Rear – Facing Car Seats:
A Decision With A (Not So) Obvious Answer
As a new parent, there are so many decisions to make. For example, if you feed your baby formula, which brand and type should you choose? For diapers, should you use disposable or cloth? If you need someone to watch your child, should you hire a nanny, use an in-home daycare, or a center? I would guess that most parents do at least a little research before making any of these decisions.
But some choices should have obvious answers, like the question should you feed your baby? Or, can I leave my baby home unattended?
One question that deserves an obvious answer (but doesn’t yield one from my experience), is “When should you turn your baby’s car seat from rear-facing to forward-facing?
Before you give me an unseen eyeroll and click away to another page, I ask you to just give me a few minutes of your time. As mentioned, as parents, we have so many decisions to make that it’s literally impossible to research all of them. That’s where I was hoping my blog would fill in some gaps. You research things that are important to you, I’ll research the stuff that’s important to me, and hopefully we can share some information in the middle.
The decision of why your child’s car seat should be rear facing instead of forward facing is based on scientific fact, it’s not one that should be up for debate. Is it common knowledge? Not in my opinion.
When Jack turned 2, his pediatrician stressed to us that we shouldn’t turn his car seat around until he maxed out either the height or weight of his car seat. I knew that his car seat (a Diono Radian) had a maximum weight of 45 pounds rear facing and knew that he was no where near it. To be honest, as a parent, I was a little disappointed. I wanted to give him a better view of the world and selfishly for me, I wanted to make sitting in the front seat of our car a little more comfortable. (Those rear facing car seats take up a LOT of space!) Other than that, I knew that keeping him rear facing was “safer,” but I didn’t know why.
At this time, all of Jack’s daycare buddies also started turning two. I started to notice his friends’ car seats were all getting turned around, to forward facing. I had an internal battle and asked Micah, should we tell them that our pediatrician recommended kids remain rear facing until they max out the height or weight of their car seat? I eventually decided I would share this information with the mother of one of Jack’s good friends. To say the least, it was an awkward conversation, mainly because I was missing a key piece of information, WHY.
So, I went home and dug into the internet to see what I could find. I was surprised to find that there were several scientific reasons not to turn your child’s car seat forward facing. I also decided I would take it upon myself to start sharing this information and educating everyone I knew with young kids. Sharing the information I found about why children should sit in rear facing car seats could prevent a severe injury or death.
Let’s talk about WHY!
As any parent knows, when a baby is born, their skeleton is not fully developed. Just like the bones of a baby’s skull are not fused initially, neither are the vertebrae that make up their back. A human back is made up of 3 types of vertebrae: cervical, thoracic, and lumbar. The figure below shows the striking difference between the cervical, thoracic, and lumbar vertebrae in a 1 year old and a 6 year old. A 1 year old’s vertebrae are not fully fused, they exist as distinct pieces of bone, which are connected by cartilage, whereas a 6 year old’s vertebrae have ossified (been converted to bone). The ossification process for vertebrae isn’t typically complete until the child is 4-6 years old.1
Right: White, T. Human Osteology, 2000 (Taken from: http://csftl.org/why-rear-facing-the-science-junkies-guide/)
So now let’s think about what that means. Because a young child’s vertebrae are partially comprised of cartilage, the entire spinal column is more capable of stretching. In fact, studies of infant cadavers have shown that a young child’s spinal column can stretch up to 2 inches! To give you some perspective, ¼ of an inch stretch is enough to rupture the spinal column, resulting in either paralysis or death.2
Additionally, the upper cervical spine doesn’t become ossified to the skull until sometime around 7 years of age. Because young children have relatively large heads, their head can be up to 25% of their body mass. In adults, the head typically is only 6% of the total body mass.3 In a forward-facing crash, a young child’s head is violently pulled forward, potentially causing a brain or spinal cord injury – an injury that is entirely PREVENTABLE by keeping your child’s car seat rear-facing!
In a head-on crash, excessive stretching or even transection of the spinal cord can occur when a child is in a forward facing car seat. Whereas when a child sits in a rear facing car seat, the head, neck, and spine are kept fully aligned, distributing the crash force over all of these areas of the body.
