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

SafeDad

CPSDarren - Admin
Staff member
Re: AAP recommending rearfacing to at least age 2

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.
 
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SafeDad

CPSDarren - Admin
Staff member
Re: AAP recommending rearfacing to at least age 2

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

New member
Re: AAP recommending rearfacing to at least age 2

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

New member
Re: AAP recommending rearfacing to at least age 2

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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

Forum Ambassador
Re: AAP recommending rearfacing to at least age 2

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.
 
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SafeDad

CPSDarren - Admin
Staff member
Re: AAP recommending rearfacing to at least age 2

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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.
 

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