REAR-FACING 5 TIMES SAFER THAN FORWARD-FACING
American Academy of Paediatrics recommends rear-facing until at least age 2
3y & 10m Safe & Rear-Facing
INTRODUCTION.
In April 2011 the American Academy of Pediatrics (AAP) published new guidelines on children in car seats,
recommending that children ride rear-facing until at least age 2, but probably up to 4 years. (1)
Surprised? We’re not; the evidence is there. A 2007 article in Injury Prevention showed that 2 year-olds were FIVE
TIMES SAFER riding rear-facing than forward facing.(2) A 2008 article Pediatrics urged pediatricians to ‘implement
what we know to be best practice: children should ride in a rear-facing seat to the highest weight or height allowed
for use rear-facing by the manufacturer of the seat.’(3) In June 2009 the British Medical Journal published “Advise
use of rear facing child car seats for children under 4 years old.”(4)
WHAT SEATS ARE BIG ENOUGH FOR 2-YEAR-OLDS REAR-FACING?
Convertible seats are ones that start rear-facing and then convert to forward-facing for older kids; kids typically start
using a convertible seat rear-facing after out-growing the infant seat. The weight limit for rear-facing is typically 3540 pounds for most convertible seats, with a few seats going to 45 pounds and one to 50 pounds rear-facing. The
height limit is the same for any rear-facing seat – the child’s head must be at least 1 inch below the top of the car
seat.
WHAT ABOUT THEIR LEGS?
3-year-old happily rear-facing
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As kids get older, their feet will touch the back of the vehicle seat; this is both comfortable & safe. Ever wonder why
a 5-year-old can sleep comfortably with his chin on his chest & never wake up complaining of a stiff neck? It’s
because kids’ joints aren’t fully formed, which lets them sit comfortably in positions that would be painful for even a
yoga master. For this reason, a 3-year-old can sit comfortably rear-facing with her legs crossed or in the “frog leg”
position. Other parents worry about leg injuries; studies show that forward-facing kids suffer many more leg injuries
than rear-facing kids.(5)
MY BABY WANTS TO SEE OUT!
Rear-facing does not have to be boring! Older kids can ride quite upright so they can see out the side and rear
windows. If there is a head rest blocking your child’s view out the back window, you can usually remove it. By 9-12
months your baby knows you’re there when you talk to them from the front – even though they can’t see you. You
can calm and entertain your child with songs & stories while they are rear-facing.
MY BABY GETS MOTION SICK!
Volvo looked at several thousand pre-schoolers and found the same rates of motion sickness in those riding rearfacing as those riding forward-facing.
RECOMMENDATIONS
It’s no coincidence that flight attendants sit rear-facing. Rear-facing is the safest way for everyone to travel, not just
babies. Therefore, it is my recommendation as a paediatrician and nationally certified child passenger safety
instructor that children ride rear-facing until at least age 2 – and ideally longer, until reaching the maximum height or
weight for rear-facing in their convertible car seat, which for most kids is around 4 years old.
Alisa Baer, MD (01/14)
WATCH: http://www.youtube.com/watch?feature=player_embedded&v=sssIsceKd6U#t=0 to see what happens
to a crash test baby dummy in a front facing car seat!
References
1. American Academy of Pediatrics, Committee on Injury, Violence & Poison Prevention. Child Passenger Safety.
Pediatrics. 2011; 127: 788-793.
2. Henary B, et al. Car Safety Seats for Children: Rear Facing for Best Protection. Injury Prevention. 2007; 13 (6): 398402.
3. Bull M, Durbin D. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics. 2008; 121 (3): 619-20.
4. Watson E, Monteiro M. Advise Use of Rear Facing Child Car Seats for Children Under 4 Years Old. BMJ. 2009; 338:
b1994.
5. Arbogast KB, et al. Injuries to Children in Forward Facing Child Restraints. Annu Proc Assoc Adv Automot Med.
2002; 46: 213-30
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