You may have recently heard that a well established child restraint manufacturer has been spreading the word that that they’ve sponsored a review of a study well known to the injury prevention community, and that review seems to suggest that one of our most baseline understandings of child passenger safety may be wrong.
In 2007, the British Medical Journal published a study evaluating the effectiveness of forward versus rear facing seats for children from ages 0 to 23 months. Using data from representative crashes between 1988 and 2003, they found a statistically significant decrease in injury risk for children riding in a rear facing seat in the whole sample group, and even in the isolated sample of children 12-23 months they still found a very significant injury reduction compared to forward facing (Henary 2007).
Based on that study, as well as an abundance of physiologically relevant information and statistical evidence from Sweden where for decades children have remained rear facing for the first years of life, North American agencies invested in keeping children safe have altered their recommendations, advocating for keeping children rear facing minimally for two years and thereafter as long as they fit by height and weight.
Car Seats for the Littles recommends that children under four continue to ride rear facing as long as they meet all height, weight and fit restrictions set by the restraint manufacturer.
A currently unreleased review of the numbers seems to suggest that not only is the finding showing improved safety for rear facing less than robust, it may even be wrong.
Does this mean that Now Is the Time to Panic? No, not necessarily.
Peer review is crucial to the scientific process. Science requires that we be open to new ideas, even if they contradict our previously held beliefs. Studies are published in such a way that another member of the scientific community should be able to take all the data provided in the study, use the methodology described in the study, and come up with the same results. Much of ‘science’ is underpaid assistants replicating published studies and comparing old and new data for any discrepancies and then repeating, repeating, repeating.
In this case, statisticians reviewed the data analysis, added more data to the pool, and believe they have demonstratively shown a different conclusion. Now we must wait for more peer review, to compare the old and new methodologies, to find anything either previous party may have missed, to see if there are confounds not addressed or addressed differently.
In the meantime! We still know that physiological reasons as detailed here mean children are best protected in a properly used rear facing seat, as their spines cannot handle the excessive force created when a child is forward facing (Brockmeyer 2012). And we know from decades of data from Sweden that children who are rear facing rarely if ever suffer serious injuries (Carlsson 2013). AND we know that children in a properly used and installed seat, whether it is rear, forward or booster, provided it’s used according to the manufacturer’s instructions, have less than 1% chance of suffering a serious injury in the event of a crash (Arbogast 2009).
At CSFTL, we are excited because this should stimulate new research, and it should in time lead to increased safety standards for seats tested and used in North America. There may be aspects to US seats that are dissimilar to Swedish seats that could be replicated, improving the safety of American children. And, as embracers of the scientific method, we acknowledge that perhaps, after all, we will have to accept that this is a huge change for caregivers in the safety community.
In the meantime we recommend that you continue to keep your young children safely and properly rear facing, respective to the capacity of their seats, that you read your manual and properly use your seat, and that you visit a Child Passenger Safety Technician to evaluate your use and installation.
We will keep you posted as new developments become available.
Arbogast, K. B., Kallan, M. J., & Durbin, D. R. (2009). Front versus rear seat injury risk for child passengers: evaluation of newer model year vehicles. Traffic injury prevention, 10(3), 297-301. doi: 10.1080/15389580802677799.
Brockmeyer, D. (2012). Pediatric spinal cord and spinal column trauma. AANS/CNS section on pediatric neurological surgery. neurosurgery. org, 1-5. Retrieved from http://www.neurosurgery.org/sections/section.aspx?Section=PD&Page=ped_spine.asp
Carlsson, A., Strandroth, J., Bohman, K., Stockman, I., Svensson, M., Wenäll, J., M. Gummesson, T. Turbell & Jakobsson, L. (2013, September). Swedish Child car passenger fatalities in Sweden during six decades. Submitted to the International Research Conference on the Biomechanics of Impact (IRCOBI).
Henary, B., Sherwood, C. P., Crandall, J. R., Kent, R. W., Vaca, F. E., Arbogast, K. B., & Bull, M. J. (2007). Car safety seats for children: rear facing for best protection. Injury Prevention, 13(6), 398-402. doi: 10.1136/ip.2006.015115
Kamrén, B., v Koch, M., Kullgren, A., Lie, A., Tingvall, C., Larsson, S., & Turbell, T. (1993). The protective effects of rearward facing CRS: an overview of possibilities and problems associated with child restraints for children aged 0-3 years (No. 933093). SAE Technical Paper. Retrieved from http://papers.sae.org/933093/