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Advise use of rear facing child car seats for children under 4 years old

BMJ 2009; 338 doi: 10.1136/bmj.b1994 (Published 11 June 2009)
Cite this as: BMJ 2009;338:b1994

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  1. Elizabeth A Watson, general practice retainer1,
  2. Michael J Monteiro, specialist registrar2
  1. 1Sunny Meed Surgery, Woking GU22 7EY
  2. 2Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Guildford GU2 7XX
  1. Correspondence to: E A Watson eliwat1{at}yahoo.co.uk
  • Accepted 30 March 2009

This article explores why it is safer for young children to travel in a rear facing seat until they are 4 years old

Key points

  • 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 on the 50th centile)

  • 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

The clinical problem

In many countries it is a legal requirement that children under a certain height or age (1 m 35 cm or 12 years, in the United Kingdom) use child restraints appropriate for their weight while travelling in a car. This significantly reduces morbidity and mortality.1 European car seats for babies and young children are classified as group 0+ (from birth to 13 kg, and all rear facing) and group 1 (9-18 kg, often forward facing but can also be rear facing). Currently, many babies are switched from a rear facing to forward facing seat at 9 kg (age 8 months for a boy on the 50th centile.2 3 Evidence is mounting, however, that it is safer for young children to travel in a rear facing seat until 4 years of age.2 3 4 5 6 7 8

The evidence for change

The relatively large head mass and differences in the anatomy of the cervical spine in young children5 can lead to excessive stretching or even transection of the spinal cord if a child is involved in a frontal (head-on) crash while in a forward facing car seat. …

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