Rear-facing: 5 Times Safer

REAR-FACING

5 TIMES SAFER THAN FORWARD-FACING

 *** American Academy of Pediatrics recommends rear-facing until age 2 (at least) ***

CURRENT RESEARCH & EVIDENCE 

3y 36lbs & 10m 20lbs Rear-Facing

In April 2011 the American Academy of Pediatrics (AAP) published new guidelines on children in car seats, recommending that children ride rear-facing until at least age 2. 1

Surprised?  We’re not; the evidence is there. A 2007 article in Injury Prevention showed that 2 year-olds were FIVE TIMES SAFER riding rear-facing than forward facing.2 A 2008 article Pediatrics urged pediatricians to “implement what we know to be best practice: children should ride in a rear-facing seat to the highest weight or height allowed for use rear-facing by the manufacturer of the seat.”3 In June 2009 the British Medical Journal published “Advise use of rear facing child car seats for children under 4 years old.”4

WHAT SEATS ARE BIG ENOUGH FOR 2-YEAR-OLDS REAR-FACING?

Convertible seats are ones that start rear-facing and then convert to forward-facing for older kids; kids typically start using a convertible seat rear-facing after out-growing the infant seat.  The weight limit for rear-facing is typically 35-40 pounds for most convertible seats, with a few seats going to 45 pounds and one to 50 pounds rear-facing. The height limit is the same for any rear-facing seat – the child’s head must be at least 1 inch below the top of the car seat.

WHAT ABOUT THEIR LEGS? 

3-year-old happily rear-facing

As kids get older, their feet will touch the back of the vehicle seat; this is both comfortable & safe. Ever wonder why a 5-year-old can sleep comfortably with his chin on his chest & never wake up complaining of a stiff neck?  It’s because kids’ joints aren’t fully formed, which lets them sit comfortably in positions that would be painful for even a yoga master.  For this reason, a 3-year-old can sit comfortably rear-facing with her legs crossed or in the “frog leg” position. Other parents worry about leg injuries; studies show that forward-facing kids suffer many more leg injuries than rear-facing kids.5

MY BABY WANTS TO SEE OUT!

Rear-facing does not have to be boring! Older kids can ride quite upright so they can see out the side and rear windows. If there is a head rest blocking your child’s view out the back window, you can usually remove it. By 9-12 months your baby knows you’re there when you talk to them from the front – even though they can’t see you. You can calm and entertain your child with songs & stories – and for older children games of “I spy” – all while they are rear-facing.

MY BABY GETS MOTION SICK!

Volvo looked at several thousand pre-schoolers and found the same rates of motion sickness in those riding rear-facing as those riding forward-facing. Regardless of the direction your child rides, placing them in the center seat with an unobstructed view out the front/back window (and limited visibility out the side windows) will help keep the nausea away.

THE CAR SEAT LADY’S RECOMMENDATIONS

It’s not coincidence that flight attendants sit rear-facing.  Rear-facing is the safest way for everyone to travel, not just babies.  Therefore, it is my recommendation as a pediatrician and nationally certified child passenger safety instructor that children ride rear-facing until at least age 2 – and ideally longer, until reaching the maximum height or weight for rear-facing in their convertible car seat, which for most kids is around 2-4 years old.

Alisa Baer, MD www.thecarseatlady.com  (last updated 01/14)

References     
1. American Academy of Pediatrics, Committee on Injury, Violence & Poison Prevention. Child Passenger Safety. Pediatrics. 2011; 127: 788-793.
2. Henary B, et al. Car Safety Seats for Children: Rear Facing for Best Protection. Injury Prevention. 2007; 13 (6): 398-402.
3. Bull M, Durbin D. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics. 2008; 121 (3): 619-20.
4. Watson E, Monteiro M. Advise Use of Rear Facing Child Car Seats for Children Under 4 Years Old. BMJ. 2009; 338: b1994.
5. Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annu Proc Assoc Adv Automot Med. 2002; 46: 213-30.