AAP article about rearfacing to at least age 2 (not a policy change)

[joolsplus3]

http://aapnews.aappublications.org/cgi/content/full/30/4/12-a

"Toddlers should remain rear-facing in a convertible car seat until they have reached the maximum height and weight recommended for the model, or at least the age of 2"
:)

[emandbri]

That is awesome! I hope lots of people see it! :whistle:

[MomToEliEm]

Great! I hope pediatricians start following the AAP recommendations. I also hope car seat manufacturers will start labeling their carseats with the new minimum recommendations and not 1 year and 20 pounds.

[BookMama]

:thumbsup:

Meanwhile, the car seat handout in our ped's office is the one from 1999. :rolleyes: I know that's just the practice's handout, and our individual ped is very supportive of car seat safety (she was happy when I told her that DD is still RF and DS still rides in at least a booster all the time) but still. I'm going to keep an eye out for updated materials on the AAP site and take her a copy when they're available.

[zeo2ski]

AWESOME!!!!!:D:love::D:love:

[mimieliza]

This is awesome! And I agree, I hope carseat manufactures start age two the minimum for FFing as well.

[christineka]

I want the manufacturers to up the forward facing minimum weight to 30 pounds, not change the age. We have all heard of babies who are 35 pounds at age 1. What legal car seat are they supposed to use if all the car seats require age 2 to forward face, but only rear-face to 35 pounds?

Anywa, I think this is awesome and great news. I've shared it already.

[Mama Jo]

Thanks for finding that!!

[capeKO71]

LOVE THAT! I've been telling people 2 (because they just don't get the "until 35lbs" thing...) and I'm so happy to now be able to say... the "new AAP recommendation is to rear face until at least 2".... whoo hoo!

[zeo2ski]

This is making me so happy, what a big step in promoting ERFing. Hopefully someday we'll be able to take the "E" off because it will just be the norm.

[jess71903]

YAY!!!!:cool!::2thumbsup:

I'm considering printing that off and sending it to every peds office in the county!

[emandbri]

I posted on my st. Louis board about it. I had a couple of people say "my child would never have let me do that" bla bla bla but a handful said they were on board.

One women JUST bought a new seat and went to have it installed at the fire station where I volunteer and was told that "she can be forward facing now." She says she wished the fight fighters were on board. Well, yes I do too! :rolleyes:

[thepote]

Does anyone know what the procedure is from the AAP for disseminating these sort of guideline changes to the physician community?

:thumbsup:

[emandbri]

Does anyone know what the procedure is from the AAP for disseminating these sort of guideline changes to the physician community?

:thumbsup:

I don't know. My dr still has stuff on her door dated 1999. :whistle: I printed new stuff for her but she never put it up.

Years ago I worked on a car seat info packet. I was hoping to put it in waiting rooms but I ended up moving and never started it again.

[Wife&MomX3]

I was SOOO happy to read this! I hope more parents realize how dangerous the '1 & 20' thing was.
I want the manufacturers to up the forward facing minimum weight to 30 pounds, not change the age. We have all heard of babies who are 35 pounds at age 1. What legal car seat are they supposed to use if all the car seats require age 2 to forward face, but only rear-face to 35 pounds?

The law isnt changing, so those rare 35lb 12 mon olds wont be riding illegally. The recommendation is changing, to say "RF to the seat's limits, or at least age two". If yer child hits the limit before age two, then you've still RF'd to the limit, regardless of age.

[joolsplus3]

I want the manufacturers to up the forward facing minimum weight to 30 pounds, not change the age. We have all heard of babies who are 35 pounds at age 1. What legal car seat are they supposed to use if all the car seats require age 2 to forward face, but only rear-face to 35 pounds?

.

AAP doesn't make laws, no child will be illegal to forward face before age 2 as long as they meet the seat's requirements.

[christineka]

I was responding to the poster(s) before me that wanted manufacturers to put an age 2 minimum to forward face. If there were no seats with a 1 year minimum to forward face, then it would be illegal for someone to forward face their 35 pound baby.

[CelticLabyrinth]

So it's probably going to say something like "All children should ride rear facing until at least their 2nd birthday OR until they reach the limits of their rear facing convertible car seat"?

Coolios. I hope this gets some press. They have yet to change their website info, though.

