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Rear-facing… still the safest way to ride

Posted in: Blog, Response to Media

As you read this post, keep in mind that rear-facing is the safest thing we know how to offer a child in a car – studies show fewer injuries to all parts of the body, including the head and spine, when kids ride rear-facing compared to forward-facing. Also remember that rear-end crashes aren’t where most kids are getting hurt; 43% of injuries to children in car seats occur in frontal crashes, 33% in side impact crashes… and just 15% in rear-end collisions. 

As a pediatrician and national expert in child car safety, I have deep concerns about the scientific validity of this study highlighted in the Nov 2, 2015 Washington Post for the following reasons:

  1. Robson Forensic, which conducted this study, is not a government approved crash test lab. They did not confirm their results at a government approved crash test lab. 
  2. They invented their own rear-impact crash test. This is problematic as:
    1. There are countries which have rear-impact regulations and the rear-impact crash test is done with LOWER G-forces than the frontal-crash test because rear-impacts in the real world typically happen at much lower speeds than frontal crashes. This study conducted their rear-impact test at the SAME 30mph speed as the frontal crash tests.
    2. The countries that require rear-impact testing do not focus on HIC (head injury criteria) which this study focused on, but rather look at neck injury as a marker for spinal cord injury which can occur without the head striking something. HIC mainly accounts for injuries due to the head striking something, but we know that serious and fatal neck injuries can occur just by the head being pulled forward and back violently – without it hitting something. Therefore, looking at neck loads is a better way of understanding the risk for head and neck injury in this scenario.
    3. They did not use a standardized test method – therefore the validity in the values of the HIC scores are in question.
  3. The sample size was way too small. They used just 3 car seats (2 infant seats, 1 convertible), and ran 27 crash tests – which makes it impossible to draw any relevant conclusions – let alone conclusions about infant seats or convertible seats in general. 
  4. The study did not account for the many ways that seats currently on the market can limit the rotation of the car seat towards the back of the vehicle, such as:
    1. Methods to limit the movement towards the back of the vehicle in a frontal impact OR rear-impact:
      1. Handle kept up in the carry position (allowed on most infant seats in the US) or rotated just above the baby’s feet – see this chart
      2. Metal anti-rebound devices – like on the Clek Foonf & Clek Fllo – instead of the small plastic one on the Britax Chaperone which they noted had deformation post-crash
      3. Swedish-style rear-facing tethering (e.g. Peg Perego 5-65, Diono Radian/Olympia/Pacifica/Rainier)
    2. Methods to limit the movement towards the back of the vehicle seat in a frontal impact:
      1. Load Leg on Pipa and Aton2.001Load leg on base (e.g. Cybex Aton2/Q, Nuna Pipa)
      2. European belt routing for carrier without base
  5. There should be less test-to-test variation than is seen in this study. In some of their tests, there was wide variation in the results between tests of the same seat, which leaves unanswered questions about the testing methods and the repeatability of the test. 
  6. The HIC (head injury criteria) values that they got – even the highest ones – are still low… meaning that at these HIC values we wouldn’t always expect to see injuries.
  7. The title of the study would lead you to believe that it can draw conclusions about whether LATCH or seat belt in your child’s car seat is more effective at reducing head injury in a rear end crash… but it simply can not do this for the above reasons. 

So… for those of you who have read this far here is what we suggest:

  1. Keep your child rear-facing as long as possible – it is hands down the best protection we can offer. Study after study consistently shows that rear-facing children suffer fewer injuries to all parts of their body when compared to forward facing children.
  2. You are statistically much, much more likely to be in a serious frontal or side impact crash – than in a serious rear-end crash – and the child is significantly safer rear-facing than forward-facing in these crashes.
  3. Make sure whatever car seat you are using is installed properly… more than 90% are not and most parents who think they are doing it right aren’t. Find someone trained in your area to get the installation checked by going to www.seatcheck.org
  4. If you want to limit the motion of your child’s car seat towards the back of the vehicle, here is what you can do:
    1. For infant (rear-facing only) seats, look for ones with:
      1. A load leg on the base (e.g. Nuna Pipa, Cybex Aton2)
      2. A carry handle that can be UP or towards the baby’s feet area while you are driving (see this chart)
      3. A European belt path for times when you install the carrier without the base
    2. For rear-facing convertible seats, look for ones with:

Still worried about having your child riding rear-facing in a rear-end crash… here’s one mom’s story of a horrible rear-end crash from December 2014 (the pictures below show how horrific it was… the trunk is nearly obliterated):

Severe rear-end crash that 22m/o survived unharmed

Rear-end crash that REAR-facing 22m/o survived unharmed

My daughter, mom and I were involved in a hit and run accident a couple weeks ago. While stopped at a red light on a highway, we were rear-ended by a man going around 90mph who the cops were in pursuit of for reckless driving. We were sent 200 ft and into oncoming traffic. Luckily my 22 month-old was rear facing in the center and came out unscathed! My mom was in the back with her and suffered neck trauma. The paramedics told us it was a good thing my daughter was rear facing as she could have suffered horrible injuries, even a broken neck!

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