Rear-facing car seats safest for kids up to age 4

June 12, 2009 "I'm lucky -- both of my kids don't have too much of a problem with it," she said.

Lal, like many parents, follows the current guidelines from the American Academy of Pediatrics that children less than 1 year of age or lighter than 20 pounds should be placed in a rear-facing child car seat -- which positions young children facing backwards in the car's cabin -- in order to decrease the risk that they will be injured in an accident.

Indeed, there is little doubt that the seats represent the safest means available to transport children in a car -- even after their first year of life. And a new recommendation published Thursday in the British Medical Journal suggests that children up to the age of 4 are safest if placed in such seats when riding in a car.

"Many parents and health care providers may be unaware that it is safer to leave children in rear-facing seats for as long as possible or that rear-facing seats for toddlers exist," the paper's authors, led by Dr. Elizabeth Watson of Meed Surgery in Woking, United Kingdom, wrote in their report. "Health care professionals should advise that rear facing seats are safer than forward facing seats for children aged under 4 years."

Child safety experts overwhelmingly applauded the recommendation.

"A child is 5.53 times safer during their second year of life in a rear-facing car seat versus a forward-facing one," said Dr. Joseph O'Neil, a pediatrician at Riley Hospital and associate professor of pediatrics at the Indiana University School of Medicine in Indianapolis. "I think that this is a very important topic for child safety."

Car Seats Mean Safety, Adjustments for Parents

But Lal said that while she appreciates the safety that the seats afford her kids, she also is familiar with some of the frustrations that some parents face with them -- not the least of which is that by design, her children are facing backward in the car.

"When my daughter was under 1 year old, we were driving home one day and she was violently throwing up," she said.

In order to check up on her baby, she had to stop her car on the highway, exit the vehicle and open the back door so she could attend to her daughter face-to-face.

"When they aren't facing toward you, you can't monitor them," she said. "You can't see them at all."

And that may not be the only problem. Lal said that for families with multiple kids, the need for more car seats means a need for more space -- and hence a bigger, less fuel-efficient vehicle that could rankle parents who wish to be more environmentally friendly or cost-conscious.

"If you have multiple kids, you have no choice but to have an SUV or another type of big car that uses more gas," she said. "We have two kids under 2. We want a third kid, which would mean that we would have three under 4."

Why Rear-Facing Seats Are Safer for Children The reason behind the safety of rear-facing seats has to do with simple physics. To begin with, children's heads are generally larger in proportion to the rest of their bodies than are adults'. Thus, their heads and necks are more vulnerable to movement-related injuries like car crashes. "There are a lot of things that rear-facing seats do that forward-facing seats do not," noted Thomas Vilt, child passenger safety coordinator at the Rainbow Injury Prevention Center in Cleveland and a former EMT. "For one, it supports the child's whole body, so the crash force is spread over the child's whole body." Sharon Munns, injury prevention coordinator at the Mayo Clinic Trauma Center in Rochester, Minn., said front-facing seats offered no such protection. "The rear harness works in a way that allows the head, neck, and spine to move all straight up and down, so the body movies with the restraint of the seat, preventing crash-related injuries," she said. "In a front-facing seating, all of the body weight is going forward on the harness, which can cause injury to the head, neck and spine for children under 35 pounds. There are documents of spinal cord injuries because of children facing frontward at such an early age." Rear-Facing Car Seats Can Be Pricey But for parents of children who weigh more than 35 pounds, finding a rear-facing seat is a challenge. For one thing, there is currently only one model of rear-facing car seat available on the United States market that can accommodate a child up to 40 pounds. Secondly, the cost of the seats ranges from as low as $40 up to $400 or more. "It's going to be tough for parents to spend this extra money. ... Car seats aren't always cheap," said Marissa Fisher, a registered nurse and injury prevention coordinator at the Jersey City Medical Center in Jersey City, N.J. "But I think safety should supersede everything else." And while rear-facing car seats that surpass minimum safety standards can be found in most price ranges, many parents may feel that the more they invest, the safer their child is going to be. "Who wants to be on the record for buying a cheap car seat?" Lal said. New Car Seat Regulations on the Way?

O'Neil said that, ideally, reports like the most recent one in the British Medical Journal and others like it eventually will lead to new laws that would raise the age during which children should be required to ride in rear-facing seats.

"The leading cause of disability and death for children over one year of age ... is injuries," he said. "We really need to get regulatory changes. If you don't have regulations in place, it's hard to get the changes moved through."

But Fisher said that such laws may not yet be on the horizon -- especially considering current safety laws, which she said leave much to be desired in some states.

"I think we're a long time away from [regulatory changes]," she said. "We're still working on getting secondary seatbelt laws in many states."

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