Center for Injury Research and Prevention

Babies Have a Say On Comfort of Rear-facing Car Seats

July 23, 2013

A note from CChIPS co-director Kristy Arbogast: Today, we are pleased to welcome a guest blog post from Julie Bing, Research Associate Engineer at the Injury Biomechanics Research Center at The Ohio State University. Julie discusses recent research from CHOP's Center for Child Injury Prevention Studies (CChIPS) on a hot topic in child passenger safety since the American Academy of Pediatrics updated its best practice recommendations in 2011- the comfort of children in rear-facing vs. forward-racing child restraints.


By: Julie Bing, MS
Research Associate Engineer
Injury Biomechanics Research Center, The Ohio State University

How do you get a baby’s opinion on something as subjective as product comfort when verbal skills aren't fully developed? I recently grappled with this research challenge concerning recommendations that children ride rear facing in car seats until the age of two years.

As most who read this Research in Action blog already know, the American Academy of Pediatrics (AAP) and the National Highway Traffic Safety Administration (NHTSA) recommends that children ride in rear-facing child restraint systems (CRS) until they are two years old or reach the maximum recommended weight of the CRS. Despite having established the superior safety of the rear-facing CRS, it has been shown that only about 13 percent of children between the ages of 12-23 months are using them. Many parents cite the discomfort of their growing child as a main reason for transitioning to a forward-facing CRS before the recommended milestones are met.

In recent research funded by the Center for Child Injury Prevention Studies, we overcame our subjects’ verbal skill deficits by designing a unique observational methodology. Children between 22 and 26 months of age were observed sitting in a rear-facing and forward-facing convertible car seat. Their comfort was quantified by rating the severity and intentions of their movements. The first phase of the study took place in a laboratory setting so that parents could also observe and rate their children on a standardized comfort scale. The second phase of this study, currently underway, will apply the same methods and techniques to video footage collected in the participants’ moving vehicles.

Preliminary results show only a small difference in comfort between rear-facing and forward-facing configurations for each child. From a scale of 0 (very comfortable) to 3 (very uncomfortable), rear-facing trials scored an average of 1.3 while forward-facing trials scored an average of 1.1. Parental perception scores, gathered throughout the duration of the trials, also reflected a similarly small increase in comfort with forward-facing CRS.

The indication of a minimal change in comfort level can be outweighed by the significant increase in safety that a rear-facing CRS provides for the child in the event of a crash. I hope the results of this study can be referenced in educational campaigns to address actual versus perceived comfort of children in a rear-facing CRS. This study provides evidence that the guidelines of the AAP and NHTSA are not only safe and smart, but they are also realistic and reasonable for caregivers to follow.


O’Neil J, Bandy R, Talty JL, MJ Bull. Drivers’ Reasons for Choosing Forward Facing Car Safety Seats. Clinical Pediatrics. 2011; 50(9):869-871.

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