Research from a few years ago showed that having a child under the age of two rear-facing provided greater protection than forward-facing: specifically up to five times more protection in a side-impact collision and almost double the protection for front-end collisions. Rollover collisions were not included in the study as they account for about 3% of all accidents, but 31% of fatalities, so including them in the study would have skewed the results. The study also concluded that the benefits of rear-facing don’t stop at age 2, but they simply didn’t study past age 2 and therefore recommended that children rear-face as long as their seat allows, with age 4 being the ideal because of how the spine & head develop, which we’ll come back to.
Side-impact crashes account for about 24% of all crashes, but result in higher injury rates than frontal or rear impacts combined. Another study showed that 40% of crashes with child fatalities were side impact collisions. This makes the fives times greater protection provided by rear-facing in a side impact collision pretty appealing. Only rollover crashes produce more injury to children than side impacts. Rollover crashes are complex, and the evidence to date shows that rear vs forward facing makes little difference, due to the severity of these kinds of accidents and the multiple forces involved. Since they only make up 3% of collisions however, keeping your child rear-facing as long as possible will afford them additional safety during the 97% of other collision types.
While the overall number of child deaths from car accidents is small, they are the # 1 cause of unintentional injury deaths for children in Canada. 61 children age 14 years and under were killed and another 501 seriously injured in motor vehicle collisions in Canada in 2010; approximately 3 deaths & 469 injuries per day occur in the US. A properly used car seats can reduce the risk of death by 71% for infants and 54% for children one to four years of age, while Booster seats provide 59% more protection for young children than seat belts alone. Yet it is estimated that anywhere from 44% to 81% (depending on the study) of car seats are not used correctly and that nearly three-quarters of Canadian children four to nine years of age are not transported in booster seats.
Which moves us into discussing the issue of just how long to rear-face for. Rear-facing until age 2 (instead of whatever the legal minimum is in your jurisdiction - 1 year/20 lbs or 22lbs/walking unassisted/according to the manufacturer’s specifications) is where you see the greatest statistical increase in safety, and is considered the minimum recommendation of car seat professionals.
Remember above I mentioned ossification of the spine? When a child is born, the vertebrae of the spine are held together by cartilage, not by bone as is the case with adults. Those pieces of cartilage can stretch up to two inches, but only 1/4″ stretch is enough to rupture the spinal column, resulting in paralysis or death. This is sometimes referred to as internal decapitation. In addition to the spinal vertebrae being held together by flexible cartilage, a child’s head makes up a large proportion of their body weight which means that there is a greater force put on the spinal vertebrae in even a minor collision. An adult head is roughly 6% of their body, while at 9 months of age the average child’s head still makes up 25% of their body weight. As they grow, the proportion of their head in relation to their body slowly decreases, however even by the time a child is in school full-time (around 6 years of age), the spinal column has not fully ossified in all children and their head is still a larger proportion of their body than an adults is. That being said, by age 4 there is sufficient ossification of the spine and proportional decrease in head-size for the risks of forward-facing to be considered low. In Sweden, where keeping children rear-facing until age 4 has been the norm for about 50 years, they have nearly zero motor-vehicle child deaths each year.
There will always of course be someone with a reason not to rearface their child any longer than the legal minimum requires them to. I encourage you to look at the facts and weigh the risks so that you can make an informed choice which is right for your family. The risk of your child being seriously injured or killed in a car accident IS small. The risk is smaller still if you ensure that you are using your carseat or booster seat properly each time. Some common objections to extended rearfacing include the following:
My child doesn’t like it and cries which distracts me…
...this is a common phase and turning forward-facing is definitely NOT a guarantee that the crying will stop.
My child gets motion sick…
...kids who are prone to motion sickness tend to experience it while both rear-facing and forward-facing; try things like Sea Bands or a little lemon essential oil spritzed in the air.
My child might get broken legs…
...actually the research shows that even when a child’s legs extend well outside the shell of a rear-facing carseat they are LESS likely to be injured than they are when forward-facing because of how the legs are impacted by other objects in the vehicle (like the front seat). Even if their legs are injured, which is very unlikely, leg injuries are far less serious/life threatening than neck and spinal cord injuries are.
The rear-facing seat doesn’t fit in my car …
...definitely talk with people in the know about your options as there is almost always a configuration that can work, although it might mean replacing the carseat.
My child outgrew the carseat and I can’t afford a new one….
...I get that. I really do. If it WAS mandated by law though, you’d find a way to replace the seat so consider planning in advance and keeping your eye open for sales. A seat that allows extended rearfacing doesn't have to be expensive. The Evenflo SureRide can be used rearfacing from newborn (5lbs - with infant insert) up to 40lbs & 24" seated height, then all the way up to a 65 lbs & 54" total height in forward-facing mode. This is currently the least expensive seat in Canada that allows for extended rear-facing and comes on sale for as little as $100 on sale ($140 regular).
Want help selecting a carseat that will allow for extended rear-facing in Canada? Click here.
References, Resources, & Recommended Further Reading
Parachute Canada - Carseats
Safety Benefits of Rear Facing
The Science Junkies Guide to RearFacing - Car Seats For the Littles
Why Ride Rear-Facing - The Carseat Lady
RearFacing Down Under
Rearfacing: The safest way to travel
Car safety seats for children: rear facing for best protection - NIH/BMJ
Recommended Canadian Carseats by carseart.org
Factors Leading to Crash Fatalities to Children in Child Restraints - NIS
Child and youth injury prevention: A public health approach - CPS
Road Safety In Canada - Transport Canada
Canadian Motor Vehicle Traffic Collision Statistics: 2010 - Transport Canada
Road Safety Research - CCMTA
Safe Roads Rollover Factsheet
Safe Roads Child Passenger Safety
What does car seat “side-impact protection” really mean? - Consumer Reports
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