[joolsplus3]

I was responding to the poster(s) before me that wanted manufacturers to put an age 2 minimum to forward face. If there were no seats with a 1 year minimum to forward face, then it would be illegal for someone to forward face their 35 pound baby.

Ah gotcha. :)

[Maedze]

It would be simply to rectify the dilemma by simply saying, for example, the child must be 1 year old, 34" inches and 30 pounds for forward facing. That will force most children to stay rf to two.


Once getting seats to 40-55 lbs rearfacing as a standard, then it's fine to put an age restriction on it (I.E, must be 3 and 30 to forward face, etc)

[ketchupqueen]

I've known kids who hit 30 lbs. before 34 inches. I hope that doesn't become universal.

[capeKO71]

I suggest everyone put it as a link on their facebook page, and also forward the release to all the newspapers/news stations around you... it's worth attempting to get press on this. Present it as "most parents have no idea" - and this is a "new" statement from AAP...

[joolsplus3]

What would be simple and feasible would be "2 or 30 pounds". Most seats could do that for most kids now.

[TechnoGranola]

I wonder if Joel's bompa (grandpa) had anything to do with this? I know that he was very disturbed with the old recommendations and was working to get them changed with the AAP and other organizations.

[capeKO71]

Wouldn't be surprised... hopefully NHTSA and Safekids will follow with a similar age based recommendation... not that it's 100% the best recommendation - but it's WAY better then what we have now... and most people don't read into the "until the max weight of your seat" - because they think of a 22lb infant bucket...

[pastrygirl]

I wonder if Joel's bompa (grandpa) had anything to do with this? I know that he was very disturbed with the old recommendations and was working to get them changed with the AAP and other organizations.Oh wow, that would be incredible!! :thumbsup:

[fyrfightermomma]

What would be simple and feasible would be "2 or 30 pounds". Most seats could do that for most kids now.


I agree. Keep it at age OR weight, not AND. And I hope they don't raise the FFing minimums much. I know I"ve said this before, and I know that I am in the minority but what is someone with a child like my daughter supposed to do if the FFing minimum changed to 2 AND 30 lbs. Or if the minimum to FF was 30 lbs? Am I supposed to RF my 7 year old? What happens when she outgrows by height well before then? Use a FFing seat illegally?? KWIM?

While my case is somewhat rare, it's not that unheard of. That's why they need to leave the FFing minimums alone and do a weight OR age, not AND.

1 AND 20 works because all children will hit 20 lbs before age 2 or 3. But 2 AND 30 lbs doesn't work because those smaller kids or slow gainers may not make it to 30 lbs before age 6 or so. Weight gain really drops off that 2nd year. I think you'd find a lot of problems with those smaller kids.

[Maedze]

Which is why it's difficult to make a recommendation when 35 pounds might get the vast majority of kids to 2-3, but there are some kids who outgrow a 35 seat at 14 months.


Once the weights are bumped up to a huge number, making it an age issue would be much more reasonable (for example, three as a minimum to forward face).

[Hollyob]

I suggest everyone put it as a link on their facebook page,

Done - hope my friend who thinks carseats are "stupid" sees it. :whistle:

ETA: I just got asked when they changed that rule, and here's what I said:
The AAP changed their guidelines a few years ago to say that children should rear-face to the limits of their seat, which is typically 30-35 lbs. Unfortunately, many peds have not kept up with the AAP's stance and still tell parents to forward-face their kids when they turn 1. Also, t's fine to have their legs on the back of the seat. Seats are outgrown by height when the child has less than 1" of hard shell above their head. People think that the legs are at risk of breaking in a crash, which makes intuitive sense, but it's a myth. Kids are more likely to break their legs in a crash when forward-facing than when rear-facing. And although adults think they *look* uncomfortable with their legs crossed or up the back of the seat, young kids are so flexible that it's not usually a problem. In fact, many don't like how their legs just dangle when they are turned around. I didn't know any of this when Toby was a baby, so we turned him around when he turned 1. Now we know better!

I am so glad I got a chance to put more info in. I didn't do it at 1st b/c I didn't want to seem preachy, but hey, now I'm just answering a question.

