Tag Archives: sweden

In Sweden, When is a Booster Seat as Safe as a Forward-Facing Seat?

If your kids are under 5, rear-face them. Once you can't, forward-face them until 6, 7, or 8, and then high-back booster them. Save seat belts until 10, 11, or 12. Save the front seat until at least 13, and save driving alone until at least 18.
Per Sweden, if your kids are under 5, rear-face them. Once you can’t, high-back booster them. Save seat belts until 10, 11, or 12 and the front seat until at least 13.

Just as with rear-facing, there’s a lot of debate in the United States over what actually constitute best practices when it comes to when to switch from harnessed front-facing seats to booster seats. However, just as with rear-facing, the Swedes are more than happy to provide guidelines for what to do and when, no matter how much we go back and forth over the basics in the United States.

As a review, rear-facing best practices means doing so for as long as possible, and ideally at least until 4 or 5. This is standard practice in Sweden, where they’ve enjoyed the best child auto safety records on Earth for decades, and it’s now becoming standard practice in neighboring Norway, which has joined Sweden at the top of the mountain in terms of the all-important task of keeping children alive in and around car traffic. While most parents in the United States are still forward-facing shortly after 1, more and more are learning about the benefits of extended rear-facing and are following the Swedish (and now Norwegian) example. So what can they teach us about forward-facing and boostering? We’ll review their practices today.

When do parents forward-face children in Sweden?

Rear-facing, forward-facing, and booster guidelines for car seats in Sweden, via The Car Crash Detective.
A high-back booster like the Flex 120 is the next step after rear-facing until 4 or 5 in Sweden.

This is actually a trick question, because parents in Sweden don’t typically forward-face. Yes, there are some parents who do (just as there are some parents who forward-face their kids before 4 in Sweden), but the vast majority of parents there don’t use forward-facing seats. If they rear-face with convertible seats, which almost all parents do, they simply stop using the seats when their kids outgrow them and switch to…booster seats.

Booster seats?

Yes! In Sweden, the standard practice is to start boostering kids once they outgrow rear-facing seats. This is visible here directly from the NTF, Sweden’s equivalent of the NHTSA:

“Question: At what weight/height/age, the child can be placed on the booster seat instead of in a car seat?

Answer: Children should travel rearward facing car seat (seat for the infant) as long as possible, to the age of 4-5 years. When the child has grown out of its rearward-facing child safety seat (seat for the infant seat) recommend NTF to move on to a booster seat.”

There is no mention whatsoever of a forward-facing harnessed seat; the standard recommendation is to move directly from a rear-facing seat to a booster seat after spending the first 4-5 years (or as long as possible) in a rear-facing seat.

Why do Swedish parents switch to high-back booster seats instead of harnessed or forward-facing seats?

Swedish booster / forward-facing guidelines on The Car Crash Detective.
In Sweden, once you stop rear-facing (at 4 or 5), you move directly into a high-back booster (e.g., something like the Clek Oobr).

This is done for a few different reasons. One involves the Swedish belief that older children who are harnessed absorb the tremendous collision forces in the head, neck, and shoulders, which is something to be avoided. In fact, this is the reason why rear-facing is so much safer–when rear-facing, the much stronger muscles and much larger surface area of the back are available to absorb forces instead of having them concentrated in the head, neck, and shoulders. The Swedish belief is that when boostered (which is essentially using a seat belt that’s adjusted to fit children as well as adults), the entire torso can move forward in a collision, spreading crash forces throughout the upper body instead of concentrating them in two of the most fragile areas of the body (the head and neck).

Does this mean that “extended harnessing” is not considered best practices in Sweden?

This is correct; in Sweden, virtually no parents practice harnessing, extended or otherwise, because it’s not believed to be safe. What’s done is to move directly from rear-facing in the first 4-5 years to using a high-back booster.

It’s also worth noting that a number of studies in the US have also shown that high-backed boosters are as safe as forward-facing (harnessed) seats once children are mature enough to sit safely in both. In other words, if you raise your child to sit upright and still in a high-back booster seat (and not reach out of it, play with the seat belt, unbuckle himself/herself, or do anything else unsafe), s/he’ll be equally safe in both kinds of seats. In Sweden, the expectation is for kids to do this from 4 or 5 onward, and kids are taught to do so the same way they’re taught not to play in the street or touch stove tops.

If forward-facing isn’t safer than boostering, then why is it recommended in the US?

Forward-facing, or harnessing, is recommended in the US due to a mixture of a lack of knowledge of best practices and due to efforts to mitigate the additional risks of premature boostering.

