Parents should keep young children in rear facing car seats for as long as possible, state doctors in a paper published on bmj.com today.
It is common practice to switch babies to a forward facing car seat at 9kg (8 months of age for an average boy), but there is mounting evidence that it is safer for young children to travel in a rear facing seat until 4 years of age, write Drs Elizabeth Watson and Michael Monteiro.
For instance, data from Sweden where rear facing up to age 4 is common practice, has shown that children who died in accidents restrained in forward facing booster seats could have potentially survived if they had been travelling in rear facing seats.
One study used the US National Highway Traffic Safety Administration crash database to examine crashes involving 870 children between 1998 and 2003, and concluded that rear facing seats were more effective than forward facing seats in protecting children aged 0–23 months for all crash types.
Recent crash tests have also reported that rear facing seats resulted in significantly lower neck and chest injury measures compared with forward facing seats. The authors of another crash simulation study encouraged manufacturers to develop rear facing seats for children up to 4 years of age.
The authors explain that, unlike forward facing seats, rear facing car seats keep the head, neck and spine fully aligned so the crash forces are distributed over all of these body areas.
They believe part of the problem is that many parents and healthcare providers may be unaware that it is safer to leave children in rear facing seats for as long as possible, or that rear facing seats for toddlers exist.
Healthcare professionals should advise that rear facing seats are safer than forward facing seats for children under 4 years, say the authors.
They also call on manufacturers and retailers to increase the availability of rear facing seats for older children and for a change to the current weight-range labelling of European seats, which may imply that forward facing seats are as safe as rear facing seats for children over 9kg.