[Tylerbmom]

Yay! I was literally just getting on here to find some info to send to my pediatrician's office. At DS's 1 year check the other day the Dr actually said, when going through his list of safety concerns for toddlers (climbing, choking, etc), "so he is 1 and over 20 pounds so you can turn his carseat around now". I was floored! I mean it is bad enough if I had asked and he gave me misinformation, but he volunteered it!! How many parents might have left their baby RF until he said something! Of course, I said, "well actually it is much safer to RF to the max weight limit on the seat". To which he said, kind-of put-off, "and you know what that is?". I said, "of course, 33 lbs". I then started in on the reasons why it is safer, but he just looked at me and didn't say anything. Dr's and their egos! Grrr! Anywho, it is a ped group and I know the owner/head partner, so I am going to send the info to him and see if I can get it disseminated. They are very proactive with free parenting classes with all their well-child classes, so I am hoping to get this info included with that. Any good AAP info I can send on harnessing along with it?
Thanks again!

[Kashi]

I shared it on my Facebook - AND since I have my kids pedi. as a friend, I sent the link to him specifically and asked if the CANADIAN AP follows the same guidelines.

[KaceyLynn]

:eek:ouch -- posted it on my face book

along with the link that MN is looking to finally change their booster law

and I have one mom i know from town here (who is a 1st responder) chewing my tush off

[shauburg]

http://www.ky3.com/news/local/42355192.html
http://www.kspr.com/news/local/42326862.html
If the comments on these stories are any indication, most of the general public will probably ignore these new guidelines, just like they ignore a lot of other current guidelines. :rolleyes:

What is up with people and the leg thing anyway? I think they just use that as a big fat excuse to do what is more convenient for the parent!

But on the postive side, I sent in the link to a local news station and they ran a brief clip on the evening news tonight. A text version is here - http://edmonton.ctv.ca/servlet/an/local/CTVNews/20090402/edm_carseats_090402/20090402/?hub=EdmontonHome. And tomorrow night they are supposed to be running a more detailed follow up story. :thumbsup:

The more we can get the word out the better, because the media really gobbles up official AAP type stuff!

[TechnoGranola]

http://www.ky3.com/news/local/42355192.html
http://www.kspr.com/news/local/42326862.html
If the comments on these stories are any indication, most of the general public will probably ignore these new guidelines, just like they ignore a lot of other current guidelines. :rolleyes:Wow, those are some REALLY uneducated comments. :( One of the commenters was freaking out that a 2 year old wouldn't be able to get in and out of the child restraint on their own if it's rear-facing. I don't get it, DD is 2.5 and climbs in HERSELF in our SUV. She even has to climb on the running boards because the vehicle is so high up. I just don't get how having the seat FF would make it any easier for her?


But on the postive side, I sent in the link to a local news station and they ran a brief clip on the evening news tonight. A text version is here - http://edmonton.ctv.ca/servlet/an/local/CTVNews/20090402/edm_carseats_090402/20090402/?hub=EdmontonHome. And tomorrow night they are supposed to be running a more detailed follow up story. :thumbsup:Sweet! Their text version says "32 pounds" instead of 35, hopefully they correct that (and say 35 in their live media versions).

[joolsplus3]

Wow, those are some REALLY uneducated comments. :(

Sweet! Their text version says "32 pounds" instead of 35, hopefully they correct that (and say 35 in their live media versions).

Evidently they misunderstood the AAP article's numbers, which does mention 22-32 as the current limits on US infant seats...maybe someone email them to make sure they get that fact checked (make a note about convertibles having higher weight limits)?
(Oh, and LOVE the picture of the FF kid in that article :rolleyes:)

[Karen]

Facebooking!

[flipper68]

:o I hate to burst the bubble of enthusiasm, but I don't think the article has the full weight of the AAP. It's listed as "information" or "news," not "Guideline" or "Clinical Report." They are supposed to be coming out with a Clinical Report on "extend" rear facing, but I don't think this is it.

I'm also worried about the line "Until they reach the maximum height AND weight recommended for the model"

I read that as a child can remain rear facing until both height & weight are met, so we could see short 40 pounders or 25 pound twiglets with their head over top of the seat.

The majority of kids I know outgrew their FF seats by height LONG before they were anywhere close to the weight limit. The same will be true with RF if parents think they must meet both limits. (Also, we all know there are kids who might meet the height limit on paper but not in the seat.) The article didn't state the "how do you know if your child is too tall for a RFing convertible. (Yea, it could be implied from the IO paragraph, but I would like it clearer.)

