1. Rear-facing Child Restraint Systems DO NOT DISTRIBUTE.

2. Do not distribute. Objectives: LEARN Why children should travel rear-facing Why rear-facing CRS should not be used with frontal airbags How to teach parents to correctly secure and install a child in a rear-facing CRS Selecting & Securing - 2

3. Do not distribute. Objective: PRACTICE Identifying parts of a RF CRS Selection, direction, location and installation of a child in a rear-facing CRS Using check list form Identifying misuse Selecting & Securing - 3

4. Do not distribute. Objective: EXPLAIN Proper use with caregivers Misuse errors with caregivers Best practice and tough choices with caregivers Selecting & Securing - 3

5. Do not distribute. 4 steps Rear facing Forward facing with harness Booster Seat belt

6. Do not distribute. Why Children Should Travel Rear-facing Physical development - Babies have big heads - Bones, tendons and muscles not fully developed Increased crash protection - CR absorbs forces of the crash - Spreads crash forces along the entire head, neck and back - Protects head and spinal cord Correct Installation - 3

7. Do not distribute. Child’s Body Proportions Update to infant

8. Do not distribute. Types of Rear-facing CRS Infant-only CRS with or without base Convertible CRS used rear- facing Correct Installation - 3

9. Do not distribute. Rear-facing Infant Only CRS Rear-facing ONLY Use rear-facing to the highest weight and height allowed by the manufacturer’s instructions Head must be 1” below the top of the shell Use in semi-reclined position Use harness straps at or below shoulder level Selecting & Securing - 28

10. Do not distribute. Low Birth Weight and Premature Infants AAP recommends testing in CSS before discharge to monitor baby’s heart rate, levels of oxygen and breathing Testing completed in a car safety seat positioned at appropriate angle Results may show child should use a car bed

11. Do not distribute. Breathing Problems Add pict in veh – diff car bed – on back

12. Do not distribute. Low Birth Weight and Premature Infants Avoid trays or shields Rear facing child safety seat with small internal harness dimensions CSS that meets child’s low weight Center in seat with rolled receiving blankets and crotch roll if necessary Angle for testing should be same as angle in car Use CSS only for transportation

13. Do not distribute. Low Birth Weight and Premature Infants

14. Do not distribute. Breathing Problems Apnea (breathing stops for more than 20 seconds) Tracheostomies (breathing tube in trachea): Avoid seats with shields or trays Upright position in CSS may make breathing problems worse. Children may travel with apnea monitors, ventilators, oxygen

15. Do not distribute. Rear-facing Convertible CRS Use when babies outgrow infant-only seat Use rear-facing to the highest weight/height allowed by the manufacturer’s instructions Use in semi-reclined position Use harness slots at or below shoulder level Selecting & Securing - 30 5 Point Harness

16. Do not distribute. These seats not appropriate for young infants Selecting & Securing - 30 Tray Shield

17. Do not distribute. CRS Parts & Functions Selecting & Securing - 20

18. Do not distribute. Other CRS – (Infant Seats) Baby Safe Companion Foot Prop Anti-Rebound Bar

19. Do not distribute. Hands-on Activity: Using Rear-facing CRS Locate instruction manual and CRS seat labels - Wt and ht limits - Use with or without base Check if on recall list Practice harness adjustments (pull tab, O-ring, metal rod and A-lock) Change harness slots Adjust harness clip Adjust recline mechanism Adjust handle (when present) Locate safety belt or LATCH belt paths Locate locking clip or built-in lock-off

20. Do not distribute. FOUR STEPS To Remember SELECTION DIRECTION LOCATION INSTALLATION

21. Do not distribute. SELECTION Correct Installation - 7 Fits your child - Appropriate for weight and height of child according to CRS instructions - Harness straps must be at or below the shoulders - Harness snug (pinch test) - Crotch strap that fits best

22. Do not distribute. SELECTION Correct Installation - 7 Fits your vehicle – Consult vehicle owner’s manual – Vehicle seat type and size (contoured, bench, captain) – Works with safety belt or LATCH system

23. Do not distribute. SELECTION Correct Installation - 7 Ease of use - Physical problems for caregivers (arthritis, limb deficiency, bad back, etc.) - With CRS (front vs. back harness adjustment) - Works with safety belt or LATCH system

24. Do not distribute. SELECTION – Securing into Rear-facing CRS Back & bottom are flat into CRS Rolled cloth at crotch strap if necessary Blankets at sides for positioning Harness at or below shoulders Harness snug Harness retainer clip at armpit level Selecting & Securing - 31

