT there’s also a height limit–when their head comes up above the top of the seat they have to go front-facing. Having heard that RF was safer, we kept our son RF until he got that tall. He was about 29 lbs at that point so weight was not the factor, height was.
There are online communities of child-restraint enthusiasts who proudly post photos of 3 year olds RF with their feet against the back seat, the kids don’t seem to mind that part that much.
If this idea takes off, I’m sure you’ll see car seats sold that allow taller, heavier kids to RF.
Fanisse Said,
June 15, 2009 @ 10:37 am
Tot remains rear-facing in my car at 2 and 1/3, but I let my husband turn her around in his car after she turned two. The biggest issue is the development of the spine which is much stronger after two than after one. My daughter also does not mind rear-facing at all, but I could see where it could be a problem if tot hated it.
Jodi Said,
June 15, 2009 @ 11:00 am
Joanna, thanks for that amazing breakdown!
Julie Said,
June 15, 2009 @ 12:17 pm
Joanna, you rock. That was fantastic.
I’ve been doing mental gymnastics about this study all day. Well, maybe not mental gymnastics, but a few mental sommersaults. And a cartwheel or two.
Add these numbers into the mix. Let’s say I buy a bigger car that will provide enough room for the rear facing convertible seat. I will only be able to use it for maybe a few months, until my enormous offspring hits 35 pounds earlier than most. And during those few months (let’s guess it’s six months), he will only be in that rear facing car seat for about 15 minutes a day, the time it takes to drive him home from daycare. My husband and I can switch cars for any times I’d need to drive longer than that, and I can keep the boy rear facing in our other car.
So, really, could it possibly be worth it to trade up and incur the expense of another car for that short amount of traveling?
Also, I could very easily stick to the streets and stay off the freeway for those 15 minutes a day, which means I would not drive over 35 miles per hour. (Really. I promise.)
So…what are the odds I would be in a car crash during that total amount of driving time? Sixth months, five days a week, 15 minutes a day, driving max 35 miles per hour?
The problem with living in LA is that those numbers don’t compare to the awful thoughts that go through your mind every day when you drive a kid around. We have to drive here. I think my husband and I actually walk to do errands more than any other couple I know, because we’re just New Yorkers at heart. But bottom line, we have to drive, and there’s no way to eliminate risk if you drive.
Okay, here’s another thought. We live close to a freeway, which means particles of exhaust are likely going up our noses every day. I wonder which risk is worse: the risk of death or injury from an auto accident, or the risk of lung cancer from the daily exposure to that stuff over the time I will live in my location?
Anyway, I’ll keep the lad in the rear facing SafeSeat until the second he reaches 30 pounds. Then forward he goes.
Kim Said,
June 15, 2009 @ 6:24 pm
It isn’t misalinged priorities. I cannot afford a larger car, at all. My car could fit one backward facing seat in the middle uncomfortably but doable, we could not fit two backwards, it would have been unsafe. My husband or I would have to drive on top of the stearing wheel almost. We followed all laws and didn’t turn them too early.
rachel Said,
June 23, 2009 @ 9:06 am
our 3.5 year old is rear facing. its safer, and that makes it a simple decision for me. i have yet to see a car that a britax blvd. wont rear face in…up to 35 lbs.
here is a link to rear facing children: http://www.cpsafety.com/articles/RFAlbum.aspx
they aren’t all in Expeditions. I used to have a VW Jetta and had rear facing seats in that.
Aaron Stewart Said,
May 11, 2010 @ 2:56 am
Sparco makes some of the best car seats in the market. I usually prefer leather car seats over cloth.”;~