First of all, most parents in the US aren’t rear-facing until 4 to 5 as in Sweden. Three out of four kids are forward-facing before they turn 2, and only around 1 out of every 100 children will still be rear-facing at 4, which means that forward-facing is the only stage between most 1 year olds in the US and being placed in a booster seat. We know booster seats are absolutely inappropriate for toddlers, so recommending forward-facing at least keeps children in a better position than they’d otherwise face in most homes.

Second, as noted above, most parents aren’t aware of how much safer it is to rear-face instead of forward-face, and this is largely because extended rear-facing isn’t propagated by any large-scale authority in the United States. The NHTSA simply says to rear-face “as long as possible” but fills their diagrams and pamphlets online with references to children forward facing from 1 or 2. The AAP is hopelessly out of date with their recommendations and only switched to recommending rear-facing until 2 a few years ago. The vast majority of states don’t require rear-facing past 1. To put it simply, the US is backwards when it comes to car safety, and the main Americans you’ll see advocating extended rear-facing (for example, yours truly) are those who have taken the time to learn about best practices in car seat safety, which are nearly-exclusively found in Sweden.

This adds up to a vicious circle. Parents stop rear-facing after 1 because they don’t know any better, and they don’t know any better because all of the authorities are telling them that they only actually need to rear-face until 1. Meanwhile, they’re told to forward-face with the focus on keeping very young children out of booster seats, which leads to very little emphasis on rear-facing and a lack of understanding of the fact that harnessed seating doesn’t necessarily offer any advantages over boostering once children are mature enough to sit in booster seats. This maturity point, additionally, will vary tremendously with how children have been raised, as well as with individual differences between children.

So what’s best if I want to follow best practices for my child?

Here’s a guide to the first 13 years:

From birth to 5, rear-face. If your child still fits at 5, keep rear-facing. There are several seats that will let you rear-face until 6 or 7, including the the Clek Fllo, the Clek Foonf, the Diono Rainier, the Graco Extend2Fit, the Graco Extend2Fit 3-in-1, the Graco 4Ever Extend2Fit, the Nuna Rava, the Safety 1st Advance EX 65 Air+, and the Safety 1st Grow and Go EX Air.

From 5 (or later, if you can still rear-face) to 10, 11, or 12, use a high-back, then low-back booster. Keep boostering until your child passes the 5-step test. Two of my favorite high-back boosters include the Clek Oobr and Maxi-Cosi RodiFix. Low-back boosters are fine once kids are about 7; high-back boosters are designed to keep kids’ heads in place even if they fall asleep.

Keep your child in the back seat at least until s/he turns 13. Later is always better here. For tips beyond the first 13 years, see the best practices page for teens and drivers of all ages.

If you find the information on car safety, recommended car seats, and car seat reviews on this car seat blog helpful, you can shop through this Amazon link for any purchases, car seat-related or not. Canadians can shop through this link for Canadian purchases.

Readers who read this article also read:

Swedish Car Seat Safety FAQ – Frequently Asked Questions Answered By Swedes

Some things in life never change. Children need adults who love them. And if they're in cars, they're safest rear-facing.
Some things in life never change. Children need adults who love them. And if they’re in cars, they’re safest rear-facing.

Every now and then a pop science article or research paper comes out stating forward-facing is safer than rear-facing (it isn’t), or insisting boosters are just fine for 2 year olds (they aren’t) or that preschoolers are just as safe in seat belts as they are in car seats (that’s wrong too). Unfortunately, with the influence corporations and ad dollars have over the dissemination of information in the United States, it’s quite easy to get tricked into believing nonsense (or “fake news”, to use recent parlance). Fortunately, good ideas remain good ideas no matter whether we believe in them or not. Let’s see what best practices look like by people who practice them.

Here’s a look at what the NTF, the Swedish National Society for Road Safety (their version of the NHTSA) has to say about car seats and car seat safety. As the Swedes continue to have the best record in child traffic safety as well as in overall traffic safety (two titles they’ve held for decades), I’ll continue to follow their lead and not the outdated or just plan bad advice bandied about in the US (where the AAP only recently began recommending rear-facing until 2, and where almost all states continue to require it only until 1).

How Long Should Children Rear-Face, Per Swedish  Recommendations?

Per the NTF, children should rear-face as long as possible and be turned forward facing earliest at 4-5 years of age.

Note how the response doesn’t state that children should stop rear-facing at 4 or 5; it says they should be rear-facing as long as possible, but no earlier than when they are 4 to 5. In other words, if you can rear-face past 4 or 5 due to a child continuing to fit in his or her car seat, that’s a good idea. But your baseline goal should be 4 to 5. As I’ve noted in previous articles, that means preschool. That means kindergarten. It means prioritizing rear-facing and not forward-facing earlier than necessary, regardless of what fellow parents or family members are saying. It’s easier in Sweden since fellow parents and family members will be doing the same thing. But whether in Sweden or in the US, these are best practices.

