Chapter 9: Rear-Facing Child Restraints

1. Chapter 9: Rear-Facing Child Restraints

2. Chapter Objectives • Explain why children should travel facing the rear of vehicle • Explain why rear-facing CRs should not be used with frontal air bags • Teach parents/ caregivers about selection, direction, location, and installation of rear-facing CR • Identify best practice and tough choices that parents/ caregivers face • Discuss medical conditions requiring special attention • Identify misuse

3. Designed to clarify transitions between restraint types: Rear-facing CR Forward-facing CR Booster seat Seat belt NHTSA’s Four Steps For Kids Consumer Information

4. Why Children Should Travel Rear-Facing Child’s Body Proportions • Physical Development • Babies have big heads • Bones, tendons, and muscles are not fully developed

5. Why Children Should Travel Rear-facing Increased crash protection: • Spreads crash forces along the entire head, neck, and back • Protects head, neck, and spinal cord • CR absorbs forces of the crash Video Courtesy of Children’s Hospital of Philadelphia

6. Activity 1: Identifying Rear-Facing CR • Infant-only CR • Convertible CR used in rear-facing position

7. Rear-Facing Infant-Only CR • This CR is rear facing only • Use rear-facing CR to the highest weight or height allowed by the manufacturer’s instructions • Note head should be 1 inch below the top of the shell • Use in semi-reclined position • Use harness straps at or below shoulder level • CRs should be used only for travel, not sleeping

8. Rear-Facing Convertible CR • Use when babies outgrow infant-only CR • Use rear-facing position to the highest weight/ height allowed by the CR manufacturer’s instructions • Use in semi-reclined position • Use harness slots at or below shoulder level 3 harness slots

9. Selection – Fits The Child • Appropriate for weight and height of child according to CR instructions • Infant’s back and bottom are flat in CR • Harness straps at or below the shoulders • Harness snug (pinch test) • Harness retainer clip at the armpit level • Crotch strap that fits best 7 days old, 9 pounds

10. Pinch Test • Test at child’s shoulder • Try to pinch webbing up and down • Your fingers should slide off Harness straps are too loose

11. Selection – Fits The Vehicle • Consider vehicle seat type and size (contoured, bench, captain)

12. Selection – Easy to Use • By parents/caregivers, including those with physical problems • Front versus back harness adjustment • Seat belt versus lower anchors

13. Rear-Facing Harness Adjusters

14. Direction – Always Rear Facing • For optimal protection, use rear-facing CR to highest weight or height according to the CR instructions. • At a minimum, use rear-facing CR until child is at least 1 year old and at least 20 pounds 14 months, 24 pounds

15. Location • The back seat is the safest location • Consider air bag effects • Consider needs of other passengers • Choose seat belt or lower anchor system

16. Location- Air Bags and Rear-Facing CR • Never place a rear-facing CR in front of an active passenger air bag • If no back seat, AIR BAG MUST BE OFF! • High forces hit child’s head during inflation • Follow CR manufacturer’s instructions and vehicle owner’s manual to take into account side airbag effects Video Courtesy of Insurance Institute for Highway Safety

17. Installation – Rear Facing Basics • Correct belt path • Appropriate recline angle • Tight and locked in place • Using seat belt or • Using lower anchors

18. Installation – Angle • Parents should use angle given in CR manufacturer’s instructions (30 to 45 degrees) • CR spreads crash forces along the entire head, neck, and back • Correct position helps keep airway open • CR may be moved more upright as child grows & ages • There are car bed options, if prescribed by physician, for children with special health needs Courtesy of Kathleen Weber Child Passenger Protection Research Program University of Michigan Medical School

19. YES! Installation Angle • Use recline adjuster as needed • Use a firm lightweight object to help recline the CR • Do not allow firm lightweight object to get in the way of seat belt or lower anchors • Avoid too much recline • Follow CR manufacturer’s instructions

20. Installation – Seat Belt or Lower Anchors • Tightly securing the CR: • Install tightly using seat belt or lower anchors • Grip CR at belt path to check • Make sure CR does not move forward or side-to-side more than 1 inch • Remember that parent or caregiver must be able to repeat installation

