Let’s Talk About Car Seats: Why Extended Rear Facing is Safest

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.

head
(Image from: American Genetic Association – Journal of Heredity (1921) Volume 12, pg 421)

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.

bones
(Image from Human Osteology, T. White, 2000.)

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!)

rear facing2

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.

rear facing1

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.

rear facing 3
(He looks just miserable, huh?)

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.

15 Responses to “Let’s Talk About Car Seats: Why Extended Rear Facing is Safest”

  • Thank you so much for continuing to share all your knowledge. Knowing that there is another mom out there who feels strongly about this makes it easier for me to stand my ground with my family (who think I’m a bit crazy for having a six-year-old in a 5pt harness and for rear-facing my 19mo old). Thank you!!

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  • purplebreath:

    Good information! I was really surprised about all the leg and hip tidbits.

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  • Mikal:

    Great post! Thanks for sharing. We recently had to(well decided to) switch to forward facing b/c he learned how to unbuckle the top strap clip and he knew we couldn’t see him and he was doing it while we were driving and it was crazy making. I had planed on forward facing for at least another year, but in the end we really need to be able to keep on eye on him to be able to keep him buckled properly in the seat.

    The legroom comments crack me up, now that my son is forward facing he’s still keeping his legs in exactly the same position he was when he was rear facing! He’s a diono radian and the sides are low and he likes to throw his legs over the sides of his seat, and he also frequently still just does the froggy position.

    And a great non-saftey reason to rear face your kid? The backseat driving comments from my three year old are insane and constant, he’s totally annoying about everything concerning driving (for a few weeks he was obsessed with me having TWO HANDS ON THE STEERING WHEEL MOM). Also b/c he’s in the middle seat he can see me every time I mess with the radio or AC controls and throws fits about that all the time too.

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    Katie Reply:

    @Mikal, I think the best perk to rear facing is that I can eat alllll the candy I want and he doesn’t know. For that alone I will rear face for as long as possible.

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    Mikal Reply:

    @Katie, YES. I miss my secret car snacking too!

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  • Christina:

    Great post. My husband and I disagree on this issue. I’m for extended rear facing, he’s of the “well we survived” mentality. Lots of great info here to help him see why it’s so important. Our almost 4 year old went forward facing at 1, just before I heard about the new recommendations. I anticipate pulling this post up to help explain to him why our 11 month old will be rear facing for as long as possible. Thank you!

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    Katie Reply:

    @Christina, You know, just last week my husband was talking about this. He goes, “you know, when you first said we were going to keep him RF until two, I though, okay, that’s what the AAP recommends, we can do that. But when you changed your mind and said until age 4, I thought you were nuts and there was no way we’d make it. But now, having seen Eli and how comfortable he is, I can’t imagine turning him until he outgrows his seat. There’s just no reason to.”

    So maybe time and seeing how easy it is will help? I know it’s tough when parents disagree on things like this.

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    Christina Reply:

    Katie, good point. I think once he sees that it’s a nonissue to keep her RF he will be onboard. Plus how can one possibly argue against a decreased risk of internal decapitation!? Now we just found out that Baby #3 is going to arrive next March (eek and yay) so we will have two RF. I know you’ve done a ton of car seat research, do you know which brands/models are the most narrow? Not sure we will be able to upgrade from our Kia Soul before #3 comes. I’m nervous about fitting 3 car seats in my car. Any insight or links would be greatly appreciated! Thanks so much and best of luck to you and your family in the weeks ahead!

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  • Heather:

    My Four year old is in a 5 point harness that I just purchased for it fits her height. However, she is extremely tall and there is no way she would be able to sit rear facing. My 2 year old is rear facing and will remain that way until she needs to be turned around. Let’s face it. When we were all kids we didn’t even have car seats and we survived. The car seat issue is starting to get a little out of control. I understand that rear facing is the safest way for an infant or small child to face. However, the age of 4 is stretching it. Maybe it depends on the size of the child. My daughter is close to 4 ft. Please tell me how a 4 ft child is to sit in a rear facing car seat.

