The Legal Stuff
As of late 2009 / early 2010, all Australian jurisdictions except the Northern Territory had legislation which requires children to be in a rear-facing car seat from birth to 6 months. Britax, which makes Safe'n'Sound capsules have summaries of the requirements by State. From 6 months on, placing your baby in a forward facing car seat is legally permissible.
The Risk of Forward Facing Car Seats
The risk is that in a front-on collision, the baby's head will slam forward abruptly. Their delicate spines, which are not yet fully formed, stretch apart with the force of the heavy and fast-moving head, so their spinal cords can literally be ripped from their skulls. It is not just a matter of head strength. Just because your baby holds their head up well doesn't mean they are strong enough not to suffer this kind of injury.
Of course, a rear-facing car seat does not protect a baby in a collision from behind, but these kinds of collisions are far less severe - front-ons tend to occur when you slam into a car coming from the opposite direction, as opposed to being bumped from behind. This article quotes a study which found that children under 2 were 1.75 as likely to suffer a serious injury in a forward-facing car seat than a rear-facing car seat.
In Scandinavian countries, it is common to keep children in rear-facing car seats until age 5, and injury rates for children in these seats are significantly lower than other arrangements - although unfortunately they were compared with booster seats and seatbelts, not 5 point harness-type seats (Carlsson and Norin).
Here is a brief video with footage from crash test dummies in front and rear-facing car seats so you can see what happens:
I have not been able to find anything which suggests it is safe to turn a baby before the age of 2. Everything I have read indicates that the longer you leave them rear-facing, the better. However, in practice, many parents turn their children before 2 years of age because:
- their children exceed the maximum height or weight limit of the rear-facing seat and it is no longer safe to ride in that seat; or
- their children are happier riding forward-facing.
The Likelihood of Injury / Death
Talking about babies having their spines ripped apart is obviously a rather emotive topic, so before you beat yourself up for turning your baby's car seat - let's just look at the risk in context. Yes, motor vehicle accidents is a leading cause of deaths in children, but that still doesn't mean it's likely to happen to you or your baby.
I think it's important to put the risks in perspective by looking at the overall likelihood of death or serious injury as a result of car accidents.
An article published by the Australian Bureau of Statistics in 2006 indicated that 587 children aged between 0-14 yrs died between 1999-2003 as a result of motor vehicle accidents, and that in 44% of these cases (258 deaths), children were passengers in the vehicles. Only 17 of all the children who died in traffic accidents were under 1 year of age, which is pretty much exactly 1/15 of the total passenger deaths - as the 258 deaths span 15 age ranges, this means that infants under 1 year of age do not appear to be dying as passengers in car accidents any more frequently than older children. By contrast to those 17 babies under 1 who died in car accidents, 29 died by accidental drowning, 88 by choking or suffocation, and 39 from assault.
17, it must be said, is a very small number. But that is just deaths. What about injuries?
A study of Victorian accidents (Lennon et al) showed that the risk of fatality for children under 1 year of age around this time was 8.5 deaths for every 1000 accidents - so we could take an educated guess that if there were 17 deaths, there were about 500 accidents involving babies between 0 and 1. About 1/5 of all children involved in accidents resulted in hospitalisation (Lennon et al), giving an estimate of 100 hospitalisations across Australian for children under 1 year of age from motor vehicle accidents between 1999-2003 .
About 250,000 women gave birth in 2003, a fertility rate which had decreased from about 275 000 in 1999, so we would expect just over 1 million children in Australia had been between the ages of 0 and 1 at some time during that period of 17 deaths and 100 hospitalisations. Remember, these figures of 17 and 100 are drawn from all babies, including those sitting on a parent's lap or in a vehicle with no restraints at all. About 25% of children under 3 in the Victorian crashes were not wearing seatbelts or restraints (Lennon et al). Failure to wear a restraint made the risk of serious injury about 3.2 times more likely.
Making a Choice
We have a rear or front facing car seat which can take a baby up to 18kg - such seats appear to be available in Australia. One mother in my mother's group imported a rear-facing car seat which can take a child up to 25kg from Sweden.
When considering whether to turn your baby's car seat, it's important not to just consider spinal safety, but the overall risk of having an accident with the two positions. Some parents find their babies are very unhappy in the rear-facing position, and carry on in a very distracting way. I myself have almost run into a gutter once I have been so distracted by my baby's crying. (We were going round a bend, literally and metaphorically.)
On the other hand, another mum in my mother's group pointed out that she was more distracted once the baby was forward-facing, because he kept dropping his toys and they'd fall to the floor, then he whinged because he didn't have a toy.
Carlsson and Norin, 'Rearward-Facing Child Seats - The Safest Car Restraint for Children?' (1991) Accident Analysis and Prevention Vol 23, p175.
Lennon et al, 'Rear seat safer: Seating position, restraint use and injuries in children in traffic crashes in Victoria, Australia' (2008) Accident Analysis and Prevention Vol 40, p829.