Why Kids Should Stay in Rear-Facing Car Seats Longer

May 14, 2018Dr. Grant RadermacherPediatrics

Why is rear-facing safer than forward-facing?

Parents are often tempted to “graduate” their kids from rear-facing to forward-facing car seats as soon as they can – often when they outgrow their infant carrier – but new research says that children’s spines aren’t ready for a major (forward-facing) impact and are safest riding in rear-facing seats until they’re closer to 4 years old.

The American Academy of Pediatrics urges parents to wait as car seat studies have shown that children under 2 are up to 500% less likely to die or sustain serious injury in a rear-facing car seat than a forward-facing one. No matter what popular opinion says or how much your child protests, the fact is, with every transition to the next seat up there’s a significant reduction in the level of protection for your child, so it makes sense to keep your child in each stage for as long as possible.

Why does it make such a difference?

First, rear-facing seats spread out the force of a car crash more evenly across the car seat and the child’s body. It also minimizes the motion of the child’s head, reducing the risk of whiplash-type neck and spinal cord injuries, and protects them from potentially harmful glass and unsecured items bouncing around in an accident.

This is more important for kids under the age of 4 than for older kids because toddlers aren’t just small adults; their bodies are still developing and those developmental changes make them far more vulnerable than an adult. A toddler’s vertebrae are connected via cartilage rather than ossified bone – in fact, even at age 3 there’s only a 50% chance that a child’s top three vertebrae (the bones we’re most concerned about injuring in an auto accident) are fully fused.

Additionally, an infant or toddler’s neck supports a head that’s much heavier proportionally than an adult’s (25% of their total body weight, while an adult’s head comprises only about 6% of their body weight). The difference in proportion of head to body, and the associated stress placed on the neck and the spinal cord in the event of an accident, only adds to the need to protect the spine.

Second, let’s talk crashes. According to NHTSA, roughly 60% of vehicle crashes are frontal impacts and 20% are side impacts. Occupants will always travel towards the point of impact, putting all the stress on the neck and spine, so it’s easy to see why experts strongly urge keeping your child rear-facing for as long as possible.

What the evidence says

A recent study from BMJ Injury Prevention compared 15 years worth of crash injury statistics involving children under age 2. They found that “the odds of severe injury for forward-facing infants under 12 months of age were 1.79 times higher than for rear-facing infants; for children 12 to 23 months old, the odds were 5.32 times higher”.

The bottom line

Many parents make the mistake of thinking that the transition from infant carrier to convertible is the right time to go forward-facing, but the evidence says they should opt for a convertible rear-facing seat instead until they’re closer to age 4. It’s not a choice to be made based on parenting style or opinion; it’s one based on fact. Keep your kids safe!