Vanessa Lal, 32, of Lake Zurich, Ill., said she considers herself fortunate that both of her children -- a 2-and-a-half-year-old daughter and a 9-month-old son -- took to the family's rear-facing child car seat well.
"I'm lucky -- both of my kids don't have too much of a problem with it," she said.
Lal, like many parents, follows the current guidelines from the American Academy of Pediatrics that children less than 1 year of age or lighter than 20 pounds should be placed in a rear-facing child car seat -- which positions young children facing backwards in the car's cabin -- in order to decrease the risk that they will be injured in an accident.
Indeed, there is little doubt that the seats represent the safest means available to transport children in a car -- even after their first year of life. And a new recommendation published Thursday in the British Medical Journal suggests that children up to the age of 4 are safest if placed in such seats when riding in a car.
"Many parents and health care providers may be unaware that it is safer to leave children in rear-facing seats for as long as possible or that rear-facing seats for toddlers exist," the paper's authors, led by Dr. Elizabeth Watson of Meed Surgery in Woking, United Kingdom, wrote in their report. "Health care professionals should advise that rear facing seats are safer than forward facing seats for children aged under 4 years."
Child safety experts overwhelmingly applauded the recommendation.
"A child is 5.53 times safer during their second year of life in a rear-facing car seat versus a forward-facing one," said Dr. Joseph O'Neil, a pediatrician at Riley Hospital and associate professor of pediatrics at the Indiana University School of Medicine in Indianapolis. "I think that this is a very important topic for child safety."
But Lal said that while she appreciates the safety that the seats afford her kids, she also is familiar with some of the frustrations that some parents face with them -- not the least of which is that by design, her children are facing backward in the car.
"When my daughter was under 1 year old, we were driving home one day and she was violently throwing up," she said.
In order to check up on her baby, she had to stop her car on the highway, exit the vehicle and open the back door so she could attend to her daughter face-to-face.
"When they aren't facing toward you, you can't monitor them," she said. "You can't see them at all."
And that may not be the only problem. Lal said that for families with multiple kids, the need for more car seats means a need for more space -- and hence a bigger, less fuel-efficient vehicle that could rankle parents who wish to be more environmentally friendly or cost-conscious.
"If you have multiple kids, you have no choice but to have an SUV or another type of big car that uses more gas," she said. "We have two kids under 2. We want a third kid, which would mean that we would have three under 4."
The reason behind the safety of rear-facing seats has to do with simple physics. To begin with, children's heads are generally larger in proportion to the rest of their bodies than are adults'. Thus, their heads and necks are more vulnerable to movement-related injuries like car crashes.