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There are no magical or visible signals to tell us, parents or pediatricians when the risk of facing forward in a crash is sufficiently low to warrant the change, and, when a parent drives around for months or years without a serious crash, the positive feedback that the system they have chosen "works" is very difficult to overcome. When in doubt, however, it's always better to keep the child facing rearward.
In the research and accident review(2) that I did a few years ago, the data seemed to break at about 12 months between severe consequences and more moderate consequences for the admittedly rare events of injury to young children facing forward that we were able to identify. Two years old is also a nice benchmark, and the shift to that benchmark in the last few years has kept many kids in a safer environment longer and has probably saved some lives, some kids from paralysis and some parents from terrible grief.
As a side comment, some convertible child restraints indicate in their instructions that a child should face forward when his/her feet touch the vehicle seatback, or alternately when the legs must be bent. This prohibition is not justified by any accident experience or any laboratory evidence, and we are hoping that these instructions will soon be revised. The only physical limit on rear-facing use is when the child's head approaches the top of the restraint shell. At this point, s/he should be moved to a rear-facing convertible restraint, or, if the child is already using one, to its forward-facing configuration.
Parents and pediatricians need to know the real reasons for the current push to keep babies rear-facing to at least one year of age, in order to be able to make an informed judgment. Perhaps this will help spread the word.
(1) Huelke DF et. al. Car crashes and non-head impact cervical spine injuries in infants and children. Society of Automotive Engineers, Warrendale, Pennsylvania, 1992. SAE 920562
(2) Weber K et. al. Investigation of dummy response and restraint configuration factors associated with upper spinal cord injury in a forward-facing child restraint. In Child Occupant Protection, SP-986. Society of Automotive Engineers, Warrendale, Pennsylvania, 1993. SAE 933101
Kathleen Weber is the Director of the Child Passenger Protection Research Program at the University of Michigan Medical School