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Rear-Facing Car Seats for Infants & Toddlers

​​The American Academy of Pediatrics (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 until they are at least 2 years of age or, preferably, until they reach the highest weight or height allowed by their car seat manufacturer. All parents can benefit from getting installation help from a CPST to ensure that their seat is properly installed.

Types of Rear-Facing Seats:

Three types of rear-facing seats are available: rear-facing–only, convertible, and 3-in-1. 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 3-in-1 seat.

Rear-facing–only seats

  • Are used for infants up to 22 to 40 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 it each time you use it. Parents can buy more than one base for additional vehicles.

  • Should be used only for 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 the weight limit, the length limit, or both for rear facing. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and 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 rear-facing–only seats, which make them 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 travel (not sleeping, feeding, or any other use outside the vehicle).

3-in-1 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 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 rear-facing–only seats, which make them ideal for bigger babies and toddlers.

Installation Tips for Rear-Facing Seats:

Always read the vehicle owner's manual and the car 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 baby's shoulders.

  • Ensure that the harness is snug (you cannot pinch any slack between your fingers when testing the harness straps over the baby's shoulders) and that the harness chest clip is placed at the center of the chest, even with to your child's armpits.

  • Make sure the car seat is installed tightly in the vehicle with either LATCH or a locked seat belt. 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 seat, right where your baby's head is, and could cause serious injury or death.

  • If you are using a convertible or 3-in-1 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 seat to be sure.

  • Make sure the seat is at the correct angle so your infant'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 angle indicators or adjusters.

  • Check the car seat instructions and vehicle owner's manual about whether the car seat may contact the back of the vehicle seat in front of it.

  • Still having trouble? Check with a certified child passenger safety technician (CPST) in your area who can help. 

How to Install A Rear-Facing Car Seat - Video: 

​​In this video, Benjamin Hoffman, MD, FAAP, a pediatrician and certified car seat technician, guides parents on how to properly install a rear-facing car seat. All infants and toddlers should ride in a rear-facing car seat until they are at least 2 years of age or until they reach the highest weight or height allowed by their car seat's manufacturer. 
 

Common Questions about Rear-Facing Seats:
Figure 1

What if my baby'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 can bend their legs easily and will be comfortable in a rear-facing seat. Injuries to the legs are very rare for children facing the rear.

What do I do if my baby slouches down or to the side in the car seat?

  • You can try placing a tightly rolled receiving blanket on both sides of your infant. Many manufacturers allow the use of a tightly rolled small diaper or cloth between the crotch strap and your infant if necessary to prevent slouching. Do not place padding under or behind your infant or use any sort of car seat insert unless it came with the seat or was made by the manufacturer for use with that specific seat. (See Figure 1)

Why should I dress my baby in thinner layers of clothing before strapping him or her into a car 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 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. Preterm infants should be tested 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 should ride in a car bed that meets Federal Motor Vehicle Safety Standard 213. They should be tested 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.​​​

Last Updated
7/18/2017
Source
Car Safety Seats: A Guide for Families 2017 (Copyright © 2017 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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