[SafeandSecureBaby]

Yes, unfortunately, this is not an AAP policy change. It is merely a statement from a correspondent to the Journal, and not an official policy statement from the AAP. The policy statement from the AAP at this time remains unchanged. It does however reference optimal safety recommendations to keep children rear facing to the maximum weight that the car seat will allow rear facing or until the child's head is within one inch from the top of the shell.

I think it is great that this issue is getting more exposure and articles such as 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, have been helpful in that regard.

We should all be careful when making claims about policy changes or statements made by others. All it takes is for someone to claim we are wrong about our source and then everything we say, regardless of its validity, is looked on as suspect or rejected in its entirety. It would be great to see the AAP make an official policy change, but I did not see that position taken based on the referenced statement. Let's hope that is indeed in the works.

For reference, below is the current AAP policy:

"Children should face the rear of the vehicle until they are at
least 1 year of age and weigh at least 20 lb to decrease the risk of
cervical spine injury in the event of a crash. Infants who weigh 20 lb
before 1 year of age should ride rear facing in a convertible seat or
infant seat approved for higher weights until at least 1 year of age. If
a car safety seat accommodates children rear facing to higher weights,
for optimal protection, the child should remain rear facing until
reaching the maximum weight for the car safety seat, as long as the top
of the head is below the top of the seat back."

[luv2bfishin]

Hi All! Grandpa here.

Yes, it is a step in the right direction. Unfortunately, it is correct that AAP has not changed their policy.

I emailed the news publication asking them speciffically, and this was their response:

"No, the AAP has not changed its policy statement on car seats. The article was reporting on a new study reflecting safety data showing that keeping older children rear facing is safer. The study was supported in a Commentary published in the March Pediatrics. In other words, parents should keep their young children rear facing for as long as the safety limits on the car seat allow. Some car seats do accommodate older children in a rear facing position."

So,after all, this really isn't "news". This information has been been out there for the last few years. The article cited was published in Injury Preventionin 2007 and stated "RFCSs are more effective than FFCSs in protecting restrained children aged 0–23 months. The same findings apply when 1 year olds are analyzed separately. Use of an RFCS,in accordance with restraint recommendations for child size and weight, is an excellent choice for optimum protection up to a child’s second birthday." It was then cited in a commentary last month by Dr. MJ Bull, thus becoming "news".

FYI = I wrote to NHTSA on Feb 6, 2009 asking them very specific questions of how they arrived at the FF 12 mo / 20 lb threshold. If they performed any controlled crash testing to substatiate that statement, and if they did, to provide the crash test data. If they didn't, well, that will be an outrage. I don't want to believe that NHTSA wouldn't test this recommendation, by slamming some child "dummies" against a wall? I think everyone assumes they have done this, but I find no evidence of it. Ironically, NHTSA tests car seat performance, but apparently not the effects of the child it it.

To date, I did recieve a call (yes, a phone call!) from NHTSA Chief Counsels Office saying they were working to get me my answers, but I have not recieved anything as of yet. Initially, they said it was based on AAP's recommendation. But my research shows AAP didn't perform any actual crash testing, but merely based it on peer reviewed documents. Some of those documents reach back to 1989, since the statement was released in 1996.

Personally, I don't think neither organization performed any controlled crash testing with child "dummies", to determine the effects on the body of a child 12 mo / 20 lbs in a front impact collision. Particularly, the neck / cervical spine load. As you know, that is how my 18 mo old grandson snapped his neck http://www.joelsjourney.org

Well, it is coming. It's just a matter of time. Maybe someday we'll catch up to Sweden, who have ERF for years.

[papooses]

Hey, Grandpa :)

Have they mentioned anything to you about autopsies in regards to this issue? A couple years ago a CPST-I in another state told me the 4 or 5 times safer under 2 years old was determined by autopsy reports.

[CPSDarren]

http://fcs.tamu.edu/safety/passenger_safety/certified-tech/rear-facing-seats.pdf

http://fcs.tamu.edu/safety/passenger_safety/certified-tech/rear-facing2.pdf

Most of the benefit is due to performance of RF child restraints in side impacts.

There were some quirks in this study. At a conference last year, Dr. Bull presented statistics for this paper. One showed that infants actually had lower risk when front-facing as compared to toddlers. When asked about this, she was unable to address it.

I contacted Dr. Sherwood about it and he suggested that the results should be taken in context with limitations of the study, including relatively low sample sizes, limitations on crash specifics like misuse, limitations on age data and other issues. All evidence available to us at this time indicates rear-facing is safer than front facing, with the benefit diminishing as we grow older.

