9/3/10

A Guide to Extended Rear-Facing Safety

Last Tuesday around 5:30pm my husband was driving our son home after picking him up from daycare. It had been raining lightly and he was passing through an intersection when a driver failed to stop at a stop sign and hit him almost head on, the impact sliding his car across the road. John quickly checked on Jude to see that he was okay. They will both be receiving chiropractic care but thankfully weren't critically injured.


When I met John on the scene of the accident I unbuckled Jude out of his car seat and as I was pulling him out of the seat I noticed that his legs were locked together, he wouldn't or couldn't open them for several minutes. It was as if his legs had taken the force of the collision. This force that would have been felt in the neck and spinal cord had he been in a forward facing car seat. These sorts of injuries can lead to paralysis and death. In fact, in the US, motor vehicle crashes are the number one cause of death for children. The extra protection offered by rear-facing seats is something that parents should take advantage of as long as possible.

I am so grateful that my boys are okay and I wanted to share this guide for families that may not be aware of the significant safety benefits when a child remains rear-facing as long as the seat allows. For most children, rear-facing can and should continue well into the second or third year of life.

Some of the articles below are from CPS Safety

Why should your child rear-face past 1 year and 20 lbs?



Every milestone in a child's life is exciting! First steps, first word, first day of school. Even car seat milestones seem exciting. The truth is, they should be looked at with a certain sense of dread, not longing. Every step in car seat "advancement" is actually a step down in your child's protection.

Rear-facing is much, much safer than forward-facing. Child safety seats: Rear-face until at least one year discusses the reasons why children should remain rear-facing for a FULL year and 20 lbs. In it, Kathleen Weber states, "In the research and accident review that I did a few years ago, the data seemed to break at about 12 months between severe consequences and more moderate consequences..." This does not mean that there are NO consequences. The consequences may no longer be death from a completely severed spinal cord, but simply life-long injury, including complete paralysis. Research studies suggest that until children are at least four, they are incapable of withstanding crash forces as well as adults - and should remain rear-facing. In a crash, life-threatening or fatal injuries are generally limited to the head and neck, assuming a child is in a harnessed seat.

When a child is in a forward-facing seat, there is tremendous stress put on the child's neck, which must hold the large head back. The mass of the head of a small child is about 25% of the body mass whereas the mass of the adult head is only 6%! A small child's neck sustains massive amounts of force in a crash. The body is held back by the straps while the head is thrown forward - stressing, stretching or even breaking the spinal cord. The child's head is at greater risk in a forward-facing seat as well. In a crash, the head is thrown outside the confines of the seat and can make dangerous contact with other occupants, vehicle structures, and even intruding objects, like trees or other vehicles. 


Rear-facing seats do a phenomenal job of protecting children because there is little or no force applied to the head, neck and spine. When a child is in a rear-facing seat, the head, neck and spine are all kept fully aligned and the child is allowed to "ride down" the crash while the back of the child restraint absorbs the bulk of the crash force. The head is contained within the restraint, and the child is much less likely to come into contact with anything that might cause head injury.


Notice the difference in stress on the child's body in the videos below:

Forward Facing


Rear Facing


The American Academy of Pediatrics (AAP) recommends that all infants should ride rear-facing starting with their first ride home from the hospital. They should remain rear-facing until they reach the highest weight or height allowed by their car safety seat’s manufacturer. At a minimum, children should ride rear-facing until they have reached at least 1 year of age and weigh at least 20 pounds. However, AAP News April 2009 recommends keeping car seats rear facing until 2 years of age (if they car seats are designed for such use).

Children can also comfortably ride rear facing up to 3 and 4 years of age!

Aaron, still happily rear-facing at 3 years old (36 months)

Won't my child be uncomfortable? Where do his legs go?



Many parents have the misconception that children are uncomfortable or at risk for leg injury by having their legs up on the vehicle seat or bent when kept rear-facing. These concepts are completely incorrect. First, children are more flexible than adults so what we perceive as uncomfortable is not for children. Think about how your child sits in everyday play. Do they sit with their legs straight out in front of them? When they sit on the couch, do they purposely sit so their legs dangle out over the edge? No. In real, everyday life, toddlers and preschoolers CHOSE to sit with their legs folded up - that IS comfort to them.


Second, there is not a single documented case of children's legs, hips, etc. breaking or being injured in a crash due to longer rear-facing. There are plenty of cases of head and neck injury in forward-facing children that could have been prevented if the child had remained rear-facing. However, even if a leg or hip were broken or injured, it can be fixed. A damaged spinal cord (from forward-facing too soon) cannot be repaired and subjects the child to lifelong disability or death.


What if I am hit from behind? Won't my child be safer facing forward?

