Monday, June 3, 2013

Rearfacing & Extended Rearfacing Information

Rearfacing & Extended Rearfacing

If you only watch two of the three videos I've posted about rear-facing, I'd choose this one and the one underneath. All are good watches though. Rearfacing is safer for everyone and as long as a child can fit that way it keeps their spinal cord safer.

Sweden started focusing on car seat safety in 1960's, decades before other countries.  They realized early on that many children were dying in traffic accidents and that almost all of these fatalities could easily be prevented by simple and affordable measures regardless of country.  In the 1960's they also discovered how amazingly safe rear facing was, something which has saved the lives of a large amount of children since then. (x

Approximately 75% of kids in Sweden rear-face until at least age 4. From 1999-2006, only 4 rear-facing children under age 4 were killed in crashes and their deaths were due to circumstances unrelated to the direction the carseat was facing (fire, drowning, excessive intrusion). During that same time frame, 6 kids under age 4 facing forward in booster seats were killed; 3 of these crashes were potentially survivable crashes had the children been in rear-facing carseats. (x)

In Sweden, where the recommendation is to keep children rear facing until age 4, ERF is rarely discussed.  Rear facing until age 4 is almost a default behavior by parents. Many parents even rear face until 6! Since 1965, but mainly during the past 25 years, parents have been told to keep their children rear facing to save lives.  Fortunately, most have listened.  Although the European law permits forward facing at any age it’s unusual to see children under age three forward facing in Sweden.  (x)

The rear-facing position reduces stresses to the neck and spinal cord and is particularly important for growing babies. Infants and young toddlers have spines made of soft bone and cartilage that doesn't begin to harden until around age 3.  As a result, the spinal column can stretch up to 2 inches; however, the spinal cord will rupture after being stretched after only ¼ inch.  This damage cannot be repaired.  (x) (x)

Babies and toddlers have weak spines that haven’t fused to protect the spinal cord, and they have proportionately huge heads, and when forward-facing, the weight of the large head pulls on the weak spine, and can separate the skull from the spine, possibly severing the spinal cord (internal decapitation), resulting in paralysis or death. Also, the way the body slides when rear-facing helps the car and car seat absorb the maximum amount of centrifugal force so your baby’s body doesn’t have to — children are 75% less likely to die when rear-facing. Everyone is, actually, but it’s just not possible for adults. As far as their legs? Not only would leg breaks be preferable to a broken neck, but forward-facing children are more likely to break their legs than rear-facing children. (x)

No children have ever been reported to have broken their legs as a result of rearfacing.

We (Sweden) keep our kids rear facing mainly for the great protection of head and neck.  As doctors say, "We can fix arms and legs – we can't fix head and neck". At this stage all children have weak neck muscles and a fragile skeleton.  Head of a child is also proportionally very large, around 25% of total weight for a 12 month old.  This makes forward facing a bad choice before age 4. (x)

The current recommendations in the US are to rearface until 2 and until they reach the “highest weight or height allowed” by their convertible carseat (The American Academy of Pediatrics) and  to keep your child rear-facing as long as possible, or as long as children fit within the height and weight limits of the car seat  (National Highway Traffic Safety Administration - On their site they set the goal as up to the 4th birthday) because of the  fragileness and non-solidity of young children and babies necks and skeletons. However, children are still safer that way until they don't fit any longer. 

Picture #1

Cervical vertebrae for a one-year old (left), and beside it a cervical vertebrae for a 6 year old (right)

Picture #2

Thoracic vertebrae for a 1 yr old (left) and for a 6 yr old (right). 

Picture #3

Lumbar vertebrae for a 1 yr old (left) and for a 6 yr old (right). 

Pictures Courtesy of: Human Osteology, T. White, 2000

Note that in all pictures, the 1-yr olds' vertebrae is still in pieces. 

The vertebrae do not begin to fuse until age 3-6 years old. This is why rear-facing is the safest as it gives more support and protection to the incomplete vertebrae and therefore the spinal cord. With vertebrae in pieces, a forward facing child has a greater chance of damage to the spinal cord when their head and neck whip forward and back in a crash. This, however, brings us back to why we want to rear face children for as long as they fit into a rear facing seat. Between the new science that we’ve got and the knowledge about the spine, we’re finding that rear facing is extraordinarily protective. (x)


Gives reasons why the recommendations recently changed and shows proportions of a child in relation to an adult, also shows why protecting the neck is so important for small children with diagrams of how the neck vertebrae change and fuse as we get older.

