Chapter 9: Rear-Facing Child Restraints

9-2National 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

9-3National CPS Certification Training - April 2007 (R1010) NHTSA’s Four Steps For Kids Consumer Information Designed to clarify transitions between restraint types: 1.Rear-facing CR 2.Forward-facing CR 3.Booster seat 4.Seat belt

9-4National 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

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

9-6National CPS Certification Training - April 2007 (R1010) Activity 1: Identifying Rear- Facing CR Infant-only CR Convertible CR used in rear-facing position

9-7National 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

9-8National 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

9-9National 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

9-10National 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

9-11National CPS Certification Training - April 2007 (R1010) Selection – Fits The Vehicle Consider vehicle seat type and size (contoured, bench, captain)

9-12National 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

9-13National CPS Certification Training - April 2007 (R1010) Rear-Facing Harness Adjusters

9-14National 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

9-15National 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

9-16National 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

9-17National CPS Certification Training - April 2007 (R1010) Installation – Rear Facing Basics Correct belt path Appropriate recline angle Tight and locked in place ▪Using seat belt or ▪Using lower anchors

9-18National 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 Weber Child Passenger Protection Research Program University of Michigan Medical School

9-19National 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!

9-20National 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

9-21National 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

9-22National CPS Certification Training - April 2007 (R1010) Installation – Situation to Consider Space Requirements Seat slope

9-23National 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

9-24National 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

9-25National 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

9-26National 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

9-27National CPS Certification Training - April 2007 (R1010) Always look in the manuals

9-28National 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

9-29National 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

9-30National 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

9-31National 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

9-32National 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 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

9-33National 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

9-34National CPS Certification Training - April 2007 (R1010) Special Consideration – Small and Premature Infants continued Three-Point Harness Five-Point Harness

9-35National CPS Certification Training - April 2007 (R1010) Special Consideration – Tough Choices for Small and Premature Infants T-ShieldTray Shield

9-36National 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?

9-37National 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?

9-38National CPS Certification Training - April 2007 (R1010) Misuse – What’s Wrong With This Picture?

9-39National CPS Certification Training - April 2007 (R1010) Misuse – What’s Wrong With This Picture?

9-40National CPS Certification Training - April 2007 (R1010) Misuse – What’s Wrong With This Picture?

9-41National CPS Certification Training - April 2007 (R1010) Misuse – What’s Wrong With This Picture?

9-42National 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.