Friday, August 5, 2011

Rear Facing

Children should ride rear facing (facing the back of the vehicle) from birth till they are at least 2yrs old or until they out grow their convertible car seat. Research has shown that children 12-24 months are 5x safer when rear facing vs forward facing. But the benefits of rear facing doesn't stop at 2yrs old.
So why rear face? When children are born and up until they are much older their heads make up 25% of their body weight. For an adult their head only makes up 6% of their body weight. Proportionally children have big heads. Infants and toddlers also have soft flexible bones that have not yet finished ossifying. They need flexible soft bones for two reasons. First is to make it out of the birth canal and second is so when they fall their bones don't break as easily.Children have soft bones for their own protection but when it comes to sitting in a forward facing car seat too early it can become dangerous.
When a small child is in a forward facing seat the big head on the weak neck is flung violently forward. This can cause the weak neck to detach from the big head, commonly know as internal decapitation. This can cause serious injury or death. But when rear facing the child is pushed into the back of the seat. The seat cradles the child, protecting the neck and head from serious injury.
Watch this crash test video of a rear facing child. If you notice on the dumby that is rear facing you can see a white piece of tape from the mouth to the back of the seat. The tape never breaks showing that there is little movement of the rear facing dumby's head.
As a child ages their bones become more and more ossified and they grow into their heads.

Joel's Journey
This is a story of a little boy named Joel. Joel was 18 months and 33lbs when he was involved in a frontal impact crash. He was restrained in a forward facing car seat in the back seat. The forces of the crash caused his neck to stretch so much it internally detached from his head. Joel was lucky to survive this type of injury. You can learn more about Joel at

I know what your thinking. "What about their legs?", "What about a rear end crash", "My toddler is too big to ride rear facing", "My child gets motion sickness when rear facing", "My child hates rear facing". Well lets address those common concerns.

What About Their Legs?

Many parents think once there little ones feet touch the vehicle seat that they must forward face them. Most fear broken legs or that their children will be uncomfortable. Small children are funny creatures. Many will play or sleep in positions I can not even imagine could be comfortable. But to them these strange contortionist positions are in fact comfortable. Children don't mind sitting in a frog position or cross legged or even with their legs thrown over the side of the car seat. In fact many forward facing children complain more about their legs being uncomfortable. This is due to their legs dangling. Imagine sitting on a bar stool with no place to prop your feed. Eventually that dead weight would get uncomfortable. Many toddlers and even preschooler ride rear facing very comfortably despite how it might look to us adults.
Broken legs don't seem to be a problem either when rear facing. In fact there have been no documented case of a rear facing child breaking their legs. But it does seem to be a common, number 2 after neck/head injuries, in forward facing children. It is also much easier to fix a broken leg than a broken neck.

What About A Rear Facing Car Crash?

Rear facing crashes are most often less sever and less common. Rear end crashes only make up about 4% of crashes. Frontal and frontal offset crashes combine for about 72% of severe crashes and side impacts are about 24%. Rear end crashes often happen at lower speeds.
Here is an example of a rare rear end crash. It happened at high speed. The only uninjured person in the car was the rear facing toddler.

My Toddler Is Too Big To Ride Rear Facing

All convertible car seat sold on the market today can accommodate most children up to at least 2yrs old. The lowest weight limit on most convertible seats are 35lbs. This includes even the inexpensive convertible seats. According to growth carts the 95th percentile for a 2yr old is about 33lbs-35lbs. So even the biggest child can make it to 2yrs or at least very close to their 2nd birthday rear facing.

My Child Gets Motion Sickness When Rear Facing

Studies have shown that children who ride forward facing are just as likely to get car sickness as a child who rides rear facing. Motion sickness is when the brain gets confused. Your eyes tell your brain that you are moving but your body is stationary. The brain cant understand these mixed messages and therefor the body gets sick.
Visit the Car Seat Lady's Blog to learn tips on how to help with motion sickness.

My Child Hates Rear Facing

Children who have been rear facing since birth will not know or understand the difference between forward facing and rear facing. Rear facing is all they have ever know. It is normal for children to throw a fit about getting in the car seat. This normally happens some time after their first birthday. They are starting to walk and crawl, they want to explore and discover. They dont hate the direction in which they face, they hate being strapped down unable to explore.
Car seat safety is just as important to enforce as any other safety issue you may encounter with your child. You wouldn't let your child climb on top of the kitchen counters to get to a knife. Its likely that if you removed your toddler from that situation s/he may throw a fit. But it would be unsafe for you to continue letting the child climb on the counter towards the knife. Same goes for car seat safety.

