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Rear-facing child safety seat effectiveness: evidence from motor vehicle crash data


Introduction In 2018, the American Academy of Pediatrics updated their car safety seat (CSS) guidelines to recommend that children ride rear-facing as long as possible, yet evidence from observational studies on rear-facing CSS effectiveness is limited. This study estimated the association between rear-facing CSS use and injuries among children aged 0–4 years who were involved in motor vehicle crashes (MVCs).

Methods This study analysed data on all MVCs involving children aged 0–4 years reported to the Kansas Department of Transportation from 2011 to 2020. Children who were in a rear-facing CSS were compared with children who rode in a forward-facing device. Logistic regression was used to adjust for potential confounders.

Results In unadjusted models, rear-facing CSS use was associated with a 14% reduction in the odds of suffering any injury versus riding in a forward-facing CSS (OR 0.860, 95% CI 0.805 to 0.919). In models adjusted for potential confounders, rear-facing CSS use was associated with a 9% reduction in the odds of any injury relative to riding forward-facing (OR 0.909, 95% CI 0.840 to 0.983). These estimates were driven by children seated in the back outboard positions. Rear-facing CSS use was also negatively associated with incapacitating/fatal injuries, but these estimates were imprecise.

Conclusions Children aged 0–4 years are less likely to be injured in an MVC if they are restrained in a rear—as opposed to forward—facing CSS. These results are particularly relevant because a number of state CSS laws do not require children of any age to ride rear-facing.

  • Motor vehicle � Occupant
  • Cross Sectional Study
  • Child

Data availability statement

Data may be obtained from a third party and are not publicly available. The Kansas Department of Transportation (KDOT) crash data can be obtained through direct correspondence with the Traffic Safety Section of the KDOT.

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