Car seats: Facing backward is the way forward

Road traffic accidents are one of the commonest causes of death in children. Child safety car seats have played a pivotal role in reducing the mortality and morbidity associated with road traffic accidents. However, there have been some concerns about the about the design of front facing car seats versus their rear facing counterparts. Legislation governing the use of rear facing car seats is variable, with some Scandinavian countries recommending their use up to the age of four, while others mandate their use only until one year of age. We present three case narratives of patients aged under 3 years who sustained catastrophic injuries after being involved in a road traffic accident despite being placed in an appropriately sized forward facing car seat. We reviewed the literature for evidence comparing the safety and efficacy of front versus rear facing car seats. Accident registry and crash test results support the increased safety of rear facing child seats. Frontal sled test have demonstrated that forward facing car seats expose children to much higher neck loads and chest displacement resulting in higher injury scores. Epidemiological data from registries and observational studies support the experimental data and demonstrate a clear injury-reducing effect of rear facing child seats compared to their forward facing counterpart. We recommend keeping children in rear facing car seats until the age of four, which is common practice in Sweden