1. Chapter 9: Rear-Facing Child Restraints
National Standardized CPS Certification Training April 2007 – R1010
Chapter 9: Rear-Facing Child Restraints
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. NHTSA’s Four Steps For Kids Consumer Information
Designed to clarify transitions between restraint types:
Rear-facing CR
Forward-facing CR
Booster seat
Seat belt

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. Harness straps are too loose
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. Installation Angle YES! 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
YES!

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