Re-evaluating Car Seat Orientation and Safety

Published: SRN July/August, 2017. Updates will be posted here as they become available.

Update: August 31, 2018. The American Academy of Pediatrics (AAP) has revised their policy on child passenger safety.
Update December 2017:
Updated Study on RF vs. FF Effectiveness.”
Update mid-November 2017:Car Sear Orientation and Safety.”
Update September 2017:NHTSA Policy Reaffirmation.”

Over the past year, certain developments have caused some CPS advocates to be concerned and/or confused about the relative safety of children riding rear facing versus forward facing.  Testimony in a recent lawsuit that questioned the benefits of extended RF, changes to RF and FF requirements in CR instructions, and updated state laws have all contributed to the confusion.  Most recently, an expression of concern published by Injury Prevention and an online statement posted by the CR manufacturer Dorel have understandably raised many questions among CPSTs.  The following describes these developments and gives additional context to help CPSTs make sense of recent news.

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Injury Prevention’s “Expression of Concern”

The following is reprinted from Injury Prevention online, July 3, 2017

“The manuscript ‘Car safety seats for children: rear facing for best protection’ was published in Injury Prevention in 2007, after peer review. The paper used U.S. data from the National Automotive Sampling System Crashworthiness Data System to conclude that children 0–23 months were less likely to be severely injured when using a rear-facing car seat than a front-facing car seat. This result, along with similar data from Swedish experience and biomechanical studies, has been used as the basis for public education and policy recommendations that favor a rear-facing position for children under age two in car seats.

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CRs May Help Prevent In-Flight Injuries

CPSTs know that children on aircraft are better protected from injury when riding in an approved CR due to the potential of turbulence or crashes.  Recently, a new study identified an additional reason:  in-flight medical emergencies.  In particular, the researchers (three doctors from U.S. universities and hospitals) looked at the in-flight injuries (IFIs, typically trauma or burns) that children sustained.  They found such incidents to be infrequent relative to the number of such events to all passengers, but not negligible.  Their takeaway:  The protection CRs can provide with respect to potential IFIs can expand their in-flight benefits beyond during takeoff, landing, and turbulence.

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Debate in the NICU Continues: What’s a CPST to Think When Doctors Disagree?

As readers know, I am not a doctor.  Occasionally, though, as CPSTs we must consider certain medical conditions that influence the safety or children as vehicle passengers.  Fortunately, there’s no need for CPSTs to hold a medical degree; simply follow the advice of doctors regarding the relevant symptoms of a diagnosis and how they might influence a child’s safety  (either in a crash or during normal riding).  To guide us, we are fortunate to have peer-reviewed scientific studies and policy statements from the medical community.

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Study Finds CR/Vehicle Mismatch Prevalent

In October, a study was published that predicted that 42 percent of the time, vehicles and CRs are somehow incompatible.  The study, “Investigation of Child Restraint System Compatibility in the Vehicle Seat Environment,” by Ohio State College of Medicine’s Injury Biomechanics Research Center, used measurements of 59 current CRs and 61 late model vehicles to evaluate over 3,599 possible CR/vehicle combinations and predict likely incompatibilities.  To validate the results, researchers conducted physical installations of 34 of the scenarios.

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Research on LATCH Usability

This information is excerpted from the 2015 LATCH Manual.

In April 2012, the IIHS reported on findings from a joint LATCH-use study it conducted with the University of Michigan Transportation Research Institute. “Keys to Better LATCH” identified and measured key factors in the usability of LATCH and then studied volunteers to see how these factors predicted the quality of CR installations.

In 2014, the IIHS published two follow-up reports (one on LA attachment use and the other on tether use), which further affirmed the findings of the 2012 study. The studies help prepare the IIHS for a possible next step, which is to explore a ratings system to evaluate LATCH setups in common family vehicles.

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Center’s Aim Is to Better Protect Pets—and Those Who Ride With Them—in Cars

Despite claims, most products currently marketed to restrain pets in vehicles can, at best, prevent them from moving about the vehicle during normal driving.  While keeping a pet from distracting a driver is extremely worthwhile, the Center for Pet Safety (the Center), a nonprofit organization based in Virginia, seeks to promote the development of devices that do more to actually protect pets and other passengers in a crash.  The Center’s founder, Lindsey Wolko, recently stated in an interview with Motor Trend magazine that her organization has been actively advocating for the establishment of safety standards for pet products since 2011.

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Children in Taxis

“We are visiting a large city, so we will be using taxis rather than a rental car . . .”

A 2006 study using 2004 data found that, in New York City alone, there were 25 taxi/livery crashes every day that caused injury. That study also found that when taxis were involved in a crash, the taxi passengers were nearly 2.5 times more likely to be seriously injured or killed than the passengers in the other vehicle in the crash.

So, best practice in taxis (and, in some states, the law) is to use a CR.  Dr. Alisa Baer, pediatrician and cofounder of The Car Seat Lady, posts excellent advice on this subject at

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Call to Industry and Government: Bring Rear-Seat Safety to Its Full Potential

Although it is always safer to ride in a vehicle’s back seat, the relative benefits today decline for children as they age, particularly after they have transitioned out of a CR. This is the overall finding of a Center for Injury Research and Prevention (CIRP) study of the state of science on the safety of children and youth in the rear seats of vehicles. CIRP, a group that is part of The Children’s Hospital of Philadelphia, published the findings in its April 2013 CPS Issue Report.   “Optimizing the Rear Seat for Children” includes extensive review of the scientific literature relevant to this subject since 2001.

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