25. Do not distribute. Selection - Low Birth Weight and Premature Infants Avoid trays or shields Rear facing child safety seat with small internal harness dimensions CR that meets child’s low weight Center in seat with rolled receiving blankets and crotch roll if necessary Use CR only for transportation

26. Do not distribute. Types of Special Needs Restraints: Car Beds Source: Automotive Safety Program Dream Ride SE 5-20 pounds and 26 inches; 3-point harness Angel Ride Birth-9 pounds and 20 inches; 3-point harness Snug Seat Birth to 21 pounds and 29 ½ inches; sleeping bag instead of harness Car beds: Infants who must lie down Head placed toward center of vehicle in all beds

27. Do not distribute. Selection: Conventional Restraints First option if meets child’s needs Less expensive Usually easier to find, use and install Often meets needs of children with special health care needs Insert age/weight

28. Do not distribute. DIRECTION Correct Installation - 7 For optimal protection, use rear- facing to highest weight and/or height according to the CRS instructions Rear-facing until at least 1 year old AND at least 20 pounds

29. Do not distribute. LOCATION A back seat is the safest location If available, use center back seat of vehicle (away from front, side, rear-end crashes) Consider position of other passengers Consider safety belt versus LATCH system Airbag implications

30. Do not distribute. LOCATION - Airbags and Rear-facing CRS NEVER place a rear-facing CRS in front of an active passenger air bag If no back seat  airbag = off! Very high forces hit child’s head during inflation Follow vehicle and CR instructions for side-airbag interactions Misuse and Compatibility - 23

31. Do not distribute. INSTALLATION Appropriate recline angle Correct belt path Tight and locked in place - Using safety belt OR - Using LATCH System

32. Do not distribute. INSTALLATION - Angle Spread crash forces along the entire head, neck and back Helps keep airway open Angle according to manufacturer’s instructions More upright as child grows Car bed option for special needs Courtesy of Kathleen Weber Child Passenger Protection Research Program University of Michigan Medical School Correct Installation - 8

33. Do not distribute. INSTALLATION - Angle Special considerations for rear-facing seats: - Space requirements - Seat slope Correct Installation - 13 NO

34. Do not distribute. INSTALLATION - Angle Follow CRS manufacturer’s instructions Use recline adjuster as needed Correct Installation - 14 YES NO!

35. Do not distribute. INSTALLATION - Angle Pool noodles or a rolled towel may help to recline CRS Avoid too much recline Do not allow pool noodles or towel to get in the way of safety belt or LATCH system Correct Installation - 14 YES NO!

36. Do not distribute. INSTALLATION - Safety Belt or LATCH System Tightly Securing the CRS: - Install tightly using safety belt or LATCH system - Grip CRS at belt path to check - CRS should not move forward or side to side more than one inch - Parent or caregiver must be able to repeat installation Correct Installation - 21 Tech pulling on belt to tighten (not knee)

37. Do not distribute. INSTALLATION - Special Situations CRS with a switchable retractor: Tension in shoulder portion may lift up CRS - Keep in ELR mode and - Use locking clip or - Try another seating position Correct Installation - 32 NO

38. Do not distribute. INSTALLATION – Rear-facing CRS and Tethers Unless allowed by CRS and vehicle manufacturer, do not tether a CRS rear-facing Read CRS/vehicle instructions Correct Installation – 49

39. Do not distribute. Rear-facing Tethering Provides... Correct Installation - 50 Swedish Method = Toward Front of Vehicle Australian Method = Toward Rear of Vehicle

40. Do not distribute. INSTALLATION – Safety Belt or LATCH System DEMO Tightly securing the CRS − Install tightly using (1) safety belt or (2) LATCH system − Grip CRS at belt path to check − CRS should not move forward or side to side more than one inch − Parent/caregiver must be able to repeat installation Misuse and Compatibility - 24 Insert RF CRS installation with Safety Belt and LATCH/Tether

41. Do not distribute. PRACTICE - Hands-On Exercise Using the information known about “your child”: - Configure CRS correctly for child, including different harness systems - Install in vehicle: Rear-facing convertible, infant only » Lap only » Lap/shoulder » Flexible/Rigid LATCH/Tether - Teach a parent to do these things Selecting & Securing - 59

