It has been established that the use of rear-facing car seats prevents serious injuries to infants’ heads and necks, and saves lives. The American Academy of Pediatrics recommends that all infants ride rear-facing starting from their first ride home from the hospital and should ride rear-facing for as long as possible. They should ride rear-facing until they reach the highest weight or height allowed by their car seat manufacturer. This is usually around 2 years of age.

There are three types of rear-facing seats available: rear-facing only, convertible seats, and 3-in-1 seats. An article in healthychildren.org describes the three types as follows:

No. 1. 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 dome 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 for sleeping, feeding or other use outside of the vehicle.

No. 2. Convertible seats:

• Can be used rear-facing and later “converted” to forward facing for older children when they outgrow the weight or length limit for rear-facing. This means the seat can be used longer by your child.

• However, they’re bulkier than infant seats and don’t 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 to 50 pounds) and height than rear-facing only seats which make them ideal for bigger babies and toddlers.

• They have a 5-point harness that attaches at the shoulders, at the hips and between the legs.

• Should be used only for travel.

No. 3. 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’s important to check that they fit in the vehicle while rear-facing.

• Don’t have a carrying handle or separate base.

Tips for the use of rear-facing seats: Place the harness in slots that are at or below the baby’s shoulders; ensure that the harness is snug and that the harness clip is placed at the center of the chest even with the child’s armpits; and make sure the car seat is installed tightly with either a latch or a locked seat belt (if you can move it more than an inch, it’s not tight enough).

Check the instructions for the seat for correct positioning and correct angle for your child. For more information, visit www.healthychildren.org.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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