We want to do what is best for our children. We would never knowingly put our little one in harm’s way or deliberately put them in an unsafe situation. But what we don’t know and what we aren’t aware of can spell out disaster. Car seat safety is one of this things. As a Child Passenger Safety Technician (CPST) I see this every day. “I’m so glad I was able to help you out with your car seat today so your kids are safe on the road.” Not all caregivers are aware of the unsafe situations their kids are in or that there is a better way to keep them safe. One of the most common situations I see is a child who is in a forward-facing car seat but could very well ride rear-facing and be safer.
Why Rear-face?
The American Academy of Pediatrics recommends children remain in a rear-facing car safety seat as long as possible until they reach the highest weight or height allowed by their seat. In some states, this is even required by law.
Research has found that keeping your child rear-facing longer helps protect from spinal cord injuries in a collision.
In pediatrics, the vertebral bodies are anteriorly wedge-shaped and have not completely formed, so they can also separate more easily from their endplates. Additionally, this less stable spine has to support an oversized head using underdeveloped neck muscles.
Taking all of this into consideration, with the same forces applied, a child’s neck is likely to be more injured than an adult’s in any given situation. (1)
When a child rides in rear-facing, the head, neck, and spine are all supported by the hard shell of the car safety seat, allowing the car seat to absorb most of the crash forces, and protecting the most vulnerable parts of the body. When children ride forward-facing, their bodies are restrained by the harness straps, but their heads – which for toddlers are disproportionately large and heavy – are thrown forward, possibly resulting in spine and head injuries. (2a)
So why only have your child rear-facing until age 2? While it is certainly recommended by safety technicians to rear-face as long as possible, one reason is that about half of the postnatal growth of the brain volume occurs during the first year of life. About 75% of its adult size is attained by the end of the second year of life. (3) So age 2 isn’t exactly the magic number but based on scientific reasoning it is the number that seems to fit best.
Another common concern brought up to Car Seat Safety Technicians now that we are keeping our children rear-facing longer, is legroom. Many parents are concerned about their children’s legs being scrunched up, folded or bent in various ways or positions, or they think their child is uncomfortable.
Well, parents, I’m here to assure you that there really is no concern for worry about your child’s leg position. Yes, it is possible that a hip or leg injury can occur in a crash. But rest assured that leg injuries are likely to be non-life threatening. Your child’s legs, just like their spine are very pliable and elastic. Cervical spinal injuries are likely to be more severe which may result in paralysis or even death by internal decapitation.
Fortunately, car seat manufacturers have created seats that allow children to remain rear-facing until they weigh 40 pounds or more, which means most children can remain rear-facing past their second birthday. It’s best to keep your child rear-facing as long as possible. This is still the safest way for children to ride. (2b)
In order for you to keep your child rear-facing as long as possible and extend the use of your rear-facing only car seat, here are a few tips that I love sharing with caregivers:
Tips for extended rear-facing:
- When shopping for a car seat (particularly a rear-facing only (RFO) infant seat), do your research and purchase a seat according to the maximum HEIGHT rating for the seat, not the weight. Many car seat manufacturers will market to the maximum weight capacity of the seat but many babies are likely to outgrow the height rating before the weight. Last time I checked, my 3.5 year old was 35lbs and there’s no way she would be able to fit in any RFO infant seat. She would be much too long!
- If shopping for a convertible car seat, pay close attention to the maximum weight a child can rear-face. For some seats it is 35, some it is 40, some even 45 or 50lbs! Once they reach that weight limit, it’s time to turn them around!
- Most vehicle lower anchors are not designed to secure more than a combined weight of 65 pounds for both child and car seat. This means if the combined weight of your child and the car seat is more than 65 pounds, then the car seat should be secured using the vehicle’s seat belt and tether. When you turn your child to face forward, you may need to use a seat belt installation instead of the lower anchors. Which brings me to my next point…
- Always read both your vehicle owner’s manual and the manual that came with your car seat for installation instructions. I know it seems like common sense but apparently common sense isn’t so common, otherwise, I wouldn’t be saying this! All vehicles and manufacturers have different directions for use because there are many different ways that manufacturers conduct their crash testing. ALWAYS ALWAYS ALWAYS read the manuals. Confession: if someone contacts me with a question, I’m always going to Google the manual for the seat and the vehicle! Every seat and vehicle is different!
Resources
(1) Richard C.E. Anderson, MD, FACS, FAAP
Pediatric Specialist
ASSOCIATE PROFESSOR OF NEUROLOGICAL SURGERY
The Neurological Institute of New York at Columbia University Medical Center/New York Presbyterian Hospital
(2a) AAP, November 2018 issue of Pediatrics
(2b) Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on Injury, Violence and Poison Prevention.
(3)Donald F. Huelke
University of Michigan Transportation Research Institute, Ann Arbor, MI USA
Association for the Advancement of Automotive Medicine
Melissa Daudelin is a nationally certified Child Passenger Safety Technician located in the Chicago area. As a mom of 3 littles, she is passionate about safety from a real-life perspective. She can be found on Instagram as www.instagram.com/our_little_suburban_life