This study touts a "5 times safer" figure. I can't dispute that, but given what I've been told about the study, I'm a little hesitant to throwing it around blindly. For the masses who throw a kid into a car with little additional thought, perhaps it is a reasonable figure. On the other hand, for a typical reader here, what does it mean?

For example, take a typical 18 month old who is 26 pounds. They are properly restrained in a front-facing 5-point harness seat in a newer vehicle with reasonable crash test results. How many times safer would they be if they were rear facing? If you ask the authors of this study, they would surely tell you that the study does not apply to important variables like these. In fact, I suspect the overall risk is so low in this case, that even if the relative risk was 2x greater, it would be meaningless. Just my 2 cents.

[CPSDarren]

FYI = I wrote to NHTSA on Feb 6, 2009 asking them very specific questions of how they arrived at the FF 12 mo / 20 lb threshold. If they performed any controlled crash testing to substatiate that statement, and if they did, to provide the crash test data. If they didn't, well, that will be an outrage. I don't want to believe that NHTSA wouldn't test this recommendation, by slamming some child "dummies" against a wall? I think everyone assumes they have done this, but I find no evidence of it. Ironically, NHTSA tests car seat performance, but apparently not the effects of the child it it.

It is most likely based on fatality statistics from the NHTSA FARS database. These are the only type with detailed enough crash reports on which such recommendations are usually based. It may also have based on injury studies, though this data is generally much less accurate. There is certainly cutoff point where fatalities and/or serious injuries have dropped to a low enough point that they chose it as a convenient age and weight based on data available at the time. This point certainly would not have been zero, however. Be careful what you wish for. Considering the improvements in vehicle and child restraint models in terms of safety, it could well be that that age/weight for the same cutoff level today would be *lower* if the same method was used again now. The author of this article might be able to provide you with a quicker response than someone at the NHTSA-

http://www.carseatsite.com/rear-face_article.htm

Personally, I don't think neither organization performed any controlled crash testing with child "dummies", to determine the effects on the body of a child 12 mo / 20 lbs in a front impact collision. Particularly, the neck / cervical spine load.

I don't believe a dummy advanced enough to do this kind of testing exists. That doesn't mean there shouldn't be a different recommendation, of course. Studies done by those like Dr. Sherwood are a big step in the right direction.

[luv2bfishin]

Hey, Grandpa :)

Have they mentioned anything to you about autopsies in regards to this issue? A couple years ago a CPST-I in another state told me the 4 or 5 times safer under 2 years old was determined by autopsy reports.

NHTSA hasn't said anything so far. They know I won't stop writing them until I get some answers. And they also know that their answer may become available to the public, through the FOIL Act, as an official response. I thought it was "odd" that they called me. I'm sure they are carefully choosing their response.

As for autopsies, I'm not aware of many reports documenting that info. But I did happen upon a very detailed accident study involving children under 3 yrs of age. It's a long read, 143 pages, but very detailed. Start around pg 26, and pay particular attention to the NASS chart of each accident that tells of the injury and the source from which they obtained the injury information. In some cases it came from the coroner. Keep in mind, Joel's injury was a fractured C-1 & C-2 vertabrae. http://www.anec.eu/attachments/ANEC-R&T-2008-TRAF-003.pdf

Nice to hear from you

[luv2bfishin]

[[
This study touts a "5 times safer" figure. I can't dispute that, but given what I've been told about the study, I'm a little hesitant to throwing it around blindly. For the masses who throw a kid into a car with little additional thought, perhaps it is a reasonable figure. On the other hand, for a typical reader here, what does it mean?

For example, take a typical 18 month old who is 26 pounds. They are properly restrained in a front-facing 5-point harness seat in a newer vehicle with reasonable crash test results. How many times safer would they be if they were rear facing? If you ask the authors of this study, they would surely tell you that the study does not apply to important variables like these. In fact, I suspect the overall risk is so low in this case, that even if the relative risk was 2x greater, it would be meaningless. Just my 2 cents.

As for "newer vehicle", what does that really have to do with a child's head ( or anyone's) flying forward in a crash. New vehicle or old, when a vehicle stops suddenly anything in that vehicle that is unrestrained continues at the same rate of speed prior to impact. That includes heads. Newer vehicles are desisned to absorb more of the impact, but if a "head" is traveling at 35 miles hr, and suddenly stops, "it's" still going to travel at 35 mi hr. Newer cars don't prevent whiplash, nor internal decapitation.