42. Do not distribute. EXPLAIN - Best Practice and Tough Choices Role Play I have 2 kids. Which one should go in the middle? It is easier if I leave the handle up. Is that okay? Should I use LATCH or the safety belt? Which is safer? Should I use a tether on my RF convertible seat? I want to see my baby. Can I turn him around? Selecting & Securing - 9

43. Do not distribute. EXPLAIN - Common Selection Errors 1.Using outgrown CRS 2.Child too small/young for CRS 3.Using non-213 certified device 4.Using a CRS that is more than 6 years old 5.Using a CRS with unknown history 6.Using a CRS that has been involved in a crash 7.Using a CRS under current recall Misuse and Compatibility - 9

44. Do not distribute. EXPLAIN - Harnessing Errors 1.Too loose 2.Not used 3.Retainer clip not at armpit level 4.Routed through wrong slots 5.Not doubled back, if needed 6.Knotted, pinned or otherwise incorrectly secured 7.Not placed on child correctly 8.Frayed or damaged 9.Metal adjuster not flush with slot or out of position 10.Crotch strap too long or wrong position 11.Using "add-ons" not approved by the CRS manufacturer Misuse and Compatibility - 10

45. Do not distribute. EXPLAIN - Installation Errors 1.Safety belt or LATCH too loose or not locked 2.CRS facing wrong way 3.Using wrong belt path 4.Incorrect recline angle 5.CRS installed using both safety belt and LATCH system 6.Incorrect LATCH use 7.Incorrect tether use 8.Carrying handle not used as specified in the instructions Misuse and Compatibility - 10

46. Do not distribute. PRACTICE - Classroom Activity Determine what is correct or incorrect with the CRS installation How would you explain to a parent or caregiver? Misuse and Compatibility - 27 “What’s Wrong With This Picture?”

47. Do not distribute. Misuse - What’s Wrong With This Picture? Misuse and Compatibility - 28Standardized CPS Training Program - Winter 2004

48. Do not distribute. SHARE with Parent or Caregiver- Child too upright Needs some type of support under front of CRS Possibly too big for CRS Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 29Standardized CPS Training Program - Winter 2004

49. Do not distribute. Misuse- “What’s Wrong With This Picture?” Misuse and Compatibility - 48Standardized CPS Training Program - Winter 2004

50. Do not distribute. SHARE with Parent or Caregiver- Harness adjuster bar missing Using rope or cords to hold straps in place Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 49 Standardized CPS Training Program - Winter 2004

51. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 50Standardized CPS Training Program - Winter 2004

52. Do not distribute. SHARE with Parent or Caregiver- Rear-facing seat is forward facing CRS too small for child Bulky clothing means harness is too loose Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 51Standardized CPS Training Program - Winter 2004

53. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 54Standardized CPS Training Program - Winter 2004

54. Do not distribute. SHARE with Parent or Caregiver- This is a household carrier No CRS labels (but a very small sticker stating it is not to be used in a vehicle) No belt paths for vehicle use No harness straps No harness retainer clip Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 55Standardized CPS Training Program - Winter 2004

55. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 56Standardized CPS Training Program - Winter 2004

56. Do not distribute. SHARE with Parent or Caregiver- CRS reclined too far in rear seat Wedged into vehicle seat Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 57Standardized CPS Training Program - Winter 2004

57. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 58Standardized CPS Training Program - Winter 2004

58. Do not distribute. SHARE with PARENT or Caregiver- Cargo tie down used in addition to safety belt Tie down secured to vehicle seat frame Too upright Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 59Standardized CPS Training Program - Winter 2004

59. Do not distribute. Misuse- “What’s Wrong With This Picture?” Misuse and Compatibility - 60Standardized CPS Training Program - Winter 2004

60. Do not distribute. SHARE with Parent or Caregiver- Wood added under rear-facing CRS to obtain correct angle for infant Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 61Standardized CPS Training Program - Winter 2004

61. Do not distribute. Misuse- “What’s Wrong With This Picture?” Misuse and Compatibility - 72Standardized CPS Training Program - Winter 2004

62. Do not distribute. SHARE with Parent or Caregiver- Front- facing only CRS used rear- facing Too upright for rear-facing Harness too loose Safety belt used for installation is threaded though the wrong belt path and is too loose Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 73Standardized CPS Training Program - Winter 2004

63. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 74Standardized CPS Training Program - Winter 2004

