Wednesday, January 20, 2016

Head Restraints for Everyone!

You probably don't think about the block of foam behind your head when you get in your car unless it hits you in an uncomfortable position. That block of foam is so much more than a place to rest your head for comfort. What exactly is a head restraint? A head restraint is more commonly referred to as a "head rest" and they are a critical piece of safety equipment in your car and everyone in the car needs to have one. When it comes to children and vehicle head restraints things get complicated. I hope I can help you sort it all out and keep everyone as safe as possible in your car. 

Head restraints are designed to protect the occupant from whiplash. Whiplash occurs most frequently when you are in a rear end collision and your neck is overextended backwards until the car rebounds and your head is whipped forward. It results in muscle strains and pain. Whiplash suffers take an average of 4 days off of work and some suffer chronic pain for years following the injury. 

Motions of whiplash
A study by the National Highway Traffic Safety Administration (NHTSA) in 1982 estimated that integral head restraints reduced the risk of injury by 17% and adjustable head restraints reduced the risk of injury by 10%. They theorized that this difference was due to the fact that 75% of adjustable head restraints were left in the down position and were not high enough to provide whiplash protection. As an adult driver or passenger, every time you get in to a new vehicle, you need to take the time to adjust your head restraint. Ideally, the head restraint will be adjusted so that the top of the head restraint is even with the top of your head. For taller than average people, the head restraint must reach to at least the tops of your ears (or the midline of your head) to provide adequate whiplash protection.

A poorly adjusted head restraint
A properly adjusted head restraint

The head restraint must also be as close as possible to the back of your head- no more than 4 inches. Some adjustable restraints allow the head restraint to be tilted forward to reduce the amount of backset but others require that you move the entire seat back in to a more upright position. You definitely want to avoid a steep recline while driving, not only because of the head restraint but also because in a reclined position your seat belt will not be in contact with your body and your body will travel a lot farther in a crash.

When NHTSA implemented updates to the Federal Motor Vehicle Safety Standard (FMVSS) 202 (effective 2008) it addressed many important issues with head restraints in the front seats. It made them taller and wider, reduced the backset and generally made them more user friendly. Unfortunately, it stopped short of requiring head restraints in all seating positions. It chose to leave the back seat head restraints optional. The reasoning for this was that the back seats are much less likely to be occupied than the front seats and so the costs of requiring vehicle manufacturers to put them in the back would be higher than the medical costs of treating injuries that occur from lack of head restraints. Obviously, this doesn’t mean you don’t need them. The FMVSS 202 does state that *if* the manufacturer chooses to install head restraints in the rear seats, they must meet all the same requirements as the front seats. Unfortunately many vehicle manufacturers choose to not install a head restraint in the center position, leaving any passenger in this position at a higher risk of injury in a crash.
When it comes to child passengers and head restraints the issues can get even more muddled. To limit the amount of backset for adult (and older child) passengers, some manufacturers make the head restraints forward-leaning. Unfortunately, this can make it difficult if not impossible to install some car seats there. The manual for your car seat will tell you if this is an issue. For example, Britax requires that the head restraint not push the moveable head wings on the car seat forward out of its natural position. 

In the lowest position, this head restraint does not
 allow the seat to fit flush against the vehicle seat.
Although this is not a issue for this particular seat,
different manufacturers have different requirements.
Always check the manual!
If the head restraint is raised, the car seat sits flush
 with the vehicle seat, the head wings are not
 pushed forward and the problem is eliminated

Other manufacturers prefer that the entire back of the car seat is flush with the vehicle seat. If you have difficulty installing a harnessed seat, consult your vehicle manual to see if the head restraint can be removed. Some vehicle manufacturers allow the head restraints to be removed (some require tools to do so), some allow you to turn the head restraint backwards and some are not removable at all. If you have a harnessed seat that cannot be installed with the head restraint in place and you cannot remove the head restraint then the car seat is incompatible with that seating position. Clearly, this can get complicated!

Booster seats bring yet another complication. Most high back booster seats do not allow a gap behind the car seat. If the head restraint leaves a gap because it is forward leaning, check the vehicle manual to see if the head restraint can be removed or turned around. 

The gap left behind this booster seat is unacceptable
Turning the head restraint around fixes the
problem and prevents the head restraint from
being misplaced

You also must check your booster seat manual to see if the booster requires head support from the vehicle. Diono and many Dorel (Safety 1st, Cosco) high back boosters require head support from the vehicle as the high backs of the boosters themselves may not be strong enough to prevent injury on their own. At this point, your options are limited to purchasing a new high back booster seat that does not require vehicle support or converting the high back booster to a no back booster and using the vehicle head restraint as intended for an adult passenger.
When you have non-adjustable or non-existent rear head restraints, you must be very aware of the height of your child relative to the vehicle seat back. The best practice in this situation is to use a high back booster that does not require vehicle support until it is outgrown. At that point it is no longer safe to transport the child in this vehicle unless they are 13 and can ride in the front seat. The Britax Parkway is a good option for this situation.
Makayla's head is well below the seat back without a
booster at 7 years old but she is no where near passing
the 5 Step Test to ride without a booster. She is at risk
for severe abdominal injuries like this.
In a backless booster, Makayla's ears are just below
the seat back. Her belt fit is great like this but any
growth will put her at increased risk of whiplash injury.
This high back booster does not require vehicle head
support. I have adjusted the back to it's highest setting
here and at ~1 inch of torso growth per year, Makayla
has about 2-3 years before she will outgrow this seat.
A final option for a position with low or no head restraints is to use a lower profile no back booster like the Safety 1st Incognito (min 60 lbs), the Bubblebum or the Mifold.

Head restraints are important for every passenger in the vehicle. They prevent the pain and suffering that comes with whiplash injuries. For adults, it’s important to adjust your head restraint for ideal protection. For children in forward facing harnessed seats, it’s important to get a good installation with adequate contact between the vehicle seat and the child restraint. For children riding in booster seats, it’s important that they have the same protection (minimum to the tops of the ears) that adults have. If the booster seat does not provide this protection, then the vehicle seat must. YOU need a head restraint! And YOU need a head restraint! I feel like Oprah. As always, feel free to contact me with any specific questions about your vehicle or car seat!