Having your child in the rear facing position whilst in a car is strongly recommended and a constant topic of conversation on Car Seat Support South Africa. Extensive research coming out of first world countries proves conclusively that having your child in a rear facing car seat provides much better protection in the event of an incident than the alternative of having them forward facing.
HOW rear facing seats HELP Your child's Body in a crash
Children are not just small adults. Their body size proportions, underdeveloped bones, loose ligaments and weaker muscles means that their necks are far less able to handle fast stops, starts and jerks without being whipped back and forth in a damaging way.
HEAD AND BODY PROPORTION
C1, C2 and C3 vertebrae at age 1 (left) and age 6 (right).
Credit: White, T. Human Osteology, 2000
Because children have big heads resting on small spines the fulcrum, or the ‘centre of movement’, of the neck for children under 5 years old is higher up than in an adult, with the most movement happening just where the head meets the first vertebrae of the neck. During a car accident, statistics show that this is the area that takes the brunt of force and becomes injured in children.
Research also shows that injury to this upper neck region in young children may affect the brainstem and upper spinal cord, possibly stopping breathing, causing full cardiac arrest, paralysis and even death.
By 6 years of age, the fulcrum moves down to the 3rd and 4th vertebrae and by 8 years and above it is the same as adults and shows the same injury patterns as adults (5-7th vertebrae) making them less susceptible to this type of brainstem injury.
The fact that young children have looser ligaments, underdeveloped joints and vertebrae that are not yet ossified (meaning that they have not yet turned from cartilage to bone) means that their spines are quite elastic and can stretch up to 5cm, whereas the spinal cord can only stretch to 5mm before it can snap.
This can lead to a condition known as SCIWORA (spinal cord injury without radiological abnormality) which is damage to the spinal cord that does not impact the bones or joints, and as a result is not always picked up on x-ray.
This can result in such a neurological injury not being detected in casualty, and serious symptoms developing up to 2 days later. In adults, the fact that the spine is made of bone limits its amount of stretch. The cartilage in children’s necks only starts to ossify (turn to bone) once they are over 2 years old and is only likely to have completed ossifying by age 7-8 years. The skeleton develops with age, not size.
SOFT RIB CAGE
Children’s ribs are more elastic and are thinner than in adults. This means that impact to the chest wall of a child (as in hitting up against the forward facing car seat’s harness) produces larger amounts of pressure on delicate organs like the lungs and heart; leaving them vulnerable to injury. The smaller rib cage also offers less protection to the larger organs in the abdomen, which would be protected by the ribs in the adult.
Accident research has shown that "rearward facing children’s car seats reduce serious injuries by 92%.”
( Rear Facing: The Way Forward)
WHY REAR FACING IS BETTER IN DIFFERENT Types OF CRASHES
FRONTAL AND SIDE Impact Collisions
So why do rear facing car seats make your child so much safer?
Statistically speaking its because head on crashes and side impact collisions happen more frequently and tend to happen at higher speeds, often resulting in severe injuries.
During an accident, a child in a forward facing car seat will move toward the point of impact, putting the most stress on the neck, as the head is thrown around violently whilst the upper body remains tightly held by the harness.
At the moment of impact there are actually three impacts that occur: the vehicle hitting another car or object, the body of the child hitting into the seat belt or harness, and then their internal organs hitting the front of the inside of the body. However, when a child is rear facing, the forces of the crash are distributed more equally along the backrest of the car seat shell, supporting their neck and spine in alignment and limiting damaging movement
Compare the crash force distribution in the below video:
You’ll notice how the dummy’s head is thrown forward in the forward facing seat, while the dummy’s head and neck in the rear facing seat is cradled by the backrest of the car seat.
Rear end collisions
Parents often raise concern over a rear facing car seat in a rear end collision.
Rear ended crashes tend to happen at lower speeds and mainly involve damage to the vehicle. So statistically, its important to have the best protection for frontal crashes.
Another point to consider is that in rear ended and side impact crashes, the driver tends to push the break just before impact, which creates a brake force with a forward direction. In this instance a rear facing child is pushed back into the seat and cradled just the same as in a frontal collision, whilst a forward facing child will be flung forward, losing contact with the back of the seat, making the side impact protection less efficient.
Considering the forces involved, two cars traveling at 100kph colliding in a double front end crash create enormous forces as the cars go from high speed to a complete standstill in mere seconds. On the other hand, two cars traveling in the same direction, with one hitting the other from behind, creates a smaller differentiating force, making the effect of the impact potentially much less serious .
Here’s another recent study looking at rear-facing car seats in rear end collisions. The study found that rear facing car seats mitigate and manage crash forces in a variety of ways that allow them to provide for protection for rear facing children
REAL LIFE EXAMPLE
Photo Credit: FaceBook
An Australian mom, Angela Brown, and her two daughters were involved in a horrendous head on collision. Her 2 year old was forward facing while her 1 year old was rear facing. Her 1 year old was unscathed, while her 2 year old had fractured her C2 and C3 vertebrae and tore all her ligaments in her C1 vertebra.
The doctors stated that most children with her injury don’t normally make it. Angela said that, “I was always unsure about turning my babies around, but after our crash and the hard evidence we are presented with I will forever rearward face my babies as long as I possibly can. Don’t make the same mistake as I did. It could cost you your baby's life.”
- In June 2009 the British Medical Journal published Advise use of rear facing child car seats for children under 4 years.
- Decades of data in Sweden also support this recommendation: “Children have ridden in rear-facing seats up to 4 years of age for many years, and very low death and injury rates have been documented” (Bull & Durbin, 2008).
- The American Academy of Pediatrics has very recently revised their car seat guidelines. They have changed their recommendation for children to rear face to a minimum of 2 years, to now recommending that children should ride in a rear-facing car seat as long as possible, up to the maximum height/weight limits of their car seat. This will include virtually all children less than 2 years of age and most children up to age 4.
Although it may be legal in South Africa to have a baby forward facing from 9kg, what is legal is just the bare minimum requirement and is not what is safest when it comes to car seats.
The reality is that babies and children are much safer in an extended rear facing car seat. The best practice recommendation is to rear face to a minimum of 2 years, however, the research proves that rear facing to age 2 is truly a bare minimum. According to this study, a 3 year old only has a 50% probability that the C3 vertebra has completed ossification.
The older a child gets, the more time their spinal column has to strengthen, and the less vulnerable the spine is likely to be. Without a CT scan, there is no way to know what stage of development your child’s spinal column is in, so the safest option is to rear face to the maximum weight or height of a rear facing car seat.
There are now several car seats on the South African market that will allow extended rear facing to 18kg/105cm (approximately 4 years) and 2 that allow rear facing to 25kg/112-115cm (approximately 5 years).
All the extended rear facing car seats and the available safety reviews can be found in the Extended Rear Facing photo album on Car Seat Support South Africa. It is not safe to use a car seat that is only approved to rear face to 9 or 13kg over the maximum approved weight/height limit. Always follow your car seat manual’s instructions on correct installation and maximum weight and height limits.
Rear facing is not a choice to be made based on parenting style or opinion; it’s one based on scientific fact. The more we know about physics and physiology, the better we’re able to protect our kids from severe injury as a result of a crash.Car Seats for the Littles
Bull, M. J., & Durbin, D. R. (2008). Rear-Facing Car Safety Seats: Getting The Message Right. Pediatrics, 121 (3), 619-620. DOI: 10.1542/peds.2007-3637