Analysis of Child Comfort in Forward-facing versus Rear-facing Child Restraint Systems

Principal Investigator: John H. Bolte IV, PhD, The Ohio State University

Below is an executive summary of this project. Please note that this summary describes results and interpretation that may not be final. Final interpretation of results will be in the peer-reviewed literature.

Equipment setup for laboratory trial of FF CRS.

According to the most recent best practice recommendations from the American Academy of Pediatrics (AAP), rear-facing child restraint systems (RF CRS) are the safest method of restraint for children under the age of two. Most currently available RF CRS accommodate children up to at least 35 pounds, and many newer models are rated for even higher occupant weights. Although the recommendations state that children should ride in a RF CRS until the upper weight or height limit of the CRS is reached, parents often transition their children to forward-facing (FF) CRS before the recommended physical milestones. Recent research indicates that while RF CRS usage rates are increasing with time, only 18.2 percent of toddlers between 12 and 23 months old were restrained in RF CRS in 2012. A primary reason for premature transition to FF CRS is concern over children’s comfort in RF CRS as their legs grow longer and the RF orientation appears more cramped. This study aimed to quantify the comfort levels of children near two years old in FF versus RF CRS.

The study consisted of an indoor laboratory session, where 23 2-year-old children were observed during trial periods in RF and FF CRS. Since the children’s caregivers make the final decisions regarding CRS usage and orientation, their perceptions of their children’s comfort are very important. Along with qualitative questions, parent participants were asked to observe their children’s movements/behavior and to rate their physical comfort every 5 minutes throughout each 20 minute interval using a pain rating scale.

Parental feedback confirmed that the parents considered the RF CRS less comfortable than FF CRS. However, unbiased observation of the children’s movements in both CRS orientations revealed no significant difference in comfort levels between the two configurations. Children’s behavior and movements (n=3) were also monitored during real car rides in each orientation using a small camera installed in the vehicle. Again, no obvious differences in comfort were observed between RF and FF configurations.

The results of this study support adherence to the AAP guidelines, as RF CRS do not appear to cause discomfort in children at the upper age and size range for these restraints. By better understanding the comfort of 2-year-old children in each orientation, parents can become educated on the importance of safety over their perceptions of comfort. In addition, this study allows pediatricians and Child Passenger Safety technicians to be better armed with data to respond to this common parental concern.

Project Team Member

Julie Bing, MS, The Ohio State University


Meagan Ita, The Ohio State University; Yeonsu Ryu, The Ohio State University

IAB Mentors

Keith Nagelski and Ken Wittenauer, Britax Child Safety, Inc.; Eric Dahle, Evenflo Company Inc.; Sara Seifert, Minnesota HealthSolutions; Uwe Meissner, Technical Advisor