Frontal and side impacts are the most common type of crashes. They account for 96% of all crashes. They are also the most deadly type of crashes (especially side impacts) and rear-facing children have MUCH more protection in both types of crashes than forward-facing. In the 4% of rear impact crashes that a rear-facing child would be in, they have at least the same amount of protection that a FF child would have in a frontal impact, with the added benefit of less crash energy being transferred to them, and the fact that the rear impact is usually not as severe.


The forces in a rear impact crash are much different from the forces in a frontal impact crash. In a frontal impact, the forces are much greater because the vehicles are usually traveling in opposite directions. Experts suggest that a frontal crash is the same as hitting a concrete barrier and the vehicle and all occupants come to a dead stop within less than 1 second.

When you are struck in a rear impact, the vehicles involved are traveling in the same direction, and the vehicle that is hit in the back has room to move forward. The crash force on the occupants is much less than in a frontal impact. The movement of the impacted vehicle, in addition to the crush zone, absorbs a lot of the crash energy, so it is not transferred to the child. Additionally, the majority of rear impacts are at low speeds.


In short, if your child is rear-facing, he has optimal protection in the types of crashes you are most likely to be in. If he is forward-facing, he may have optimal protection in a rear-end crash, but statistically, that is the least likely to happen and he is 60% more likely to be injured or killed in the types of crashes (frontal, side impact) you are most likely to be in.


You can learn more about the physics of rear-facing at http://www.car-safety.org/rearface.html

Different types of Infant Safety seats:
There are 2 types of rear-facing car safety seats: infant-only seats and convertible seats.
When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat.

Infant-only seats
  • Are small and have carrying handles (and sometimes come as part of a stroller system).
  • Are used only for travel (not for positioning outside the vehicle).
  • Are used for infants up to 22 to 35 pounds, depending on the model.
  • May come with a base that can be left in the car. The seat clicks into and out of the base so you don’t have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.
Infant-Only Car Safety Seats


Convertible seats (used rear-facing)






  • Can be used rear-facing, then "converted" to forward-facing for older children. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and do not come with carrying handles or a separate base.
  • Have higher rear-facing weight and height limits than infant-only seats, which make them ideal for bigger babies.
  • 5-point harness is ideal-attach at the shoulders, at the hips, and between the legs.
The Basics of Rear-Facing Seats - A correct use checklist created by CPS Safety

