How long will it take for the minimum to be 2 years?

Safer car seats face rear to age 2: study

Studies show fewer injuries to children in crashes than in forward-facing seats.

By Jennifer L. Boen

Research published in this month’s Injury Prevention journal could spur the federal government to scrap its recommendation that children older than 1 can ride in a forward-facing car seat.

Between 1988 and 2003, children 12 to 23 months old were five times more likely to be seriously injured when riding in forward-facing car seats than in rear-facing seats, according to data cited in the study.

Dr. Marilyn Bull at Riley Hospital for Children in Indianapolis co-authored the article. She is medical director and founder of the Automotive Safety Program and Kohl’s Center for Safe Transportation of Children, both at Riley.

“It is really a dramatic difference for the 1- to 2-year-olds,” Bull said.

In frontal crashes, the differences in injuries in rear-facing vs. forward-facing car seats were not statistically significant. But researchers noted that overall statistics for infants and 1-year-olds involved in any type of crash show rear-facing seats were 93 percent effective compared with 78 percent for forward-facing.

“The rear-facing seat is more protective, we think, because the forces are distributed over the entire back,” Bull said. “With forward-facing, the harness straps assume the force over the smallest part of the body.”

She likened it to a strong finger-push to the forehead compared to an entire hand. “There’s a lot more force in a localized place. In the rear-facing seat the force is distributed over the head and the entire body. We think it also provides a kind of cocooning effect,” Bull said.

Children in rear-facing seats did not sustain spine injuries, Bull said. There were some head injuries, but not to the extent found in forward-facing infants and toddlers.

“Spine injuries definitely occur in the forward-facing seats,” she said. Children in rear-facing seats are more likely to sustain injuries to their extremities, which Bull said are more reparable and usually less likely to have lifelong consequences.

The National Highway Traffic Safety Administration’s current guidelines dictate that a child should be 1 year old and weigh at least 20 pounds before using a forward-facing car seat. No state statute requires rear-facing seats for a particular age-group or minimum weight.

The American Academy of Pediatrics in 1996 found that children should remain in rear-facing seats past age 1. But the authors said, “This message is somewhat overshadowed by the more highly publicized 12 months- and 20-pounds guideline.”

Bull hopes the data will be the catalyst for parents to use the convertible-type seat in the rear-facing position until their children are at least 2, and that pediatricians will also discuss the benefits of rear-facing seats with parents.

The findings have significant implications for car-seat and vehicle manufacturers. Bull said most children of average height and weight can comfortably remain rear-facing up to age 2 in a convertible-type seat. But if further data shows benefits for children to sit rear-facing past age 2, cars would have to be built differently.

“It would take a whole change in the federal motor vehicle safety standard process,” Bull said — something that takes years to accomplish.

Larger seats are available in Europe. In Sweden, for example, children must remain in rear-facing seats until age 4, but Bull said cars are designed so seats sit in a pod-like place, with more leg room.

Keeping children rear-facing longer can bring additional frustration to parents who cannot see whether their child’s pacifier has fallen out or if the child is asleep. Children, too, like to see their parents and get a straight-ahead view of the scenery. Bull cautions against putting mirrors on the back seat, which can become projectiles during an accident and hurt a child.

“We’d certainly talk about things like soft toys, soft books, more amusing things for the child,” she said. “It is very possible that car manufacturers might figure out how to use those video (screens) so kids could see them.”

In Indiana, 85 percent of infants under 1 are riding in rear-facing seats, and Bull would like that number to be 100 percent.

“Armed with the information we now have, it is imperative for parents to keep their children rear-facing in car seats longer,” she said.


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