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Car safety seats for children: rear facing for best protection
  1. B Henary1,
  2. C P Sherwood1,
  3. J R Crandall1,
  4. R W Kent1,
  5. F E Vaca2,
  6. K B Arbogast3,
  7. M J Bull4
  1. 1
    Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
  2. 2
    Center for Trauma and Injury Prevention Research, University of California, Irvine, CA, USA
  3. 3
    Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  4. 4
    Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
  1. J R Crandall, University of Virginia, Center for Applied Biomechanics, 1011 Linden Avenue, Charlottesville, VA 22902, USA; jrc2h{at}


Objective: To compare the injury risk between rear-facing (RFCS) and forward-facing (FFCS) car seats for children less than 2 years of age in the USA.

Methods: Data were extracted from a US National Highway Traffic Safety Administration vehicle crash database for the years 1988–2003. Children 0–23 months of age restrained in an RFCS or FFCS when riding in passenger cars, sport utility vehicles, or light trucks were included in the study. Logistic regression models and restraint effectiveness calculations were used to compare the risk of injury between children restrained in RFCSs and FFCSs.

Results: Children in FFCSs were significantly more likely to be seriously injured than children restrained in RFCSs in all crash types (OR = 1.76, 95% CI 1.40 to 2.20). When considering frontal crashes alone, children in FFCSs were more likely to be seriously injured (OR = 1.23), although this finding was not statistically significant (95% CI 0.95 to 1.59). In side crashes, however, children in FFCSs were much more likely to be injured (OR = 5.53, 95% CI 3.74 to 8.18). When 1 year olds were analyzed separately, these children were also more likely to be seriously injured when restrained in FFCSs (OR = 5.32, 95% CI 3.43 to 8.24). Effectiveness estimates for RFCSs (93%) were found to be 15% higher than those for FFCSs (78%).

Conclusions: 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.

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  • Competing interests: None.

  • Abbreviations:
    forward-facing car seat
    Injury Severity Score
    National Automotive Sampling System Crashworthiness Data System
    National Highway Traffic Safety Administration
    rear-facing car seat

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