64. Do not distribute. SHARE with Parent or Caregiver- Infant is facing the front Rear-facing only CRS installed is installed facing forward Handle left up Harness too loose and off the shoulders No retainer clip used Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 75Standardized CPS Training Program - Winter 2004

65. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 78Standardized CPS Training Program - Winter 2004

66. Do not distribute. SHARE with Parent or Caregiver- Handle left up Harness may be too loose if infant can turn around Note: Shoulder belt around back of CRS is allowed on this model Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 79Standardized CPS Training Program - Winter 2004

67. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 80Standardized CPS Training Program - Winter 2004

68. Do not distribute. SHARE with Parent or Caregiver- CRS is not semi-reclined Harness on edge of shoulders Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 81Standardized CPS Training Program - Winter 2004

69. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 82Standardized CPS Training Program - Winter 2004

70. Do not distribute. SHARE with Parent or Caregiver- Infant bundled before harnessing Harness retained clip is not at armpit level Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 83Standardized CPS Training Program - Winter 2004

71. Do not distribute. Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 86Standardized CPS Training Program - Winter 2004

72. Do not distribute. SHARE with Parent or Caregiver- Too upright for infant Harness too loose Harness retainer clip twisted and out of position Safety belt not through belt path slots Safety Belt too loose Misuse- What’s Wrong With This Picture? Misuse and Compatibility - 87Standardized CPS Training Program - Winter 2004

73. Do not distribute. Objectives – A REVIEW Describe an infant’s physical characteristics that require added protection during travel. Describe ways that rear-facing CRS provide additional protection during travel. Identify all CRS parts on a: - rear-facing infant CRS (with and without a base) - rear-facing convertible CRS. Identify correct CRS installation techniques - tight fit, appropriate angle, harness use, and seat selection Describe correct placement of harness straps, harness retainer clip, carrying handle, etc. Selecting & Securing - 2

74. Do not distribute. Core elements Why RF (phys char)? Selection IO and RFC Harness adjustment Install – angle, belt path, tightness location

75. Do not distribute. Hands-on Activity: Identifying Labeling Participants will locate labels re: weight and height requirements on infant-only CRS and convertible CRS

76. Do not distribute. CRS Parts & Functions Adjustment Foot Detachable Base Selecting & Securing - 20

77. Do not distribute. CRS Parts & Functions ADD – RF Convertible Selecting & Securing - 20

78. Do not distribute. CRS Parts & Functions ADD – RF Convertible Selecting & Securing - 20

79. Do not distribute. CRS Parts & Functions ADD – RF Convertible Selecting & Securing - 20

80. Do not distribute. LOCATION Airbags - Passenger » NEVER place a rear-facing CRS in front of an active passenger air bag » If no back seat  airbag = off!

81. Do not distribute. INSTALLATION – ID Safety Belt Path HANDS ON - Read CRS manufacturer’s instructions - Identify belt path on » Infant seat (with and without base) » Rear-facing Convertible Seat Correct Installation - 19 Update to RF seat – safety belt RF only

82. Do not distribute. I INSTALLATION – Identify LATCH System - Read CRS manufacturer’s instructions - Identify LATCH belt path » Infant seat (with and without base) » Rear-facing Convertible Seat Correct Installation - 19 Update to RF seat – LATCH system

83. Do not distribute. INSTALLATION - Safety Belt or LATCH System Tightly Securing the CRS: - Install tightly using safety belt or LATCH system - Grip CRS at belt path to check - CRS should not move forward or side to side more than one inch - Parent or caregiver must be able to repeat installation Correct Installation - 21 Tech pulling on belt to tighten (not knee)

84. Do not distribute. INSTALLATION – Rear-facing CRS and Tethers Correct Installation - 50 Currently, ONLY the Britax CRS is designed to be tethered rear-facing Rear-facing tethering with Britax provides…..

85. Do not distribute. Best Practices Suggested option for the safest way to travel May conflict with the real world Selecting & Securing - 10

86. Do not distribute. LATCH - Best Practices Situation for rear-facing infant CRS or rear-facing convertible CRS: If CRS has LATCH attachments but vehicle has no LATCH anchors. Vehicle has LATCH anchors but CRS does not have LATCH attachments. Both CRS and Vehicle have user-ready LATCH hardware but the system is not used. Both CRS and vehicle have LATCH hardware but no tether is used. LATCH components used incorrectly. Correct Installation - 42

87. Do not distribute. EXPLAIN - Most Common Misuses Selection Harness Installation

88. Do not distribute. Child’s Body Proportions Update to infant