21. Installation – Rear-facing CR and Tethers • Do not tether a rear-facing CR unless allowed by CR and vehicle manufacturers • Read CR instructions and vehicle owner’s manual

22. Installation – Situation to Consider • Space Requirements • Seat slope

23. Installation – Situation to Consider CR base that tilts with a switchable retractor: • Tension in shoulder portion may lift up CR • Keep in ELR mode • Use locking clip or try another seating position

24. Common Selection Errors • Using outgrown CR • Child too small/young for CR • Using non-FMVSS 213-certified device • Using a CR that is too old • Using a CR with unknown history • Using a CR that has been involved in a moderate to severe crash • Using a CR under current recall

25. Harnessing Errors • Not used • Too loose • Routed through wrong slots • Not doubled back, if needed • Knotted, pinned, or otherwise incorrectly secured • Not placed on child correctly • Frayed or damaged

26. Installation Errors • Safety belt or lower anchor straps too loose or not locked • CR facing the wrong direction • Use of wrong belt path • Incorrect recline angle • CR installed using both seat belt and lower anchors unless allowed by manufacturer • Incorrect lower anchor tether use • Carrying handle not used as specified in the instructions

27. Always look in the manuals

28. Activity 2: Selection and Installation Hands-On • In small groups, you will select and install CRs by children’s age/weight/height: • A child (card with age, weight/height) will be assigned to your team • Select an appropriate CR for your child. • Adjust harnesses to fit your child. • Install a rear-facing infant only CR (with or without a base) or a rear-facing convertible CR in a vehicle using: • Lap belt only • Lap and shoulder belt • Lower anchors • Repeat the CR selection, harness adjustment, and 3 installations for the type of CR (rear-facing infant only or rear-facing convertible) not chosen the first time

29. Special Consideration – Children With Special Health Needs • First option is to use a standard CR if it meets the child’s needs: • Easier to find and use • Less expensive 19.5 pounds, 13 months

30. Special Consideration – Small and Premature Infants • Use rear-facing CR with small internal harness dimensions • Use CR designed for child’s low weight • Center infant in CR with rolled receiving blankets and crotch roll, if necessary • Use CR only for transportation

31. Special Consideration – Breathing Problems • Reclined position of CR could make breathing problems worse • Children may need to travel with special medical equipment

32. Birth-9 pounds and 20 inches; three-point harness 5-20 pounds and 26 inches; three-point harness Birth to 21 pounds and 29 ½ inches; sleeping bag instead of harness Special Consideration – Car Beds • Car beds: • For infants who must lie down • Infant’s head placed toward center of vehicle in all beds Source: Automotive Safety Program

33. Special Considerations – Small and Premature Infants and Children With Breathing Problems • Follow AAP discharge recommendations • Test in a CR positioned at same angle as in vehicle • Results may show need for car bed use

34. Special Consideration – Small and Premature Infants continued Five-Point Harness Three-Point Harness

35. Special Consideration – Tough Choices for Small and Premature Infants T-Shield Tray Shield

36. Activity 3 – Communicating Best Practice and Tough Choices • I have two children. Which one should go in the middle? • It is easier if I leave the handle up. Is that OK? • Should I use lower anchors or the seat belt? Which is safer? • Should I use a tether on my rear-facing convertible seat? • I want to see my baby: May I turn him around?

37. Misuse – What’s Wrong With This Picture? • Determine what is correct or incorrect with the CR installation • How would you explain your answer to a parent or caregiver?

38. Misuse – What’s Wrong With This Picture?

39. Misuse – What’s Wrong With This Picture?

40. Misuse – What’s Wrong With This Picture?

41. Misuse – What’s Wrong With This Picture?

42. Chapter Review • Describe an infant’s physical traits that require special attention during travel • Describe ways that rear-facing CRs provide additional protection during travel • Identify all parts on a: • Rear-facing infant CR (with and without a base) • Rear-facing convertible CR. • Identify correct CR installation techniques • Describe correct placement of harness straps, harness retainer clip, carrying handle, etc.