How should a rear-facing child sit in his car seat?

There are three important components to properly seated rear-facing children: recline angle, shoulder-strap positioning, and safety belt positioning.

Recline angle: For safety and comfort, newborns should ride semi-reclined, so that the angle of the car seat (where their head and back rests) is reclined enough to keep their head back and their chin off their chest, but never more than 45 degrees from vertical. Most newborns will require a 45-degree angle to keep their head well-positioned and their airway open. We must position a newborn's head and neck for him, because he doesn't have the neck muscles required to hold his head up himself. Without this reclined position, a child's head could easily fall down onto his chest, pinching off his airway. As he grows older and can hold up his own head, you can move the car seat into a more upright position to provide better crash protection.

Many infant car seats now come with removable head supports. It has been our experience that the vast majority of these head supports are ineffective or worsen the positioning of the baby’s head. Most of these head supports place more padding behind the child's head, which further encourages the head to fall forward--exactly what we don't want to occur!

Better positioning--even for the smallest preemies--can usually be achieved with a rolled diaper cloth or receiving blanket alongside the baby’s head. Before removing the head rest on your car seat, read the owner’s manual, since the head rest on a few car seats (like the Britax Companion) is not supposed to be removed (since it also functions to increase the side impact protection for the child.)

If a newborn needs extra head support, place two rolled up blankets or cloth diapers on either side of his head. Never place anything behind a newborn's head or under his neck.

Shoulder-strap positioning: Properly tightened harness straps also help keep a newborn's body straight, keeping his head straighter and allowing him to breathe more easily. Tight straps do more than just keep a child safely snug in a car seat!

Since a rear-facing child is likely to slide up the seat in a crash, the shoulder straps should start slightly BELOW the child's shoulders and come up and over in order to best prevent the child from sliding up too much. When the straps come so far below the shoulders that they slip off, you need to raise them to the next slot level. Note that many convertible seats have 3 slots for shoulder straps--the lowest two for rear-facing and the top one for forward-facing only.

Vehicle safety belt/LATCH belt path: The safety belt or LATCH belt should take the path closest to the back of the vehicle seat--for rear-facing this is usually under or above the the child's legs.