The AAP recommends that all infants ride rear facing starting with their first ride home from the hospital. All infants and toddlers should ride in a rear-facing seat as long as possible until they reach the highest weight or height allowed by their car safety seat manufacturer. Most convertible seats have limits that will allow children to ride rear facing for 2 years or more. When infants outgrow their rear-facing–only seat, a convertible seat installed rear facing is needed. All parents can benefit from getting installation help from a CPST to ensure that their child’s seat is properly installed.
Types of Rear-Facing Seats:
Three types of rear-facing seats are available:
rear-facing–only, convertible, and all-in-one. When children reach the highest weight or length allowed by the manufacturer of their rear-facing–only seat, they should continue to ride rear facing in a convertible or all-in-one seat.
Rear-facing–only seats
- Are used for infants up to 22 to 35 pounds, depending on the model.
- Are small and have carrying handles.
- Usually come with a base that can be left in the car. The seat clicks into and out of the base so you don’t have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.
- Should be used only for a child’s travel (not sleeping, feeding, or any other use outside the vehicle).
Convertible seats (used rear facing)
- Can be used rear facing and, later, “converted” to forward facing for older children when they outgrow either the weight limit or the length limit for rear facing. This means the seat can be used longer by your child. Convertible seats are bulkier than infant seats, however, and they do not come with carrying handles or separate bases and are designed to stay in the car.
- Many have higher limits in rear-facing weight (up to 40–50 pounds) and height than those of rear-facing– only seats, a feature that makes convertible seats ideal for bigger babies and toddlers.
- Have a 5-point harness that attaches at the shoulders, at the hips, and between the legs.
- Should be used only for a child's travel (not sleeping, feeding, or any other use outside the vehicle).
All-in-one seats (used rear facing)
- Can be used rear facing, forward facing, or as a belt- positioning booster. This means the seat may be used longer by your child as your child grows.
- Are often bigger in size, so it is important to check that they fit in the vehicle while they are rear facing.
- Do not have the convenience of a carrying handle or separate base; however, they may have higher limits in rear-facing weight (up to 40–50 pounds) and height than those of rear-facing–only seats, a feature that makes all-in-one seats ideal for bigger babies and toddlers.
Installation Tips for Rear-Facing Seats:
Always read the vehicle owner's manual and the car safety seat manual before installing the seat.
When using a rear-facing seat, keep the following tips in mind:
- Place the harnesses in your rear-facing seat in slots that are at or below your child's shoulders.
- Ensure that the harness is snug (you cannot pinch any slack between your fingers when testing the harness straps over the child's shoulders) and that the retainer clip is placed at the center of the chest, even with your child's armpits.
- Make sure the car safety seat is installed tightly in the vehicle with either lower anchors or a locked seat belt. Many car safety seats have an integrated lock-off to keep the seat belt locked. If your seat has one, follow the manufacturer’s recommendations on how to use it. If you can move the seat at the belt path more than an inch side to side or front to back, it's not tight enough.
- Never place a rear-facing seat in the front seat of a vehicle that has an active front passenger airbag. If the airbag inflates, it will hit the back of the car safety seat, right against your child's head, and could cause serious injury or death.
- If you are using a convertible or all-in-one seat in the rear-facing position, make sure the seat belt or lower anchor webbing is routed through the correct belt path. Check the instructions that came with the car safety seat to be sure.
- Make sure the seat is at the correct angle so your child's head does not flop forward. Check the instructions to find out the correct angle for your seat and how to adjust the angle if needed. All rear-facing seats have built-in recline indicators.
- Check the car safety seat instructions and vehicle owner's manual about whether the car safety seat may contact the back of the vehicle seat in front of it.
- Still having trouble? Check with a certified CPST in your area who can help. See
If
You
Need
Installation
Help on page 16 for information on how to locate a CPST.
Common Questions:
What if my child's feet touch the back of the vehicle seat?
- This is a very common concern of parents, but it should cause them no worry. Children are very flexible and can always easily find a comfortable position in a rear-facing seat. Injuries to the legs are very rare for children facing the rear.
What do I do if my child slouches down or to the side in the car seat?
- You can try placing a tightly rolled receiving blanket on both sides of your child. Many manufacturers allow the use of a tightly rolled small diaper or cloth between the crotch strap and your child, if necessary, to prevent slouching. Do not place padding under or behind your child or use any sort of car safety seat insert unless it came with the seat or was made by the manufacturer for use with that specific seat.
Why should I dress my child in thinner layers of clothing before strapping him or her into a car safety seat?
- Bulky clothing, including winter coats and snowsuits, can compress in a crash and leave the straps too loose to restrain your child, leading to increased risk of injury. Ideally, dress your baby in thinner layers and wrap a coat or blanket around your baby over the buckled harness straps if needed.
See
Winter Car Seat Safety Tips from the AAP.
Do preemies need a special car seat?
A car safety seat should be approved for a baby's weight. Very small babies who can sit safely in a semi-reclined position usually fit better in rear-facing–only seats. Babies born preterm should be screened while still in the hospital to make sure they can sit safely in a semi-reclined position. Babies who need to lie flat during travel may be able to ride in a car bed that meets Federal Motor Vehicle Safety Standard 213. They should be screened again while in the hospital to make sure they can lie safely in the car bed.
Additional Information from HealthyChildren.org:
Figure 1 from Bull MJ, Engle WA; American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention, Committee on Fetus and Newborn. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009;123(5);1424–1429.