Rear facing car seats for all!

I wanted to avoid this issue, but I can’t. So be it.

Toddlers are usually switched from rear-facing to forward-facing car seats right after their first birthday — an event many parents may celebrate as a kind of milestone.

But in a new policy statement, the nation’s leading pediatricians’ group says that is a year too soon.

The advice from the American Academy of Pediatrics, issued Monday, is based primarily on a 2007University of Virginia study finding that children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear.

According to the NYT, parents viewed this as a milestone, and even something to brag about. Kevin Drum asks:

I don’t have kids and my personality is kind of weird anyway, but I still have to ask: Really? Do parents really turn their kids around at age one because they think it shows how brilliant and advanced their child is?

Or do they do it because up until a few hours ago the American Academy of Pediatrics said it was OK to turn them around at age one? That actually seems more likely, doesn’t it?

It’s the latter, Kevin. It is for most people, at least.

Regardless, this is throwing all of my friends with small children into an uproar.If you have a child, you understand. It it easier – way easier – to put a child into a front facing car seat than a rear facing one. Also, as kids get bigger, it’s hard for them to fit their legs comfortably into the rear facing seat, especially in smaller cars.

I don’t doubt the results of this study. However, I also don’t doubt that being in a rear facing seat is safer for a three year old, either. I bet if we could get adults into rear-facing seats, they would be safer, too. I imagine this is why when astronauts returned to Earth in the Gemini and Apollo capsules, they did so in rear facing seats.

But we’re not going to recommend that all adults start riding in such seats. Why? Because the absolute reduction in deaths isn’t worth the inconvenience to adults. That’s why we face forward. At some point, the absolute reduction in deaths won’t be worth it to parents, either. Remember that the number one killer of kids is car accidents. The best way to prevent childhood death is not to put kids in cars. But that’s inconvenient, and so we place them at risk. We don’t say that we as  parents are “condemning lots of kids to death” in order to be able to get around. We make the conscious (or sub-conscious) determination that transportation in the form of cars is  so life-improving that it overcomes the small chance of death. We do the same with lots and lots of things in life.

Unfortunately, we don’t make these kind of arguments too often in the medical literature. An improvement is an improvement. And so a 75% relative reduction in risk becomes a new policy. I am not expert enough in this area to know if that’s worth the inconvenience, or even feasible, but I wish that discussion about trade-offs was part of the conversation. Otherwise, we should all be in rear-facing car seats, shouldn’t we?


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