As for the "meaningless" 2x greater, here's my thought. Let's say your going to fly somewhere on a commercial flight. The planes have signs posted as to their "crash" statistics by model, based on previous years of use. One type of plane has a "standard" risk of crashing, and another type of plane has a risk 2 times greater of crashing than the "standard". If given the choice, which plane would YOU choose to fly in?

But then, there is a third plane. That plane has a crash rating 5.32 times greater than the first plane. Again, which plane would you choose to fly in?

And as for what was "said" at the conference with Dr. Bull, I wasn't there so I can't comment. But I will say Dr. Bull is VERY well versed in the RF arena, and I find it very hard to believe she would be at a loss for words on one of her studies.

[TechnoGranola]

Newer cars don't prevent whiplash, nor internal decapitation.Bompa, I totally agree with everything you're saying and applaud you for all of your efforts thus far. One clarification, that for seat belt passengers, newer vehicles do limit or prevent whiplash. Active head restraints move forwards with the head and keep it supported longer. My Acura has active head restraints. I've also read about something called WHIPS seats where the entire seat moves to prevent whiplash, although I haven't heard of those in a modern NA vehicle so I am not sure where they are used.

Of course this doesn't cover children in child restraints, or kids in high back booster, and usually not kids on low back boosters either (since there usually isn't active head restraints in rear seating positions), but the good thing is, they are working towards preventing whiplash in some passengers at least. Sadly, kids need it the most, so the onus is currently on the child restraints manufacturers rather than the vehicle manufacturer.

[CPSDarren]

[

As for "newer vehicle", what does that really have to do with a child's head ( or anyone's) flying forward in a crash. New vehicle or old, when a vehicle stops suddenly anything in that vehicle that is unrestrained continues at the same rate of speed prior to impact. That includes heads. Newer vehicles are desisned to absorb more of the impact, but if a "head" is traveling at 35 miles hr, and suddenly stops, "it's" still going to travel at 35 mi hr. Newer cars don't prevent whiplash, nor internal decapitation.

Vehicle design has everything to do with it. It's the most important factor. The more energy the vehicle can absorb in the intitial stage of the crash, the less energy is transferred to the occupants. Any additional ride down time from the crushing frame can easily make the difference between minor and severe injury or death. A head is not unrestrained if the occupant is properly restrained. It still moves relative to the neck and spine, but the movement would be significantly worse if the body to which it is attached stopped moving in 30 milliseconds, rather than 300 milliseconds. That's where the vehicle and restraint systems come in handy.

There's no question that rear-facing has significant advantages in a frontal and side crashes. The question is when do those advantages become statistically insignificant. Sure, that doesn't help a child who is the 1 in a million, but guidelines and regulations aren't able to prevent every possible injury. If you want to split decimals, you would safer rear-facing any time you are a passenger, too.

As for the "meaningless" 2x greater, here's my thought. Let's say your going to fly somewhere on a commercial flight. The planes have signs posted as to their "crash" statistics by model, based on previous years of use. One type of plane has a "standard" risk of crashing, and another type of plane has a risk 2 times greater of crashing than the "standard". If given the choice, which plane would YOU choose to fly in?

It's as I said. If the odds are 50% and I can cut them to 25%, I'd choose the safer one without a doubt.

If the odds are .0000002% and I can cut them to .0000001%, I'd probably choose based on cost or comfort or some other factor. Twice zero is still zero.

Point is, if you leave out variables important to your situation, the choice isn't as clear.


And as for what was "said" at the conference with Dr. Bull, I wasn't there so I can't comment. But I will say Dr. Bull is VERY well versed in the RF arena, and I find it very hard to believe she would be at a loss for words on one of her studies.

In fact, she was unable to answer the question. The question was posed, if I recall correctly, by Deborah Stewart of Safe Ride News. I was preparing to ask the same question. Just because she wasn't familiar with the specifics of a particular study doesn't mean she isn't well versed on rear-facing topics in general. Many of us support extended rear-facing. We don't have to follow advice blindly, however. In this case, I suspect the strange data was simply due to the fact that there simply aren't enough data points for kids under 1 year old who are front-facing in the USA to compare to kids over 1 year old who are rear-facing in the USA. That data was probably not statistically significant and shouldn't have been presented. Just a guess.