Are pediatricians not communicating, or are parents not listening?
I don’t know the answer to that question, but recent data suggests that there is a communication breakdown somewhere in the process of education about child safety. In 2011, the American Academy of Pediatrics released updated child passenger safety guidelines, with the recommendation that children remain rear-facing in car seats until they are at least 2 years old, or until they have reached the highest weight or height allowed by the car seat manufacturer. A recent study done at the University of Michigan shows that the majority of parents are not following these guidelines.
Investigators conducted national surveys of car seat position in 2011, just after the recommendations were released, and then again in 2013 to see how parents were positioning car seats. While more parents are now keeping their children rear-facing until age 2, almost one in every four parents in the survey are still turning the car seat around at or before 12 months of age.
Clearly, we can do a better job! Most people don’t realize that there is a five-fold reduction in the risk of severe injury for children who are rear-facing compared to those who are forward-facing — in every type of car accident.
I have talked about car seat position with mommy friends, online chat acquaintances and even with my husband. I have heard it all: “I didn’t know” and “What if his leg gets broken?” are common comments. “She is bored looking at the back of the seat,” is another popular response.
Here are some truths to address some of the common myths I have heard about rear-facing car seat use.
Top Myths About Rear-Facing Car Seats
Myth: Children are at increased risk for lower-extremity injury from rear-facing car seats.
Truth: The risk of lower extremity injury from rear-facing car seats is about one per 1000 children. However, head and cervical spine injuries are much more common with forward-facing car seats. Kids can recover from a broken leg, but a broken neck can be deadly — and life-threatening injuries are far more likely to occur to children in forward-facing car seats.
Myth: Children are uncomfortable when they are rear-facing because their legs are cramped.
Truth: Parents who keep their children rear facing say that the kids are comfortable with their legs extended against the seat back in front of them. In Sweden, children remain rear-facing until they are at least 4 years old, and they have lower rates of child injury and deaths from motor vehicle accidents.
Myth: My child gets bored rear- facing.
Truth: If your child has never been forward-facing, then he or she does not know any different. Rear-facing children can still look out the window or at other children in the car. If you want to turn your forward-facing child back to rear-facing, but your child protests, think of this as your first parenting “I am going to do what is right, even if it is not popular with my child” opportunity.
Myth: I rode in the back seat before they even had seatbelts, and I was fine. Why are we being so cautious now?
Truth: According to the Centers for Disease Control and Prevention (CDC), child passenger deaths among children aged less than 5 years have decreased 30 percent since 1975. Unfortunately, motor vehicle collisions remain a leading cause of death for our children. Up to 80 percent of users of child passenger safety seats use the seats incorrectly — the child may be in the wrong type of seat, the seat may be installed improperly, or the child may not be correctly fastened into the seat. If more parents followed proper safety instructions for car seat use — regardless of how cautious they seem — fewer children would die. That’s hard to argue with.
There are so many things that we cannot control in our children’s lives. But while they are small and we are responsible for a lot of what happens in their little worlds, we need to do whatever we can to keep them safe. So take out that crazy-long manufacturer’s guide that came with your seat, figure out the height and weight limit for the seat, and keep your child rear-facing until that limit is reached.
For more information on choosing the correct seat for your baby, common installation mistakes and how to properly fasten your child’s car seat, visit safercar.gov.
Sarah Denny, MD, FAAP, works as an attending physician in the Section of Emergency Medicine at Nationwide Children’s Hospital and as an associate clinical professor of pediatrics at The Ohio State University College of Medicine.
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