Dear Nanny: Why Rear-Facing Until age 2?

Dear Nanny,

I read that children should rear-face in carseats until age 2. Why did the recommendation change? I have also heard of people doing "extended rear-facing." What does that mean? Thanks for your help!

- Carseat Confused

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Dear Carseat Confused,

There was a study done in 2007 that proved that children under 24mo are 5.23x safer rear-facing than forwards facing. This study, along with others caused the American Academy of Pediatrics to revise their previous stand of 'rear to a year' in carseats. Now the official recommendation is that children should be rear-facing to at least two years old, or when they outgrow their rear-facing seat.

The study was done with children aged 24mo and under, so we do not now the exact data for how much safer a child is rear-facing past 24mo. 24 months is not an exact number. It is not the magic age that makes children safer. We would all be safer rear-facing in a car - but that would make it difficult to drive ;). This is where extended rear-facing (ERF) comes in.

A young child's body is very different from the adult body. The head is significantly larger, which puts strain on a small neck, and the bones (in this case, specifically the spine) and muscles are not fully formed. When rear-facing the forces from a crash are spread out more evenly over a child's body, meaning that the child's body is under less strain. Also, a child's head is much better protected while rear-facing, so the pressure that would cause a forward facing child's neck to snap is much lessened.

In Sweden, children are rear-facing until four years old, and then moved directly into a booster seat (side note, it is much safer to have a 4yo harnessed forward facing than in a booster seat). They have significantly lower rates of death and injury to children under 4 in cars than we do in the US. Many families in the US are picking up on this trend of extended rear-facing. When they buy a rear-facing seat, they get one with high height and weight limits so they can rear-face longer. These families are rear-facing until 3, 4, 5, and even 6 years old. This is around the time that the ossification of the spine is complete, which is why parents are choosing to do ERF so long.

I would like to note that rear-facing is only safe in a carseat that fits your child and your car properly. Check the fit of your carseat by finding a CPS (child passenger safety) technician near you at www.seatcheck.org. Most carseats are installed incorrectly, so even if you think you did it right, have it checked.

Here is a link to the study: http://fcs.tamu.edu/safety/passenger_safety/certified-tech/rear-facing2.pdf
And a link to the AAP's policy statement: http://pediatrics.aappublications.org/content/early/2011/03/21/peds.2011-0213.full.pdf+html
And here is a link to a great video by thecarseatlady.com: http://vimeo.com/thecsl/2011aap

- Katie