By Heather Hollingsworth
Fairway, Kansas - Anne Epperson thought little of it when she flipped her daughter's convertible car seat around so she could face forward after her first birthday.
But if car seat advocates get their way, parents like Epperson will be delaying the switch, possibly for years.
The American Academy of Pediatrics is revising recommendations that they hope will clear up confusion over how long children should spend riding rear facing in car seats and make them safer in the process.
Some experts, citing a much-touted 2007 study, say tots are being put at risk switching to the forward-facing position at one year of age and nine kilograms, currently the minimum guideline from the pediatrics group and the US National Transportation Highway Safety Administration.
That's because the extreme forces in some frontal crashes can jerk the heads of forward-facing children away from their immature bodies, creating a risk of spinal cord injuries. Rear-facing children are safer because their entire backs absorb the force of the crash.
The issue becomes confusing because both groups also advise that children are safer if they remain rear facing until the upper height and weight limit of their car seats. Many seats top out at 15kg in the rear-facing position, a weight many children don't reach until somewhere between their third and fourth birthdays.
It's rare in the US for children to remain rear facing that long, although several countries require their youngest passengers to ride rear facing until they are four or five years old and 25kg.
The issue has attracted growing attention since a 2007 article in the journal Injury Prevention showed that US children are five times less likely to be injured in a crash between their first and second birthdays if they are rear facing.
"We rarely if ever see spine injuries in children in rear-facing car seats," said Dr. Marilyn J. Bull, the contributing paediatric researcher in the study. "We will see head injuries or we will see a few other injuries, but the vast majority of serious injuries occur when children are forward facing."
The American Academy of Pediatrics is still discussing how it is going to revise the recommendations.
Dr. Dennis Durbin, who is leading the effort to update the group's policy on child passenger safety, said the emphasis will be more on remaining rear facing to the upper weight limit of the seat. The academy is hoping to introduce the new guidelines late next year.
Durbin said he is well aware of the research and said one of the goals with the revision is to reorder the policy and "really state what the ideal is."
Pediatricians get some of the blame, said Dr. Benjamin Hoffman, part of an American Academy of Pediatrics committee that helps educate parents and doctors about injury prevention. The Albuquerque, New Mexico, paediatrician said some are still promoting old guidelines that say children must be turned forward at a year.
Hoffman, also a certified car seat technician, came across a mother recently whose paediatrician had given her that old advice, and she balked when he suggested she keep her one-year-old son in the rear-facing position.
Stories like these make activists shake their heads. Motor vehicle crashes are the single leading cause of death for U.S. children, claiming an average of about four lives a day. Hoffman said it is tragic that "people are not operating on the best information they possibly could."
"The bottom line is that in a crash, a child who is rear facing is going to have all the crash forces spread over their entire back, from the tops of their head to the tips of their toes," Hoffman said. "And spreading all that force out over such a wide area significantly decreases the risk of injury."
Experts said part of the problem is that parents often have viewed switching their children to the forward-facing position as a rite of passage. - Sapa-AP
Comment from a South African reader:
Thank you for highlighting this important issue. I do hope the manufacturers and suppliers take note.
I have a 14 month old baby girl and I was obliged against my better judgement to switch her to the forward facing position when she grew out of her rear facing car seat.
The benefit of a rear facing car seat for children up to 4 years old has long been known in Europe. However as consumers in SA we do not have the option of a rear facing seat simply because there are no rear facing Group 1 car seats available. I searched and searched on the internet and when I asked about rear facing car seats for her age and size in both Reggies and Baby City I was simply given the curt reply that she should be forward facing; with the implication that I was ignorant to even ask for such a thing as they do not excist. This is upsetting as like all mothers I want the best for my child and I have to put mine in a car seat that I know could cause spinal injury in an accident because there is no alternative.
Yes the legal requirement is for a forward facing car seat, but that is only the minimal safety requirement. Surely parents in SA deserve more than the minimum when it comes to safety for their children particularly when you consider the high road accident rates we have?