Child and adult passenger safety has evolved tremendously in the past few decades. We went from no seat belts in cars, no car seats, to car seats that sat in the front seat or didn’t buckle in, to children in the backseat and so on. And today, we have highly complicated and specialized car seats and a lot of research telling us what does and does not work in the car.
The trouble is, not everyone has evolved with the times. Just this week I saw on FB a picture of a child who was much too young to forward face and someone politely commented that the child should still be rear facing (which, we can argue the appropriateness of this another time). And then the wrath of the uneducated masses fell upon the commenter. People repeated an unbelievably large number of falsehoods about rear facing and about why it’s not safe or best and why it’s dangerous and I just felt so very disheartened. I know that as parents we want the very best for our kids, but how can we provide that when we refuse to open our minds to the latest research?
Most states have 1 of 2 laws on the books about rear facing. Either 1) children need to rear face until age 1 and (sometimes or) 20 pounds, or 2) children must be seated in properly used car seats and there is not a single car seat on the market that allows forward facing before age 1, so basically, it means no forward facing until 1. And for a long time, the best practice was at age 1 it was time to flip the seat around to face front. But we know now, without hesitation, that that is simply not what is best for kids.
To break down why this is the case, I want to start with the science behind it. The major issue with forward facing a child before at least age 2, but really before age 4, is head size. Look, my kid has a giant head, but this isn’t about that. Up until age 2, children have significantly disproportionately large heads. Even those that don’t have the percentiles of Charlie Brown.
The muscles that control the head are very, very, very small, especially in comparison to the size of the head. So when forward facing in a collision, those tiny muscles are trying to control a very, very large head and they basically do a really crappy job at it. When rear facing, the child’s head and neck are supported by the seat and there is very little excursion of the neck at all. The consequence of a collision for forward facing young child is a phenomenon known as internal decapitation, where the spinal cord is severed internally and it virtually always results in death.
The other major reason that rear facing is safer, especially for younger children, is spinal maturity. The spine of a young child is made in large part of cartilage. This is why kids are so crazy flexible (okay, part of why) and it serves them well. Except in a car accident. The fact that the spine is made of cartilage and does not begin to ossify until age 4 means it’s not as solid or protective of the spinal cord as it is in older children. This image shows the difference between the vertebrae of a 1 year old and a 6 year old. The seemingly missing pieces of the 1 year old’s spine are filled in by cartilage, which is significantly more flexible and allows much more pressure and damage to occur to the spinal cord in a collision.
So there’s the science. What the research shows is that between the ages of 1 and 2, toddlers who are forward facing have a 532% greater risk of suffering a catastrophic neck injury than their rear facing peers. Five hundred and thirty two percent greater risk. This isn’t theoretical, it’s a real scientific evidence and it’s not something we can argue with. The AAP recommends that children stay rear facing until age 2 or until they reach the maximum height or weight of their rear facing seat (they mean convertible, not infant carriers). The National Highway Transportation Safety Administration says to rear face as close to age 4 as possible. It’s a far cry from 1 and 20 pounds. The science unquestionably supports it, but why aren’t more parents doing it?
The most common concern parents state is leg injuries. Now, let me be clear: there is absolutely zero evidence of an increased risk of leg injuries from rear facing. Zero. In fact, leg injuries are the 3rd most common injury in forward facing children, but they are virtually unheard of in rear facing, even for extended rear facers with longer legs. Why? Because when forward facing, children strike the seat in front of them or the sides of the vehicle. There is much better containment when rear facing and in most crashes, the child moves towards the back of the car seat and away from vehicle seat, thus not injuring the legs (or the spine! woo!)
Other parents are concerned that an extended period of time with the legs in the frogged position is dangerous. Actually, the opposite of that is true. A frogged leg position is one of the best, most stable positions for the hip. When children have developmental hip dysplasia and need to have the hips stabilized that is the position they’re braced in because it helps deepen the hip socket. From a anatomical/physiological standpoint, the dangling legs that occur with forward facing are significantly worse for a child’s hips than sitting criss crossed or frogged.
The next concern is that it’s uncomfortable. I can’t speak for all children, but as the mother of an extended rear facer and the friend of many children who rear face until age 4 and sometimes beyond, it really isn’t the case. Parents want children to forward face, but most kids, especially before age 2, they have zero idea that there are any other options besides what they’re used to.
Eli is 26 months, his feet touch the seat in all his car seats and he’s never expressed any discomfort (and trust me, he can express it). He’s able to sleep very, very well in his car seats, which I’d argue is pretty challenging if you’re uncomfortable. Many kids who forward face have issues with the legs falling asleep and the head slumping, neither of which are an issue with rear facing.
Another major concern is about what happens in rear ending collisions. I can see why this is a concern, unquestionably, since the back of the car will move toward the child. Rear end collisions comprise less than 20 percent of serious car accidents, so even if there was a risk to a rear facing child, it would be a rarity for it to even be an issue. Most rear ending collisions are at low speed and do not result in injuries and do not result in enough intrusion to even be a concern. However, even in higher speed rear ending collisions, a rear facing rider will be no more at risk than a forward facing back seat passenger. Their seat will move forward and they will ride into it, which moves them away from the intrusion.
The only reason for forward facing over rear facing that I have no response to is car sickness. Studies show that there’s no significant difference in car sickness in rear v. forward facing as long as the child has a clear view out a front or back window, but I know that it’s not been the case for many people. I do not recommend this, but I can absolutely understand how a child vomiting in their car seat would present a significant safety hazard (as a distraction) and may outweigh the benefits of rear facing. It’s a decision that needs to be very carefully weighed and not taken lightly.
No one here is advocating rear facing beyond the limits of a car seat, but if a child still fits within the height and weight maximum of a seat, there is no reason to turn them around and doing so immediately reduces their safety in the car. Yes, decades ago we survived without car seats and forward facing from birth, but a lot of other children haven’t. If we want to reduce the number of fatalities and catastrophic injuries from car accidents, we have to educate ourselves and educate others. We have to move forward and not take new research and recommendations as a criticism of our parenting or the choices we made before we knew better.
It is critical that we listen to the science and that once we know better, we do better. Our children look to us to keep them safe. There is no question that rear facing, until at least age 2, or if possible, age 4, is the best way to do that in the car.