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Wednesday, June 11, 2008

Post#8 A Car Seat Conundrum

Henary B, Sherwood C, Crandall J, et al. Car safety seats for children: rear facing for best protection. Inj Prev. 2007;13(6): 398-402

A 2007 study on injury prevention, cited above, shows that children ages 1-2 years of age who were placed in a forward-facing car seat had a 5.32 times greater risk for serious injury as opposed to children in a rear-facing car seat. Five times the risk. WOW.

It is common practice to keep children rear-facing until 1 year of age AND 20 lbs. However, after children turn 1, most moms can't wait to turn the car seat forward. The change in position allows greater visibility of the child, more interaction with the child (perhaps a negative in terms of accident prevention), easier access to the child (again maybe not so good for accidents), and a perception that the child will now be happier with the new and improved view of the mother and the world through the front windshield. I certainly thought our first child cried less after we turned her forward.

But this new finding indicates that the child will be safer facing the world through the rear window, as children in Sweden do until 4 years of age. In fact, the study found that for children under 12 months, the safety factor of a rear-facing car seat was only 1.79 times higher than a forward-facing car seat. Meaning, from a statistical standpoint, it is even more important to keep them rear-facing from 1-2 years of age then it is before they turn 12 months.

This data poses a conundrum: At what point does the comfort and well-being of the child/family trump a statistical safety factor?

There is no question in my mind that my first child hated her car seat for the first 12 months of her life. No, hated is too weak of a word. Loathed. My wife and I counted the days until we could turn her forward, and in fact we cheated by graduating her a few weeks shy of her first birthday. Life in our car became significantly more serene once we made the change, and driving no longer raised our blood pressure.

And though the above study clearly demonstrates we took a risk in making the switch, I could argue a significant counterpoint. I believe the harrowing cries produced by my daughter while driving posed a risk in and of themselves. The amount of anxiety that her crying generated was a driving distraction which could have (but never did) led to an accident.

Did her crying offset the potential 5X increase in risk we took by turning her forward? I'm not sure and never will be. Would I change what we did with her based on this new data? Perhaps, but probably not.

However, I do plan to keep my third child (and would have with my second child) rear-facing for as long as he (and my wife) will tolerate. Seems the boys (child #2 and #3) are more content facing the world from the rear. (I'm not sure if there are any implications here about their future!)

And like many pieces of advice available to mothers out there, each must be weighed and individually determined for each family. Not only that, depending on the demeanor of the child in his/her car seat, an individual family may use different timelines to make the switch forward for each of their children.

One thing is clear: I do believe that this information is pertinent, and pediatricians need to make it available to their patient population so that each family can make an informed decision as to what is best and ultimately safest for them.