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Expert opinion

A study commissioned by ANEC, the European consumer voice in standardisation, March 2008
An accident Study of the performace of Restraints Used by Children Aged Three Years and Under
Authors: Dr. Peter Gloyns, James Roberts, Vehicle Safety Consultancy LTD
Anec report: The UK, US and Swedish accident databases all have examples of unexpected poor protection in forward facing seats. The report leads to the suggestion that children up to four year of age would be better protected if they travelled rearward facing. Use of well designed rearward facing restraints would avoid the injuries seen in most cases. The Swedish data indicates that there are no dis-benefits associated with this pattern of use.

NHTSA, National Highway Traffic Safety Administration, March 21, 2011
Car seat Recommendations for children
Keep your 1 to 3 year old child in REAR-FACING car seat for as long as possible. It's the best way to keep them safe. They should remain in a rear-facing car seat until they reach the top height or weight limit allowed by your car seat's manufacturer. Once your child outgrows the rear-facing car seat, your child is ready to travel in a forward-facing car seat with a harness.
A rear-facing car seat is the best seat for your young child to use. It has a harness and in a crash, cradles and moves with your child to reduce the stress to the child's fragile neck and spinal cord.

NTF - The National Society for Road Safety is a non governmental organisation which works to improve road safety, July 2006
Policy on safe and secure traffic
Rear-facing child seats reduce the risk of being killed in a crash by 90-95 %, while front-facing seats reduce the risk by 50-60 per cent. Approximately 5 children under the age of 7 are killed in cars every year. Almost all of them would have survived if they had used a rearward facing child seat. The car industry should take more responsibility for in-car safety. EU and EuroNCAP should be influenced to make it a standard to use rearward facing child seats for up to 3-4 years old children.

American Academy of Pediatrics, April 2011
In a new policy published in the April 2011 issue of Pediatrics (published online March 21), the AAP advises parents to keep their toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat.

Issued in Pediatrics, Official journal of the American Academy of Pediatrics, March 2008
Rear-Facing Car Safety Seats: Getting the Message Right
Authors: Marilyn J. Bull, MDa, Dennis R. Durbin, MD, MSCEb

A recent analysis of the protection provided in rear-facing compared with forward-facing car safety seats has revealed that children under the age of 2 years are 75% less likely to die or sustain serious injury when they are in a rear-facing seat. This finding was true regardless of direction of the crash, even those crashes with side impact, which typically are the most severe.; Henary B, Sherwood C, Crandall J, et al. Car safety seats for children: rear facing for best protection. Inj Prev. 2007;13(6): 398–402

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. This information is additionally supported by data from Sweden, where children have ridden in rear-facing seats up to 4 years of age for many years, and very low death and injury rates have been documented; Jakobsson L, Isaksson-Hellman I, Lundell B. Safety for the growing child: experiences from Swedish accident data. In: Proceedings of the 19th International Technical Conference on the Enhanced Safety of Vehicles. Washington, DC: National Highway Traffic Safety Administration; June 6–9, 2005. Paper Number 05–0330

Lower-extremity injuries are rare for children facing the rear, on the order of 1 per 1000 children (Partners for Child Passenger Safety Study, unpublished data, 2007). In addition, riding facing front does not eliminate a child's risk of lower-extremity injuries, because these injuries, as well as injuries to the head and spine, have been described among forward-facing children in child-restraint systems; Arbogast KB, Cornejo RA, Kallan MJ, Winston FK, Durbin DR. Injuries to children in forward facing child restraints. Annu Proc Assoc Adv Automot Med. 2002;46:213–230.

An accident study of the performance of restraints used by children aged three years and under, March 2008
Authors: Gloyns P., Roberts R. [Vehicle Safety Consultancy]
From 1999 to 2006 four children aged under 4 years and restrained in rear facing seats were killed. The deaths were due to fire, drowning, or excessive intrusion and were unrelated to the type of car seat.2 During the same period six children aged under 4 years in forward facing booster seats were killed. Three of these crashes would have been potentially survivable if the children had been travelling in rear facing seats.

Advise use of rear facing child car seats for children under 4 years old
BMJ2009; 338 doi: 10.1136/bmj.b1994 (Published 11 June 2009)
Authors: Elizabeth A. Watson (Sunny Meed Surgery, Woking GU22 7EY), Michael J. Monteiro (Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU2 7XX)

Currently many babies are switched from a rear-facing car seat to a forward facing seat at 9 kg (8 months of age for a boy and 9 months of age for girl).  Excessive stretching or even transection of the spinal cord can result if a child is involved in a head-on crash while in a forward facing car seat. Rear facing seats are safer than forward facing seats for children under 4 years old.

Parents and guardians should be advised to keep young children in rear facing seats for as long as possible.

SafetyBeltSafe U.S.A., 2009
If the baby is facing forward in a frontal crash, which is the most common and most severe type, the body is held back by the straps — but the head is not. The head is thrust forward, stretching the neck and the easily injured spinal cord. Older children in forward–facing safety seats or safety belts may end up with temporary neck injuries or fractures that will heal. But a baby's neck bones actually separate during a crash, which can allow the spinal cord to be ripped apart.

In contrast, when a child rides facing rearward, the whole body — head, neck, and torso — is cradled by the back of the safety seat in a frontal crash. Riding in a rear–facing safety seat also protects the child better in other types of crashes, particularly side impacts, which are extremely dangerous, if not quite so common.

Rear-Facing Car Seats Advised at Least to Age of 2

Published in The New York Times, March 2011
Dr. Dennis R. Durbin, scientific co-director of the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia

Dr. Durbin said: "A baby's head is relatively large in proportion to the rest of his body, and the bones of his neck are structurally immature.  If he's rear-facing, his entire body is better supported by the shell of the car seat. When he's forward-facing, his shoulders and trunk may be well restrained, but in a violent crash, his head and neck can fly forward.

We want parents to recognize that with each transition they make, from rear-facing to forward-facing, to booster seats, there is a decline in the safety of their child. That's why we are urging parents to delay these transitions for as long as possible."

Rear-Facing Car Seats Advised at Least to Age of 2

Published in The New York Times, March 2011
Debbi Baer, a labor and delivery nurse in Baltimore who has been a car safety advocate for children for more than 30 years.

Debbi Baer said: "People cheer when they turn their kid around at one year, but hopefully some day they'll cheer at how long they were able to keep their child rear-facing.  She noted that parents often told her that their 2-year-olds would be uncomfortable with their legs squashed against the back of the seat, and that they might be more likely to break their legs in a crash. Neither is true, she said.
I always reassure parents that just because it looks uncomfortable to you doesn't mean that it is for a child."

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Rear facing facts

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Rear facing children are 5,32 times safer.
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Child is 75 % less likely to suffer severe body injuries.
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Reduces the risk of car accident deaths by 90-95 %.
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No reports of leg injuries
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