What Kind Of Seats Rear Face

There are two types of seats that allow for rear facing. The infant seat and the convertible seat.

Infant seat
An infant seat is only a rear facing seat and can NEVER EVER be forward facing. These seats are normally used from birth. Parents like these seats because some seats come with a base. The base is installed into the car and then the seat can be snapped in and snapped out. This allows for parents to remove a sleeping baby from the car without waking the baby and then place the baby back into the car. Some seats can be installed without the base though. These seats normally fit from birth to about 20-22lbs. There are some infant seats that have a higher weight limit of 30lbs-35lbs. If you are expecting to have had smaller weight baby pay close attention to the starting weight of car seats when you are shopping. Some seats start at birth but some state a specific weight, like 5lbs or 4lbs.
  • Infant carriers should not be placed on top of shopping carts (read here). It can be dangerous. Even though your infant carrier may seem to snap on securely to the shopping cart it is not meant to snap there. It makes your shopping cart top heavy and can cause the cart to tip.
  • Small babies shouldn't be left in the infant car seat for long periods of time while out side the car. (read here).
  • Some infant carries require that the handle be in a certain position when the vehicle is in motion. You can find this information in your car seat's manual. The Car Seat Lady has a blog post on the handle position each brand of car seat must be in.

Convertible Seat

Convertible seats are car seats that rear face and then can be turned forward facing. These seats are often used when the infant seat has been outgrown. Although some parents choose to skip the infant carrier and go straight to the convertible seat. This is perfectly safe but parents should remember that not all convertibles will fit an infant. Most of these seats have weight limits of at least 35lbs rear facing but some have 40lb weight limits or even 45lbs.

3 in 1 car seats or All in One
3 in 1s or all in ones are car seats that will rear face, forward face, and booster. Although the selling point of only needing one car seat for your child their entire life is a nice one, its not always a good option. Car seats have a life span or expiration date and it is dangerous to use them past this date. Most of the time this is around 6 years. If you use this seat from birth your child will not be ready to be without a seat by age 6. Another reason these seats do not make good seats is that they make poor boosters. Either they position the seat belt incorrectly or they are outgrown in booster mode at the same time they are outgrown by the harness. These seats may work for rear facing or for forward facing but they will likely not work when your child needs to be boostered and you will likely need to buy another seat.

  • Rear facing seats (infant and convertible) should NEVER EVER be placed in front of an active air bag. Children should ALWAYS be placed in the back seat when a place is available. If there is not a place available because there are more children than seat belts in the back seat then the oldest forward facing harnessed child should be placed in the front passenger seat. If possible the vehicle seat should be moved as far back away from the air bag as possible. If it is a single cab truck the air bag should be turned off first.
  • The best car seat is the one that fits your child, fits your car, and will be used correctly 100% of the time. All seats are held to the same federal safety standards (FMSS 213). This makes all seats equally as safe as the next seat, regardless of price. Price is normally based on brand name, ease of use, and extra features such as cup holders, padding, and how easy it is to install. NHTSA has issued an Ease of Use Rating for every car seat. You can search for a seat on their Child Safety Seat Ease of Use Ratings.
Placing your child in a rear facing car seat

Before installing your car seat into the car you will need to make sure that the harness is in the correct position for your child. For convertible seats check with the car seat manual to see which harness slots are allowed to be used when rear facing. When your child is sitting in a rear facing car seat the harness should be AT OR BELOW the child's shoulders, it should be tight and able to pass the pinch test, the harness shouldn't be twisted, and the chest clip should be even with the arm pit. Car Seat Lady video on strapping in a baby.

Here are some videos on Extended Rear Facing (extended rear facing (ERF) is when a child remains rear facing past 1yr and 20lbs)
The Importance of Rear Facing
Rear Facing vs Forward Facing
Rear facing is Safer
How Do You Catch a Raw Egg
American Academy of Pediatrics's policy statement from March 2010
The National Highway Traffic Safety Administration's policy statement from March 2010

How to Tell When Your Rear Facing Car Seat is Out Grown

Each car seat comes with a weight limit for each stage the car seat can sit (rear facing, forward facing, and booster). Some come with a height limit. You should look in the car seat's manual to see what are the rear facing weight and height limit. Once your child reaches either of these they have out grown the car seat rear facing.
If your child's seat doesn't mention a height limit for rear facing then you should go by the 1 inch rule. When there is less than one inch from the top of your child's head to the top of the car seats shell , the car seat is outgrown by height for rear facing. Read how to measure this click here.