Ask almost any grandparent over the age of 50 and they will readily recount tales of road trips with their kids to Mount Rushmore, Disneyland, Niagara Falls, and the Grand Canyon with little to no thought of seat belts, much less car seats -— all without incident or injury.
I personally recall my mother thrusting her arm out during abrupt stops as I sat unbuckled in the front of her VW bug. That technique kept me “safe” throughout my childhood. But as a pediatrician and parent, I question the wisdom of that practice now knowing what I do about car safety for kids.
Indeed, it is true that not every trip across town or across the country with an unrestrained child will end in an injury. But it’s clear from years of statistics that child restraints in motor vehicles — infant seats, child seats, booster seats for older kids and seat belts — have significantly improved the safety of this generation of children.
Properly placed, installed and maintained, car safety seats have sometimes — albeit morbidly — been referred to as “orphan seats” because restrained children are often the sole survivors in otherwise devastating crashes.
While the number of child deaths in motor vehicle crashes has decreased as the use of restraints has increased, motor vehicle related deaths remain the leading cause of death for children ages four and older. For this reason car restraint safety continues to be refined.
New recommendations and requirements are always on the horizon in almost every area of child safety, and car seats are no exception. Being current on these updates requires vigilance on the part of parents, grandparents and pediatricians alike.
Most caregivers are aware that babies must be placed in rear-facing infant car seats — preferably in the middle backseat. However, there is often confusion about when the best time is to transition to a forward-facing child seat. While new recommendations on this were introduced over 18 months ago, I still find that as I talk with families in my practice many remain are unaware of these updates.
Furthermore, many families don’t appreciate how vulnerable children become when they transition to a forward-facing position and as a result are often turning their kids forward-facing too soon.
The old recommendations dating back to 2002 were to: 1) keep a child rear-facing until they had reached the manufacturer’s specified limits of the infant car seat with 2) a minimum age of 12-months and weight of 20 pounds before facing them forward in a child seat.
With a significant number of children being at or over 20 pounds by a year of age, some caregivers were eagerly facing children forward immediately after their first birthday (regardless of the car seat’s maximum parameters) or, even more concerning, rotating their position as soon as they reached 20 pounds, no matter what their age.
The forward-facing position is much more dangerous for young children because of the instability of their head, neck and spine. This instability greatly increases the chance of injury when facing forward in the car. Forces generated during a motor vehicle collision are distributed better — more to the seat, less to the child’s body — when a child is rear-facing.
One study demonstrated that a rear-facing child was 75 percent less likely to die in a car crash than one facing forward. Because of this and other similar studies, in April 2011 the American Academy of Pediatrics recommended that the minimum recommended age for forward-facing position be changed to 24 months.
It is also important to recognize that reaching 24 months is NOT a deadline or an absolute time to face forward in the car. In fact, in countries such as Sweden and Australia, children are commonly kept in the rear-facing position until age 4. Interestingly, Sweden also has the world’s lowest highway fatality rate for children under 6.
One of the common criticisms of this recommendation that I often hear from parents is their perception that the rear-facing position appears uncomfortable for children because of their legs being pushed up against the back of the seat. They are also sometimes concerned about the possibility of an increased chance of their legs being broken in a crash.
While these might at first glance appear to be reasonable concerns, neither have any supportive evidence that they are true. There is, however, ample evidence that the rear-facing position is both safe and effective.
Smaller children will continue to be safer the longer they stay rear-facing, assuming they are still within the parameters given by the car seat’s manufacturer. When the transition to forward-facing is made, it should continue to be a harnessed seat the child remains in until the designed height/weight maximum for the seat are reached.
At that point, transition to a booster seat can be made in order to make certain that the car’s seat belt apparatus is properly positioned: shoulder belt across the middle of the shoulder/chest — not near the neck/face — and lap belt low-and-snug on hips/thighs — not across the belly/abdomen.
Booster seat use should continue until the child is at least 4-feet 9-inches tall (usually between 8-12 years of age). Finally, children should remain in the rear seats of the vehicle until 13 years of age.
It is also vital that the child restraint fits the vehicle in which it is used and be installed properly. A significant number of seats are improperly installed, which makes them far less effective.
Having the seat inspected by someone trained in their proper installation is highly recommended. The Walla Walla County Traffic Safety Task Force periodically hosts installation checks. They can be reached at 524-2936.
It is obviously impossible to completely eliminate the risk to children, particularly when it comes to motor vehicle accidents, but as parents, grandparents, caregivers and medical providers we should strive to do what we can to minimize the risks by following the most recent recommendations available.
Dr. Trent Rogers is a pediatrician with Walla Walla Clinic.