Child car seat advice questioned
Toddlers should face the rear longer, some experts say

msnbc.msn.com

By Victoria Clayton
MSNBC contributor
Updated: 6:47 a.m. ET Nov. 7, 2005

Ask any parent about graduating their infant from a rear-facing car seat to
a forward-facing one and you'll likely hear this common refrain - at least
20 pounds and at least one year (although some estimates say a full 30
percent of parents go against this guideline and actually face their
children forward earlier).

This advice is generally what our doctors tell us and it's the car seat
safety mantra that's been drilled into our heads from organizations such as
the American Academy of Pediatrics and the National Highway Traffic Safety
Administration.

Two years ago, however, the American Academy of Pediatrics quietly added
this wording to its guidelines: If a car safety seat accommodates children
rear facing to higher weights, for optimal protection, the child should
remain rear facing until reaching the maximum weight for the car safety
seat, as long as the top of the head is below the top of the seat back.

There's a growing body of evidence, however, that this lesser known
guideline, which is considerably different from the well-known minimum
guideline, will soon take center stage.

"In Scandinavian countries it's common to keep children rear facing up to 3
or 4 years old and there's some good data there that proves it's effective,"
says Chris Sherwood, a research scientist who is studying the issue at the
University of Virginia Automobile Safety Laboratory. Yet, until recently,
Sherwood says there was not U.S. data to prove that keeping an older child
rear facing would result in significantly less injuries.

As part of a project sponsored by the federal Centers for Disease Control
and Prevention, Sherwood and colleagues recently completed a study looking
at the benefits of keeping children in car seats that face rear. Sherwood's
research is now undergoing the necessary stage of being published and peer
reviewed but the outcomes look intriguing.

His study, presented at a recent meeting of the American Academy of
Pediatrics, involved 870 children under age 2 who had been in either
rear-facing or forward-facing car seats at the time of an automobile
accident. He found that the children in forward-facing seats were more than
four times as likely to be injured in side crashes as opposed to the
children in rear-facing seats. The study also found a small but not
statistically significant benefit for facing rear in frontal crashes.

"The findings from the other countries and in Chris Sherwood's work,
although preliminary, should be considered carefully," says Kristy Arbogast,
associate director of field engineering with Traumalink at Children's
Hospital of Philadelphia and a leading researcher in the field. Arbogast
notes that in general the newest evidence appears convincing that keeping
children facing rear longer is probably the safest way to go.

Why is rear facing safer?
Since the 1970s with the introduction of the first seat belt and child
safety seat laws, there's been an increased focus on how to make children
safer in cars. In the last decade improvements have been made in computer
modeling and child-size crash test dummies to give researchers a clearer
understanding of what happens to children in car crashes.

What we know is that children aren't just pint-sized adults. Their anatomy
differs significantly from an adult's and puts them more at risk for certain
serious injuries.

"The biomechanics of their necks facilitate the birth process - there's a
lot of flexibility in a child's neck compared to an adult's," says Arbogast.
"The youngest kids have a neck or cervical spine that doesn't have the
strength to withstand the forces they'd experience in many crashes."

When a child is placed in a rear-facing seat there is less chance of trauma
to the highly vulnerable neck and head areas during the most common crashes.
Arbogast notes, too, that even older children - up to age 12 - still haven't
fully developed. They - along with adult passengers - would also probably be
safer sitting rear-facing. Of course, this isn't feasible. Adults and older
children won't do it or they can't because the car seats won't allow it. So
the question safety experts are trying to answer now is how long we can get
our very youngest children to do it.

The answer is a lot longer than many parents might think, says Kathleen
Klinich, a senior research associate at the University of Michigan
Transportation Research Institute.

Over the last few years U.S. car seats manufacturers have drastically
improved the car seats. Besides making the seats much easier to use in
general, they are making the seats safe to use rear-facing with older
children.

"Unlike previously, now the majority of seats offered in the U.S.
accommodate children up to 30 pounds rear-facing," says Klinich. (In
Scandinavian countries most seats accommodate even heavier and taller
children.) "That means that most children can remain rear facing until at
least around age 2 and some even beyond." This 1- to 2-year-old gap is the
most crucial time, according to Klinich.

"A comparison study of Scandinavian to German crash data seems to indicate
that the safety benefit is particularly strong for kids from 1 year to 2
years," she says.

Still, Klinich understands that some parents will resist keeping their
children rear-facing. Forward-facing means parents are able to see their
child. But also many parents claim their children are more content facing
forward.

"I think there's a notion out there that kids are somehow happier when they
go forward-facing," says Klinich. "But we haven't found this to be true.
Besides, safety shouldn't be a choice. If your child cried and screamed
because you wouldn't let him play in middle of road, you still wouldn't let
him play in a the middle of the road."

Parents also express concern that an older child's longer legs will hit the
back seat when rear-facing.

"When I talk to parents some feel that the bigger children are more at risk
for leg injuries because their legs are bunched up. But that concern has
never been borne out in the data," says Arbogast. "Besides, remember, the
risks you're trying to prevent by keeping a child rear facing are head and
spinal injuries." Broken legs are easy fixes compared to the other injuries,
she notes.

The biggest obstacle to longer rear-facing rides, though, is simply changing
a parent's perception, says Miriam Manary, also a senior research associate
at the University of Michigan.

Manary says parents need to realize that as a child moves through various
car seat stages - from an infant seat, to a convertible to a booster seat to
regular seat belts - each one offers less protection than the prior phase.

"Parents should be looking to prolong these stages rather than rushing
through them," advises Manary. "Remember, graduation to the next level isn't
progress. It's a decrease in safety."

Victoria Clayton is a freelance writer based in California and co-author of
"Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a
Mom," published by Fair Winds Press.