When should you turn your child’s car seat around?
When they reach EITHER the maximum height or weight for their specific car seat in the rear-facing position. The maximum height and weight are specific to each car seat, so check your manual to find this information. The maximum height is usually considered to be when the top of your child’s head is within 1 inch of the top of the car seat.4 Typically, children reach the maximum height before the weight, so if you haven’t bought a convertible car seat yet, select the tallest one you can find. Most car seats on the market will allow kids to rear face until they are 3-4 years old.5 Without a CT scan, there is no way to know the stage of your child’s spinal column development.
Additionally, in April 2011, the American Academy of Pediatrics published new guidelines, recommending that children ride rear facing until at least age 2. All research points to the fact that 2 years old is the MINIMUM age requirement, in Europe children are commonly rear facing until they turn 4 year old, at which time they convert to a forward facing booster seat.
Misconceptions about Car Seats
Some parents with kids at the top of the growth curve think it’s okay to turn their child forward facing based solely on size. Just because a child is bigger than other children their age, doesn’t mean their skeleton is more mature. In fact, it’s actually worse to turn a big kid forward facing because chances are their head weighs more than the head of an average sized child of the same age, which means in an accident, forward facing can lead to more severe injuries.
Parents are often concerned that older children are uncomfortable rear facing, because of limited legroom. Let me start by telling you that they are ZERO incidence reports in the literature for children getting broken legs by sitting in rear facing car seats during an accident. There are however incidences of leg injuries for children in forward facing seats.6 But to take that one step further let’s think about a young child’s legs when they are forward facing. As most people do, when you get in a crash you tense up, which for a kid means their legs will straighten and most likely go up into the air. Depending on the collision, the driver and front passenger’s seat may get pushed back into the cabin, ultimately crushing the young child’s legs.
Some parents think that turning their child’s rear facing seat forward will help with their motion sickness. Volvo did a study and found that the incidence of motion sickness was the same in both forward and rear facing kiddos.
Mind-Blowing Stats and Facts:
Rear facing car seats have been found to be more safe in crashes from all directions (including side – impacts).7
One to two year olds are 5 times safer in side impact crashes in comparison to when they face forward.7
Children under age 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing 7
Between July 2006 and November 2007 not one child under the age of six died in Sweden due to a car accident. 8
Rear Facing Your Child’s Car seat is Not a Decision to Make Based on Opinion:
I read this quote in an article on the Car Seats for the Little’s website and found it to be a perfect summation of my thoughts:
“Rear facing is not a choice to be made based on parenting style or opinion; it’s one based on scientific fact. The more we know about crashes, the better we are able to protect our kids from severe injury as a result of a crash.”
I hope the information in this article was helpful to you and that it will save you some time. Websites with more amazing information about rear-facing car seats can be found below, in addition to references sited.
It takes a village – join mine!
Amazing Additional Articles You Should Check Out:
Car Seat Blog:
Carseats for the Littles:
The Carseat Lady:
1 Moore K.L., Persaud, T.V.N. The skeletal system. The developing human: clinically oriented embryology. W.B. Saunders; Philadelphia, PA, USA: 1993. pp. 354–369.
2 McCall, T.; Fassett, D.; Brockmeyer, D. Neurosurgical Focus, 2006, 20, 1-8. (link: http://thejns.org/doi/abs/10.3171/foc.2006.20.2.6)
3 Thomas Turbell, VTI (Swedish National Road and Transport Research Institute) (link: http://www.rearfacing.co.uk/expertquotes.php)
4 Bull, M.J.; Durbin, D.R. Pediatrics, 2008, 121. (link: 10.1542/peds.2007-3637)
6 Arbogast, K.B; Cornejo, R.A.; Kallan, M.J.; Winston, F.K.; Durbin, D.R. Annu Proc Assoc Adv Automot Med. 46, 213-230.
7 Henary B.; et al. Injury Prevention, 2007, 13, 398-402. (link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598309/)