Advise use of rear facing child car seats for children under 4 years old
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1994 (Published 11 June 2009) Cite this as: BMJ 2009;338:b1994
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It is not at all surprising that rear facing is safer up to age 4. I
recall a reference to a study in the 70s suggesting rear facing is the
safest position for adults.
This recommendation will be received as very inconvenient, I suspect.
While it may seem foolish to weigh convenience against safety, we do so
all the time. After all the safest place for the child would be not in the
car at all.
We have hundreds, if not thousands of health and safety
recommendations we could make. To be taken seriously, and as a matter of
practicality, we must weigh the absolute risks and difficulty of
implemenation in deciding which recommendations to actually pass on to
patients/parents.
Perhaps we need more data on absolute risk--how many lives saved per
mile driven if we change from current recommendations to this one?
Competing interests:
Father of 4 kids who were very glad to turn front facing at 12 months
Competing interests: No competing interests
Whilst we were preparing this article, rear facing group 1 car seats
were only
available at 1 or 2 outlets in the U.K. Since this article has been in
press, many
more nursery retailers have started to sell some of these seats. A useful
website
which gives practical advice regarding the available rear facing seats,
and where
they can be purchased from is; www.rearfacing.co.uk
The group 0+ (birth-13kg) car seat manuals/car seat manufacturers
websites
we have read do state that rear facing is safer until 13kg, but it is
perhaps not
always prominently stated, meaning that parents may believe forward facing
is
as safe as rear facing, or even recommended, from 9kg (the weight that
forward
facing group 1 car seats begin at).
Of course, if parents are not aware that rear facing group 1 seats
exist, then
they cannot seek them out. In an ideal world, a range of group 1 rear
facing
seats would be sold in the main retailers, at a similar price to the
forward facing
seats, so that parents could find a seat suiting their child, their car
and their
budget, without having to travel large distances to test the seats. It is
not an
option to order seats over the internet without previously being shown how
to fit
the seat in the appropriate car by a road safety officer or suitably
trained
retailer, as an incorrectly fitted seat can be dangerous.
Competing interests:
None declared
Competing interests: No competing interests
I enjoyed this article which answers an important question.
When my children were 1 yr old I kept them in rear facing car seats for as long as possible, but could not find rear facing seats suitable for >9kg.
A quick online search of major car seat providers (Mothercare, Halfords, kiddicare.com) confirms that forward facing seats are recommended from 9kg. Even 'combination' seats that are supposed to be suitable from birth to 4 years have instructions that they should be used rear facing up to 9kg, then forward facing.
If there are no rear facing seats available in the UK then it is not possible to implement this sound advice.
Competing interests:
Mother to 5 year old twins, in forward facing car seats form age 14mo.
Competing interests: No competing interests
I read this article with interest, mainly to check whether the high
casualty rate reported for forward-facing seats was linked with the type
of harness used. We investigated car seats before replacing our main
family vehicle (to one that did not take Isofix), and bought a German
brand that claimed to reduce cervical vertebral injuries by not using a 5-
point harness. The seat was very highly rated in the latest Which? tests.
It would be useful to know whether this claim is valid - does anyone
know of data on the relative safety of this seat design versus 5-point
harness? (It uses a broad 'impact cushion' in front of the child instead)
Also, I have checked the current WHO growth charts, which although
only adopted by the NHS after this article was accepted, were available
before then. A boy on the 50th centile would reach 9Kg at 42 weeks (just
under 10 months). Our daughter was over 12 months old when we changed
seats, mainly because her legs were squashed.
Perhaps the recommendations and/or seat designs should, like the new
WHO growth charts, be based on breast-fed babies? A 9Kg breast-fed baby is
likely to be taller than a 9Kg formula-fed baby, surely?
Competing interests:
Parent of a 13-month-old, currently using a forward-facing seat (not 5-point harness)
Competing interests: No competing interests
Authors response Re: Need for perspective
We agree that for adults, rear facing in cars is impractical.
However, it is for the
reason that young children are not small adults in an anatomical sense
that the
benefits of rear facing are greater for them.
Within Europe there are already many seats tested to ECE standards
that allow
rear facing until either 18 kg or 25 kg. These seats are designed for
older
children, allowing more legroom than the infant rear facing seats, and
allowing
as good a view out of the windows as forward facing seats. These are
mainly
marketed in Sweden, Norway and Finland. As the vast majority of Swedish
parents restrain their toddlers in rear facing seats, it would not appear
to be an
impractical proposition.
Even with the seats that are currently widely available within North
America and
throughout Europe, if parents have the knowledge that rear facing is safer
for
young children, they have the option to keep their children rear facing
until the
limits of the available seats. Certainly more data comparing rear facing
and
forward facing car seats would be welcome.
Competing interests:
None declared
Competing interests: No competing interests