The seat must be designed for use rear-facing and must actually face the rear of the vehicle.
  • Be sure you check the labels and manual for the seat to find out whether the seat can be used in the rear-facing position. If the seat can face backward and forward, be sure you locate the belt path that is required for rear-facing and use it. Infant seats, those that double as carriers, can ONLY be used in the rear-facing position and should never be used forward-facing. For infant seats with a base, the vehicle's seat belt must thread through the belt path on the base, not the belt path on the infant seat. Only use the belt path on the infant seat if you are using the seat without the base. All rear-facing seats should have a label indicating that it meets motor vehicle safety standards.
The seat must be tightly installed in the vehicle.
  • After installation, grab the seat at or near where the car's seat belt threads through the car seat belt path. Give a firm tug, not a yank, from side to side, and from the back of the car towards the front. The seat should not move more than 1 inch in either direction, and preferably as little as possible, or not at all. The same policy that is the foundation of Aviva and all other insurance providers holds true: better safe than sorry! It only takes a minute to check. A rear-facing seat will have normal movement throughout the top of the seat - towards the back of the car and from side to side. This movement is part of the seat's safety design, and should not be a concern.
The seat must be reclined at no more than 45 degrees
  • For newborns, a 45 degree angle is necessary to keep their air passage open. For older babies that are able to maintain head control, a more upright position is okay. Although some seats come with "level indicators", these are not always accurate due to any incline the vehicle may be on. If you use the built-in level indicator, be sure the vehicle is parked on a flat surface (even your garage floor has a slight incline). An easy way to check for a 45 degree angle is to take a piece of paper and fold the shorter top edge over to meet the longer side edge. You'll get a triangle with one long side. Place the longest side of the triangle against the seat where baby's back normally rests. The top of the paper should be parallel to the floor of the car.
The safety harness must fit the child snugly.
  • "As snug as a hug" is a good guideline. You don't want your child to have problems breathing, but a too loose harness could have devastating results. Many instruction manuals suggest that only one or two fingers fit under the harness at collarbone level, but this could be too loose, depending on the size of the fingers. Instead, use the pinch test: grabbing the harness at shoulder level, try to "pinch" the harness together from top to bottom. You should not be able to pinch a vertical fold on a snug harness.
The safety harness must be in the slots that are at or below the child's shoulders.
  • In a rear-facing seat, the harness will hold the child down and in the seat in a crash. The harness must be at or below the shoulders to do this properly. If the harness is above the shoulders, the child can "ramp up" or rotate toward the top of the seat, exposing the head and neck to possible injury. For newborns and very young babies, the bottom harness slot may still be above the shoulders. As long as the harness is in the bottom slots, and the harness is snug, this will protect the baby.
Chest clip must be at armpit level.
  • The chest clip is designed to keep the harness straps properly positioned on the shoulders before a crash. This clip is ONLY for pre-crash positioning. A chest clip that is too high may interfere with the child's ability to breathe. A chest clip that is too low could allow the straps to slip off the shoulders before a crash, leaving the child free to slip out of the seat.
The carry handle must be in the correct position, usually either curved around the top of the seat or under the seat.
  • Many people mistakenly think that the carrying handle will perform as a "roll bar" in a crash, but in reality, most handles are not designed to withstand the force of a crash. Upon impact, the handle can shatter or break, sending sharp, jagged pieces towards baby or other occupants in the car. CHECK THE INSTRUCTIONS. Most seats require the handle to either be around the top of the seat or underneath it. Only a few seats allow the handle to up over the baby during travel.
NEVER place a rear-facing seat in front of an active airbag.
  • The airbag is protection designed for adults, not children and especially not babies. The rear-facing seat sits too close to the airbag, and when it inflates, it does so rapidly and violently, causing massive head and neck injury. EVERY REAR-FACING CHILD WHO HAS BEEN IN FRONT OF AN ACTIVE AIRBAG IN A CRASH HAS BEEN SERIOUSLY INJURED OR KILLED!!!
The back seat is the safest place.
  • This doesn't just apply to rear-facing seats. Everyone would be safer in the backseat - in the middle, if possible. The back seat is safest because it is farther from any point of impact. A front seat passenger is 30% more likely to be injured or killed than a rear-seat passenger. Use the back seat position that offers the best installation. A good fit in an outboard position is safer than a poor fit in the middle. *NOTE* In mini-vans, the safest position may be in the MIDDLE seat, as the rear has less "cargo space" to absorb a rear impact.
Avoid using add-on products
  • Anything that did not come in the box with the seat could potentially put your child at risk. Adding strap covers could cause the chest clip to be positioned incorrectly. An added head support cushion could compress in a crash, introducing slack in the harness and allowing the child to be ejected from the seat. In general, you want nothing under baby or between baby and the straps that is any thicker than a placemat. Adding NOTHING under, behind or between baby and the straps is the best. Also, keep in mind that any product you add that is not included with the seat can release the manufacturer from being responsible for any injuries your child may suffer in their seat.
The child must fit properly in the seat
  • There are several conditions that must be met for a child to fit correctly in the seat.
A child is too small for the seat if:
  • The child weighs less than the seat's lower weight limit.
  • The harness can not be adjusted to snugly fit.
A child is too large for the seat if:
  • The child weighs more than the seat's upper weight limit.
  • The top of the child's head is less than one inch from the top of the hard plastic shell of the seat.
  • Some manufacturers used to state that the child must use a forward-facing seat when the child's feet are touching the vehicle seat back. All manufacturers have now removed these instructions, as there is no real-life data to suggest that the feet touching the seat back would cause injury, but there are cases of children who have been turned forward-facing too soon and suffered life-threatening or fatal head, neck and spinal cord injuries.
Used seats may be dangerous
  • Never use seat that is damaged, under recall*, over 5-6 years old, or has an unknown history. Check out Not New? for more information on any seat that is not brand new before using it.
  • *Some recalls do not affect the safety of the seat (for instance, a recall on the handle of the seat when used as a carrier), and the seat may safely be used to transport your child until the problem is fixed. You will need to contact the manufacturer to find out whether any recalls on your seat must be fixed before using it for transporting your child.

GET YOUR SEAT CHECKED! Find a certified CPS Technician. Lists of certified CPS Technicians and Child Seat Fitting Stations are available on the NHTSA Web site at www.nhtsa.gov or at www.seatcheck.org.You can also get this information by calling 866/SEATCHECK (866/732-8243) or the NHTSA Vehicle Safety Hotline at 888/327-4236.





Car Seat Shopping Guides

The following Convertible Models for Extended Rear-Facing have above average height and/or weight limits for rear-facing use. These may allow children to face the rear for safety longer than many other models. Also listed are the rear-facing weight limits according to the manufacturer. Most of these models are taller than average, with the possible exception of the Cosco Scenera that is listed primarily as a value option. Please verify these yourself in case of errors. Please note that nearly all convertibles can be used for extended rear-facing beyond 20 pounds and models not listed may have ratings similar to the examples below.
  • Britax Marathon/Decathlon/Boulevard/Advocate (33 or 35 lbs)
  • Learning Curve / Compass True Fit (35 lbs)
  • Cosco Alpha Omega Elite (35 lbs)
  • Sunshine Kids Radian XTSL (45 lbs)
  • Graco MyRide 65 (40 lbs)
  • Evenflo Triumph Advance (35lbs)
  • Evenflo Titan Elite (35 lbs)
  • Cosco Scenera (35 lbs)

1 comment:

  1. Thank you for this informative post! I'm so glad your hubby and Jude are ok.

    ReplyDelete

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