How much safer is rear facing?  Research has shown rear facing to be 500% safer up to two years of age.  Do benefits disappear after that?  Not at all.  Rear facing is always safer, even for adults like you and me.  Benefits decrease with age as our children develop fragile head, neck and spine.  Rear facing at ages 3 or 4 still offer large benefits which the Swedes have shown in real life.
500% may sound like a lot but numbers can be hard to grasp.  In 100 collisions of rear facing kids, 8 rear facing children will die or become seriously injured.  92 will walk away fine.  In 100 collisions with forward facing  kids, 40 will die or become seriously injured.  60 will walk away fine.  Those are large differences which help to save lives.

"Yeah, I don't understand how we are all ok. Especially T2... every single person coming on scene thought they were dealing with at LEAST a medvac, if not a casualty. People didn't believe us when we told them the 2 year old I was holding that kept shrieking "I can't want a bandaid!!!!!" was the kid sitting there"
Rachel's crash demonstrates SO well one of the lesser-touted benefits of rear-facing- it places the child's head, the most vulnerable part, toward the center of the vehicle, inside it's protective cage, during the initial impact, the most severe part of the crash- no matter where that impact is, to the front, the rear, or the side- allowing the vehicle to protect the rear-facing occupant. 

The safest place for your child to ride is in a rear-facing car seat, in the back seat. In a crash, the rear-facing car seat protects your child's head, neck, and spine. Keep your child rear-facing for as long as possible according to manufacturers' instructions.


Infant Car Seat (Rear-Facing Only)

"Infant-only" car seats can only be used rear-facing. These types of seats are designed to be portable and
are generally lighter in weight and easier to carry than car seats intended for older kids.
Best Practice: When your child outgrows the infant car seat, move him or her to a convertible, 3-in-1 or an All-in-One car seat, used rear-facing. These seats typically have higher height and weight limits for the rear-facing position, allowing you to keep your child rear-facing longer. If a baby under 1 year old grows too tall or too heavy for an infant-only car seat, we recommend moving the baby to a car seat with higher rear-facing size limits.


Convertible car seats offer you the advantage of using one seat for both the rear-facing and then the forward-facing position as your child grows. Read the manual carefully, and remember that children should continue to ride rear-facing until they reach the top height or weight limit before you move them to the forward-facing position.

All-in-One or 3-in-1

All-in-One and 3-in-1 seats offer you the advantage of using the same seat for the following positions: rear-facing, forward-facing with harness, then booster.

Best Practices

For both types of seat: Read the manual carefully, and remember that children should continue to ride rear-facing until they reach the top height or weight limit, before you move them to the forward-facing positions with harnesses.

 Commonly Asked Questions
Won’t his legs get hurt rear facing? No. Nationally, in rear facing children, there have been no reported cases of injury to the extremities. On the other hand, in forward facing children, we’ve found that there are a great number of extremity injuries – it’s the second most likely thing to get hurt, after the head and neck. 

What’s he do with his legs? Well, many kids put them over the sides of the car seat, up on the back of the vehicle seat or sit “criss-cross-applesauce”. It’s easy for them, they are very flexible. 

Won’t she be squished? This child has just spent 9 months curled up in her mother’s womb. We recommend swaddling. This is no different. Children are very flexible and they can do many things that we as adults would be uncomfortable doing. Adult perceptions should be put aside when looking at comfort for a child. If your child outgrows their infant seat, there are now many convertible seats that rear face to 35, 40 and even 45 lbs. 

When is my rear facing seat outgrown?

When the baby's legs reach the end of the car seat or are touching the seat? No. The seat is outgrown when:
  • The child has outgrown the rear facing weight limit of his or her car seat (if the child is younger than one, he or she needs a car seat with a higher rear facing weight limit.) AND
  • The child is at LEAST two-four years old – rear facing longer is safer
  • The child’s head comes to within one inch of the shell of the rear facing car seat
Car Seats For The Littles has an ERF album. You can see a 6 year old, not included in the album, happily rearfacing here.

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