James in his rear facing Britax Multi Tech

Would parents in the UK, if given the necessary information, be so quick to change their children to a forward facing car seat? This is the subject of today’s column and one which will, no doubt, engender some serious debate on the topic. The subject of rear facing car seats seems to be almost as emotive as that of breastfeeding versus formula or cloth nappies versus disposables but, personally, I wonder how much of that emotion is down to a simple lack of knowledge.

The BBC recently published a news story based on an article in the British Medical Journal which provided serious evidence that children should be kept rear facing until the age of four as a minimum (http://news.bbc.co.uk/1/hi/health/8094829.stm). The article,  (http://www.bmj.com/cgi/content/full/338/jun11_2/b1994), by Dr Elizabeth A Watson, (general practice retainer,  Woking), and Dr Michael J Monteiro, (specialist registra, Royal Surrey County Hospital, Guildford), looked at a number of studies across the world into accidents involving children in both rear and forward facing car seats.

The most common misunderstanding is that a child is ready to travel facing foward when their neck muscles are strong enough to support and control their head. Unfortunately, when a car hits something, most often another vehicle, even at 25 to 30mph, it will come to stop at a negative acceleration rate of somewhere between 20 and 30G. Because of the time lag between when the vehicle stops and when the occupants stop, in combination with the fact the head of a forward facing adult or child is still free to continue moving forward relative to their bodies being restrained, the head can experience a force of as much as 60 or 70G for a brief moment. This information is taken directly from Carseat.org’s website (http://www.carseat.org/Technical/tech_update.htm#rearfacFF) which also provides additional information for parents looking at buying their next stage car seat (although it is US-orientated the information is still useful).

Swedish research

In Sweden, where it has been common practice for more than 25 years to keep children rear facing until the age of four, statistics show that a forward-facing seat increases safety by 50%, while in a rearward-facing seat, safety is increased by 90-95% (Inggard Lereim, Professor, Doctor of Medicine and Chairman of the Nordic Traffic Medicine Association). In fact, Swedish accident research has shown that rearward facing children’s car seats reduce serious injuries by 92%, while the forward-facing seats only reduce injury by 60%. According to Thomas Turbell, VTI (Swedish National Road and Transport Research Institute), the reason for this is simple.  He says: “The child’s head is very heavy compared with the rest of the body. A nine-month-old baby’s head comprises 25% of its total body weight, while in an adult the head weighs 6%. In a collision, a child’s neck is subjected to a proportionally higher strain. In a rearward-facing seat, the force of a collision is distributed optimally over the child’s head and back.”

Studies in the US, where it is also common practice in many states to keep children rear facing until age four, also back up this data. A retrospective cohort study (http://injuryprevention.bmj.com/content/13/6/398.abstract?ijKey=0c98ad51be182213950768631967adeb14504bbc&keytype2=tf_ipsecsha) used the US National Highway Traffic Safety Administration’s vehicle crash database for 1998-2003 to search for evidence of car seat safety. Of the 870 children studied (all aged under two-years-old), 352 were in rear facing car seats and 518 were in forward car facing seats. The study defined injury as an injury severity score of nine or more, which is considered to represent moderate and severe injuries.

Their study concluded that rear facing seats were more effective in protecting children under the age of 23 months in all crash types. The effectiveness estimates of car seats versus no restraint at all were 93% for rear facing seats and 78% for forward facing seats. When children aged 12-23 months were analysed separately, the findings remained: children in forward facing seats were much more likely to be injured (5.32 times more likely). However, it must also be pointed out that US studies also show that more than half of all children killed in accidents in America are improperly restrained or unrestrained.

Lack of information for UK parents

Here in the UK, Government advice from the Department of Health/Department of Transport is that children have to travel rear facing from birth until they weigh 9kg (around eight months of age for a boy on the 50th centile to give people an idea), when they should be switched out of the infant carrier and into another seat. Now here is where the lack of important information starts to creep in. UK parents are still being advised to switch to a forward facing seat even though medical and safety experts have repeated the call for children to be kept rear facing until the age of four .  Did you also know that the rear facing car seats which are widely used in Scandinavia aren’t easily available to parents to buy directly in the UK even though they’re manufactured here by companies including Britax and Graco?

Fortunately, this lack of information is slowly beginning to change. A superb website – http://www.rearfacing.co.uk/index.php – was set up by a half British/half Swedish couple who were staggered to find how difficult it was to find a group 1 rear facing car seat for their nine-month-old child. Their website provides a Q&A for the main queries parents have when trying to find out about rear facing car seats. However, it’s not comprehensive but it does provide the information in a factual and totally none emotive fashion.

One argument against the use of rear facing second stage car seats I often see mentioned is that the child will be uncomfortable or their legs would get squashed or they would be bored/get fed up/be nauseous traveling backwards. All of these arguments can easily be answered though. The rear facing car seats are specifically designed to create additional leg room when the child is smaller and, as they grow bigger, most children either pop their legs up on the seat in front of them or dangle them out the sides of the seat. They are elevated enough that they can still see out of the side and rear windows and there are plenty of in car entertainment systems which will work just as well with a rear facing seat as they will with a forward facing one. In addition, most rear facing car seats can be fitted in the front passenger seat providing any airbag system has been disabled if this really is an issue.  Take a look at this blog for answers to most of these questions – http://carseatqueen.com/rf.aspx

There’s also a blog by an American woman which shows pictures of her two girls rear facing (http://myangelsaliandpeanut.tripod.com/carseats/index.album) and provides great proof that kids in a rear facing seat will sort out what they do with their legs. The same blog also has information about what would happen to a child in a rear facing car seat in the even of a rear impact collision. The evidence is surprising. Find out here – http://myangelsaliandpeanut.tripod.com/id5.html

Further questions

A few other objections I’ve heard raised to using a rear facing car seat include the cost. Unfortunately, yes they are more expensive. This is directly down to the demand for them. If more parents started to buy them, the manufacturers would reduce costs as a method of competing between themselves for customers. Another thing to bare in mind is Government legislation in the UK says all children have to be restrained by specialist car seats and boosters until the age of 12. Most people  buying a group 1 car seat end up also having to buy a group 2 or 3 one later, usually for around the same price as buying a single rear facing seat would cost.

More and more parents are switching to rear facing second stage car sets. Many of these parents are picking up information from sites like this one. Many cloth using mummies also advocate the use of rear facing car seats until the age of four and there have been lots of posts on parenting forums asking for more information. Hopefully this column will go a long way to answering some of the questions usually asked and providing the right information for parents wanting to find out more themselves.

For a list of UK stores selling rear facing car seats see here – http://www.rearfacing.co.uk/buyersguide.php