Safety experts and the American Academy of Pediatrics recommend that children remain rear-facing as long as possible and never travel forward-facing before they are 1 year old and also weigh at least 20 pounds to reduce the risk of serious neck injury and lifelong disability. All new convertible seats available today allow a child to remain rear-facing until they weigh up to 30 or 35 lb, depending on the model.
When the child is rear-facing, the head, neck, and thorax are restrained together by the back of the child restraint in a frontal crash. There is little or no relative motion between the head and torso that could load the neck. If the same child were facing forward, the harness would restrain the torso, but the head and neck would pull and rotate forward, leading to the potential for serious upper spinal injury.
Real-world experience has shown that a young child’s skull can be literally ripped from their spine by the force of a crash. The body is being held in place, but the head is not. When a child is facing rearward, the head is cradled and moves in unison with the body, so that there is little or no relative motion that might pull on the connecting neck.
Another aspect of the facing-direction issue that is often overlooked is the additional benefit a child gains in a side impact. Crash testing and field experience have both shown that the head of a child facing rearward is captured by the child restraint shell in side and frontal-oblique crashes, while that of a forward-facing child may be thrown forward, around, and outside the confines of the side wings. Field data show better outcomes for rear-facing children than forward-facing children, even though most child restraints are not specifically designed to protect children in side impact.
Some older convertible child restranits indicated in their instructions that a child should face forward when her feet touch the vehicle seatback or when the legs must be bent due to lack of space. This prohibition is not justified by any crash experience or any laboratory evidence, and these instructions have now been revised. There have not been any crashes documented in which rear-facing children sustained leg injuries because they were rear-facing. Even if this were the case, broken legs are easier to fix than broken necks. The only physical limit on rear-facing use is when the child’s head approaches the top of the restraint shell. At this point, they should be moved to a rear-facing convertible restrain.
In an international research and crash review conducted in 2004, the data seemed to show a change in outcome at about 12 months between severe consequences and more moderate consequences for the rare events of injury to young children facing forward in a child restraint. At the time, one year old was useful as a simple benchmark, but now the message is to keep the child facing rearward as long as possible within the weight and height limits of the child restraint, possibly until they are 24 months old.