What About Rear-Facing Safety For Side and Rear Impacts, Per Swedish Recommendations?

Per the NTF, rear-facing is always the safest position for young children. They note it would also be safer for adults, but that because we have stronger necks, we’re slightly more capable of handling crash stresses. They then note that forward-facing might be slightly safer for rear-impacts, but because most collisions are frontal collisions, while rear-enders are typically not at the high speeds inherent in frontal collisions, it’s best to always rear-face. They add that the best position for a side impact is away from the point of impact, but that this is of course impossible to predict. They concede that other factors are probably more important than rear- or forward-facing in side impacts, but that rear-facing is still not a bad position in such collisions.

This recommendation is in line with those I’ve made indicating that rear-facing is still overall the safest orientation for a car seat when aggregating all crash positions and risks. By extension, it supports the argument that the 3rd row is a safe one for child and adult passengers (I posit the safest). The Swedes additionally believe that the front and back rows are equally safe for rear-facing children as long as the frontal airbag can be disabled. This isn’t the case in the US for 99% of passenger vehicles, so on this side of the Atlantic, the back rows are safer.

How Long Should Children Use Booster Seats, Per Swedish Recommendations?

Per the NTF, children should remain using booster seats until they are 10 to 12 years old. They note this is because children’s hips aren’t fully formed until then and that controlling the belt path around the child is necessary to keep the lap belt from penetrating a child’s abdomen and causing internal injuries. They note that the amount of time a child will be able to sit on a booster seat will depend on the child’s length as well as on the vehicle one uses. If the shoulder belt path is affected, they suggest bypassing the booster seat and ensuring that the shoulder belt path is appropriate.

This recommendation is directly in line with those from the 5-step test, which most children are typically not able to pass until they are between 10 and 12 years old. While the 5-step test is not specifically mentioned, the principles are the same, as are the risks of bypassing the recommendation (internal organ damage).

What Makes a Car Seat Dangerous, Per Swedish Recommendations?

Per the NTF, what makes a car seat dangerous is allowing a child to forward face from age 1. They recommend car seats capable of rear-facing up to 25 kg, or 55 lbs, and state once again that the safest way to travel in a car is rear-facing. They then state that children should rear-face for as long as possible, and preferably until they are 4-5 years old.

This section is rather self-explanatory. To the Swedes, the main danger in a car seat is using it to forward face young children. They explicitly recommend rear-facing for all occupants and car seats that allow rear-facing until 55 pounds. Such seats don’t yet exist in the US as of 2017, but as late as Spring 2014, there was only one car seat sold in the entire country that allowed rear-facing until 50 pounds (the Clek Foonf). Now there are many more–the Clek Fllo, the Clek Foonf, the Diono Rainier, the Graco Extend2Fit, the Graco Extend2Fit 3-in-1, the Graco 4Ever Extend2Fit, the Nuna Rava, the Safety 1st Advance EX 65 Air+, and the Safety 1st Grow and Go EX Air. Things have improved immensely, but we still have a ways to go in all elements of transportation safety and in child traffic safety. The key takeaway is to max out your seat to its height and weight limits, and ideally to do whatever possible to rear-face until at least 4 or 5.

What Do I Do With This Information? What If I Want To Know More?

There are more questions to answer, but this is a good start. You can read far more on the NTF site; if you don’t read Swedish, you can use built-in browser translators or head over to Google Translate or your favorite translation tool. But the answers are rather clear in most cases. Resist the urge to follow one breathless study after another suggesting something’s good one week and bad the next. Rear-facing is what’s safest no matter how young or old a passenger vehicle occupant is. Aim for at least 4-5, and continue to booster until 10 to 12. Beyond that, drive as little as possible, and choose safe speeds and choose safe roads whenever you do. None of these steps require any money whatsoever aside from that for convertible or all-in-one seats, which are available for well under $200 (e.g., the Graco Extend2Fit, the Graco 4Ever Extend2Fit, the Safety 1st Advance EX 65 Air+, and the Safety 1st Grow and Go EX Air). The driving techniques are completely free and will far, far, far more of a difference than the safety benefits from buying the latest and greatest vehicles.

If you find my information on best practices in car and car seat safety helpful, you can do your shopping through this Amazon link. Canadians can  shop here for Canadian purchases. Have a question or want to discuss best practices? Join us in the forums!

Readers who read this article also read: