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Swedish study on rear facing saving lives

8 replies

toastofthetown · 11/03/2026 23:55

I saw this report posted, and the study is linked at the bottom and found it interesting to see an analysis of whether child fatalities could be prevented either by being in any kind of car seat, or rear facing. I’m curious to see what BertieBotts thinks if she reads this thread, because when I asked last year about FF in a harness, the response was really detailed and evidence based (which I don’t see that often in the Facebook group I still haven’t quit) and wondered if that changes that.

https://axkid.com/uk/axkid-news/new-swedish-study-reveals-rear-facing-saves-lives/

New Swedish study reveals: rear-facing saves lives.

Folksam’s Swedish crash review highlights the preventable risk of early forward-facing and the proven protection of correct rear-facing use.

https://axkid.com/uk/axkid-news/new-swedish-study-reveals-rear-facing-saves-lives/

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Walkacrossthesand · 12/03/2026 00:29

I don't think this article clarifies anything - eg of the 0-6 year olds who died, ‘Only 28% were in a rear-facing seat, while 34% were forward-facing, and 33% were unrestrained.’ That just doesn’t make sense to me - you could use that data to say that car seats make only a small difference to chance of fatality in a crash, and that can’t be right. But it’s late, and I’m tired, so maybe I’m reading it wrong.

BertieBotts · 12/03/2026 11:27

I also saw this study Smile

Both things are true. The study was funded by Axkid so the framing of it is clear that they are prioritising the results showing rear facing is protective. But the results aren't skewed, ie the information is accurate, it's just only one part of the picture. If you read the actual study, linked at the bottom of the article, rather than the bits presented on this page, it gives you a bit more of the full picture.

It is worth noting that this study is completely useless for assessing the relative protection of 5 point harness forward facing vs high back booster, partially because the numbers involved were so low that you can't realistically draw any conclusions, and partly (possibly for this reason) they have all been lumped together into one category.

There have been other studies of this nature which have been done previously and they all show fairly similar results, in fact this particular study shows less of an effect from rear facing. In the older studies, it was shown that roughly 3/4 of deaths in forward facing or unrestrained children could likely have been prevented by rear facing. In this study it is lower, more like 2/3. My guess as to why this is is that modern cars are better at protecting the occupants, and perhaps better usage of high back booster type seats for children in the in-between phase. In the past it was common to place children in booster seats, sometimes booster cushions, or just a seatbelt from around 3. Possibly also that modern forward facing seats tend to use isofix and are easier to use, as misuse is much more impactful in forward facing seats.

This is essentially a case study type where they look at fatality cases and analyse using recreations, crash test data, and expert analysis whether the child could have possibly survived if they were in a different kind of seat. These are only ever estimates, obviously we don't have a time machine to actually know, and because thankfully child passenger car deaths are low in number, the numbers will only ever give you a very rough idea.

@Walkacrossthesand These figures only make sense when you compare to what people normally do, and whether the group is larger or smaller for children who died in accidents. If car seat type had no effect at all, you'd expect to see that "normal use" of car seats roughly correlates with the distribution of type of car seat used when a child has died. Usually though what you see is a significant difference in that more children who died were travelling unrestrained or forward facing compared with rear facing, suggesting the rear facing seat is the most protective.

For some reason they didn't include the figures here, but in another fairly recent study from Sweden, the standard usage for different kinds of child car seats up to age 4/5 is as follows: 57% rear facing (although this will be higher in reality as this study mainly observed children aged 2+) and 2.5% unrestrained with presumably the other ~40% being in forward facing seats.

That does show a clear difference - over 57% normally RF, vs 28% of children who died, around 40% normally FF vs 34% of children who died, and around 2.5% usually unrestrained vs 33% unrestrained - the biggest difference is in the unrestrained group, which is expected, but there is also a large difference in the RF group.

However there is another statistical problem with comparing these kinds of stats - there is a correlation between generally risky or irresponsible driver behaviour such as driving without insurance/license, distracted driving, drunk/drug driving, and not using child restraints. So while it's absolutely true that driving with unrestrained children is putting them at massive risk if you were to crash, and using a rear facing seat significantly reduces risk compared with forward facing, there is some aspect especially in the unrestrained group of bias because if you're the kind of parent to use a car seat and particularly to select a car seat based on safety credentials, then you probably are also less likely to have a crash because you are more likely to care and think about safety when driving. That's not any direct effect from the type of restraint, it's just a correlation.

The case study approach which is used in this study is more comprehensive - it looks at each case in detail and makes a judgement for each. For this study they did not actually compare whether a child who was unrestrained and under 125cm would have been better protected in a forward facing seat. They ONLY compared the likely outcome if the child had been in a rear facing seat. So it simply doesn't really tell you anything about whether forward facing seats are protective or not. We know from other studies that forward facing seats are indeed protective mainly because being unrestrained is so high risk. But it's not what this study is looking at. This study only compared FF and unrestrained to RF, and unrestrained to FF in children over 125cm.

I need to do the school run, but I can come back later with other, older studies of this type if interested.

toastofthetown · 12/03/2026 14:18

Thanks for such a detailed response and I’d be really interested in other studies like that if you have the time. I also realised I assumed you were a she, so sorry if that’s wrong.

What you said about comparing it to the percentage of the population using the car seats is part of the puzzle I thought was missing so that data adds amazing context. And I’d misread the likelihood of survival FF, because I see now that only applies to over 125cm. I wondered why there was no duplication- probably why I shouldn’t read car seat safety studies in the middle of the night when I can’t sleep. It would have been interesting to have a comparison, and also an evaluation of if the children were properly restrained in their car seats though I guess that would be difficult. But on social media I see loads of kids with straps hanging off their shoulders in a big puffy coat, which would probably be equivalent to being unrestrained when forward facing, so pretty different to actually being fitted properly. I suppose that would be difficult to analyse cleanly though.

OP posts:
Tanyyya · 12/03/2026 14:22

Mine were rear facing. I am Scandinavian so really surprised that rear facing post initial baby stage is not a thing in the Uk. I think the studies are pretty conclusive on this.

BertieBotts · 12/03/2026 15:35

Yes I am a she 🙂

It is difficult to judge restraint misuse at the time of an accident as this data is not always recorded or known and presumably in the chaos of getting any survivors medical help it's obviously a much lower priority. It is included in some studies but not many because the data isn't really available. Most of the data we have about misuse is based on observation (random traffic stops) and crash tests in a lab based on specific observed misuses.

I did read something a while back about how Swedish parents are not particularly any better with using car seats correctly so you get all the same mistakes, loose straps and puffy coats for example but with a rear facing seat the shell performs the majority of the job of stopping the movement so it is less likely to be a catastrophic failure. It is possible that this tolerance for mistakes with rear facing seats is part of why they tend to perform better.

BertieBotts · 12/03/2026 15:57

There is a tool here using US data (give it a min to load and scroll down) which compares observed (ie "normal") restraint type use and restraint type when recorded in a child fatality, showing that similar patterns are also seen in the US, even though restraint use patterns are different (US parents tend to forward face earlier, but keep children in harnesses longer than Sweden).

https://injuryfacts.nsc.org/motor-vehicle/occupant-protection/child-restraint/

BertieBotts · 12/03/2026 20:35

For the older, similar studies. The first is a large one from 2008 which I believe was produced in the lead up to creating the newer R129 legislation. The intent of this study was to look at the difference in performance in rear facing seats compared to forward facing for children up to 4 years old. It is, similar to the Axkid study, skewed in the direction of looking for benefits of rear facing so it doesn't really consider whether forward facing restraints would be beneficial, although this is sometimes mentioned. It is a good and convincing study about the efficacy of rear facing though, and it is probably why R129 has the 15 month minimum limit for forward facing. I understand that this organisation argued for the rule to be changed to age 4 but faced pushback from industry. However today on the market the vast majority of seats people buy to immediately follow on from the infant carrier have the ability to keep children rear facing up to 105cm / 18kg which is roughly 4.5 years on average, and I think that is a direct result of this study. The data mostly is taken from the late 90s/early 00s so bear in mind different child seats and common practice at this time.

It contains descriptions of the crashes and injuries to children involved, including fatal injuries, so warning for distressing content. The format is similar in that they looked at both large scale databases with injury statistics but also took several case studies to analyse whether children could possibly have survived if they had been in a different restraint type.

https://www.anec.eu/attachments/ANEC-R&T-2008-TRAF-003.pdf

The other one is even older. It's from 1980 (so refers to crashes throughout the 1970s) and essentially wanted to answer the question of whether child seats work at all, because at the time this was not yet known and most countries had no standardisation of child seats yet. The majority of the child seats in this study are forward facing, and with the exception of a couple of seats which are of a type which are no longer produced, it shows overwhelmingly that [forward facing] child seats do work. The ones which always amaze me are the ones where the description of the child seat is abominable (e.g. old, broken, the wrong size, completely wrongly installed) yet it protects the child. Again, distressing content.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/500/44653.0001.001.pdf

That link should download the file rather than open it. If this does not work, copy and paste the following and insert the above link directly after the last slash. Archive links don't work on MN directly no matter how you format them.

<a class="break-all" href="https://web.archive.org/web/20230412135804/deepblue.lib.umich.edu/bitstream/handle/2027.42/500/44653.0001.001.pdf" rel="nofollow" target="_blank">https://web.archive.org/web/20230412135804/

https://www.anec.eu/attachments/ANEC-R&T-2008-TRAF-003.pdf

BertieBotts · 12/03/2026 20:55

Ah well it broke it anyway. You can copy and paste the actual link out of the mess MN makes of it.

BTW the "harness and shield" car seats described in some of the US reports were like this. Not like the impact shield seats we have in Europe.

Their "Shield boosters" were more like the impact shields we have although they were banned in 2005 and widely thought to be dangerous.

Swedish study on rear facing saving lives
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