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    Katie Reply:

    Heather- The recommendations are to RF as long as possible- until a child outgrows their RF seat or reaches age 4, whichever comes first. I’m not advocating RF a child who can’t fit in a RF seat (I’m not even advocating buying a bigger seat unless the child is under 2), but if a child still fits, there’s no reason to turn them around. There are lots of big kids who ride rear facing- they sit with their legs criss crossed, hang them over the sides, put them up on the seat. I know several kids who were turned forward at age 4 who immediately asked to be turned back around because they were more comfortable RF. Kids like weird positions. My son is the opposite of your child. He’s 26 months and 34ish inches. He will easily make it to age 4 in all his car seats, why would I turn him around sooner?

    The car seat issue really isn’t getting a little out of control. Car collisions are the number one killer of children in this country. Yea, we didn’t have car seats and you and I survived, thousands of other kids didn’t. We also rode cars that drove much, much slower and much shorter distances, where we now drive 80+mph for hours at a time. Things are not what they were decades ago not to mention that now we KNOW better, so why wouldn’t we do better? Why would we do what was recommended 30 years ago when we now have solid scientific evidence that it’s not safe?

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    GreenInOC Reply:

    @Katie, My response to this is, then why not use old carseats too? How about this one:

    http://www.thebusinessbehindtheboogie.com/wp-content/uploads/sites/4/2010/04/car_seat.jpg

    That being said, I totally get the “it was safe for us / a long time ago” argument to a lot of things. With something like this though, for me at least, the easiest question to ask is “what is the negative of leaving a child rear facing for up to 4 years?” Other than a parent’s perception that they might be judged for being “overprotective” I really can’t think of any and of course what other people think of us is none of our business anyway!

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    karen Reply:

    @Katie, I thought the rec was to leave them rearfacing until they outgrow the height or weight limit of the seat, which may be well after age 4 for some kids (depending on the seat). My 3 year old is rearfacing in a diono and we have no plans to turn her forward at 4 since she should still be under the height/weight limit.

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    Katie Reply:

    You’re right, we’d all be safer rear facing, basically. It’s just that a lot of the reasons for rear facing are anatomically less important after age 4 so giving parents an end goal of 4 is the typical recommendation. You won’t put your child in any danger by keeping them RF longer, there just isn’t any strong science to make it a formal recommendation (yet). By all means, keep them rear facing as long as possible, I wish we could all ride that way.

  • Aaron:

    “We also rode in very large metal cars that drove much, much slower and much shorter distances. We now drive in cars made of plastic that crumple into the frame, we drive 80+mph for hours at a time.”

    ^^ I agree with many of the views presented in the article, however I did want to correct this statement…those “very large metal cars” are no where near as safe as current automobiles that are “made of plastic that crumple into the frame”. The crush on newer vehicles is actually designed to crush and is much much safer for the occupants of the vehicle. The crush of the vehicle reduces the amount of force and intrusion into the vehicle. This is why if you look at a ’69 Chevy Malibu and a 2009 Chevy Malibu that were both involved in a head-on collision at 50 mph the 2009 Malibu would be completely destroyed where as the ’69 may not have as much exterior damage to the vehicle, however the occupants of the 2009 are much more likely to survive the crash (not even consider in better seatbelts and of course airbags).

    The article has many good points, don’t follow a good article with bad comments making it seem like vehicles today are less safe that when we were growing up because it is simply not true.

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    Katie Reply:

    Great point. I will edit my comment so as not to be misleading in that way. I appreciate the point of correction.

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Welcome!
I'm Katie, a 30-year-old, wife, mom, former teacher-turned PT, who also had brain surgery in November of 2007. This blog chronicles my daily life, from mundane to crazy, often with far too much detail. Sit down, get comfortable and stay for a while.
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