Chapter 9: Rear-Facing Child Restraints

9-2 National CPS Certification Training - April 2007 (R1010)

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

9-3 National CPS Certification Training - April 2007 (R1010)

NHTSA’s Four Steps For Kids Consumer Information

Designed to clarify transitions between restraint types:

1.Rear-facing CR2. Forward-facing CR3. Booster seat4. Seat belt

9-4 National CPS Certification Training - April 2007 (R1010)

Why Children Should Travel Rear-Facing•Physical

Development▪ Babies have big

heads▪ Bones, tendons,

and muscles are not fully developed

Child’s Body Proportions

9-5 National CPS Certification Training - April 2007 (R1010)

Why Children Should Travel Rear-facingIncreased crash

protection:•Spreads crash forces

along the entire head, neck, and back

•Protects head, neck, and spinal cord

•CR absorbs forces of the crash

VideoCourtesy of Children’s Hospital of Philadelphia

9-6 National CPS Certification Training - April 2007 (R1010)

Activity 1: Identifying Rear-Facing CR

•Infant-only CR

•Convertible CR used in rear-facing position

9-7 National CPS Certification Training - April 2007 (R1010)

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

9-8 National CPS Certification Training - April 2007 (R1010)

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

9-9 National CPS Certification Training - April 2007 (R1010)

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

9-10 National CPS Certification Training - April 2007 (R1010)

Pinch Test

•Test at child’s shoulder

•Try to pinch webbing up and down

•Your fingers should slide off

Harness straps are too loose

9-11 National CPS Certification Training - April 2007 (R1010)

Selection – Fits The Vehicle

•Consider vehicle seat type and size (contoured, bench, captain)

9-12 National CPS Certification Training - April 2007 (R1010)

Selection – Easy to Use

• By parents/caregivers, including those with physical problems

• Front versus back harness adjustment

• Seat belt versus lower anchors

9-13 National CPS Certification Training - April 2007 (R1010)

Rear-Facing Harness Adjusters

9-14 National CPS Certification Training - April 2007 (R1010)

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

9-15 National CPS Certification Training - April 2007 (R1010)

Location

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

9-16 National CPS Certification Training - April 2007 (R1010)

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

9-17 National CPS Certification Training - April 2007 (R1010)

Installation – Rear Facing Basics•Correct belt path•Appropriate recline angle•Tight and locked in place

▪Using seat beltor

▪Using lower anchors

9-18 National CPS Certification Training - April 2007 (R1010)

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 WeberChild Passenger Protection Research Program

University of Michigan Medical School

9-19 National CPS Certification Training - April 2007 (R1010)

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

YES!

9-20 National CPS Certification Training - April 2007 (R1010)

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

9-21 National CPS Certification Training - April 2007 (R1010)

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

9-22 National CPS Certification Training - April 2007 (R1010)

Installation – Situation to Consider•Space Requirements•Seat slope

9-23 National CPS Certification Training - April 2007 (R1010)

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

9-24 National CPS Certification Training - April 2007 (R1010)

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

9-25 National CPS Certification Training - April 2007 (R1010)

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

9-26 National CPS Certification Training - April 2007 (R1010)

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

9-27 National CPS Certification Training - April 2007 (R1010)

Always look in the manuals

9-28 National CPS Certification Training - April 2007 (R1010)

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

9-29 National CPS Certification Training - April 2007 (R1010)

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

9-30 National CPS Certification Training - April 2007 (R1010)

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

9-31 National CPS Certification Training - April 2007 (R1010)

Special Consideration – Breathing Problems

•Reclined position of CR could make breathing problems worse

•Children may need to travel with special medical equipment

9-32 National CPS Certification Training - April 2007 (R1010)

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

5-20 pounds and 26 inches; three-point harness

Birth-9 pounds and 20 inches; three-point harness

Birth to 21 pounds and 29 ½ inches; sleeping bag instead of harness

9-33 National CPS Certification Training - April 2007 (R1010)

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

9-34 National CPS Certification Training - April 2007 (R1010)

Special Consideration – Small and Premature Infants continued

Three-Point Harness Five-Point Harness

9-35 National CPS Certification Training - April 2007 (R1010)

Special Consideration – Tough Choices for Small and Premature Infants

T-Shield Tray Shield

9-36 National CPS Certification Training - April 2007 (R1010)

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?

9-37 National CPS Certification Training - April 2007 (R1010)

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?

9-38 National CPS Certification Training - April 2007 (R1010)

Misuse – What’s Wrong With This Picture?

9-39 National CPS Certification Training - April 2007 (R1010)

Misuse – What’s Wrong With This Picture?

9-40 National CPS Certification Training - April 2007 (R1010)

Misuse – What’s Wrong With This Picture?

9-41 National CPS Certification Training - April 2007 (R1010)

Misuse – What’s Wrong With This Picture?

9-42 National CPS Certification Training - April 2007 (R1010)

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.