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Carseats and Torticollis


When I’m not carseating, I work as a physical therapist in a pediatric setting. As you can imagine, there tends to be a lot of overlap with carseats and my “real” job, but you might be surprised to hear that the most common intersection of the two has to do with babies who are born with a tight neck muscle.

Torticollis is a condition where a muscle in one side of the neck gets tight, usually because of the position of the baby in utero. Torticollis tends to cause babies to have a strong preference for rotating the neck in one direction and tilting the head in the other direction. It’s most common in first babies, twins and babies of petite mothers (all because of space constraints in utero). One of the biggest issues that results from torticollis is that babies can end up with an asymmetrically flat head, known as plagiocephaly. For some kids this is mild and it improves on its own; for others, they may require a specially made and adjusted helmet to help the head round out.

In virtually every evaluation for a baby with torticollis and plagiocephaly, parents (understandably) express concern about what, if anything, they can do in the carseat to keep their baby’s head from tilting or rotating. And sometimes they’ve already tried things- usually aftermarket inserts, sometimes wash cloths, when the secret is, you probably don’t need to add anything.

As we know, adding anything to a carseat that didn’t come with the seat (or was not expressly crash tested with the seat and approved by the carseat manufacturer), is generally not a good idea. It will void the carseat warranty, it goes against every manual (which, in most states makes it illegal) and it may potentially result in injury in a crash. So, basically what I’m saying is, even if you’re worried about your baby’s head shape, please don’t put aftermarket products in the carseat. They won’t help much and they may put your child at increased risk.

Truthfully, unless your baby spends hours, like, literal sustained hours each day in a carseat, the seat isn’t really what is causing the flatness to develop. So fear not, the carseat is just fine the way it is. I know that at times seeing baby’s head tilted or rotated in the car can be troubling. But rest assured that a tilt to the side or rotation isn’t unsafe. The only position that is worrisome is if baby’s chin tips down onto its chest, which in small infants can compromise the airway (and is probably a sign that your child’s carseat isn’t reclined enough- find a CPST in your area to have it checked out!).

blanketsIf you’re worried about baby’s head falling to the side, you can try rolled up receiving blankets on either side of baby, placed after baby is buckled. I will be honest that I don’t necessarily love this set up because baby could rotate their head and spend a sustained amount of time with their face in a blanket, but it is a parental decision and if you feel strongly that something needs to be done to keep baby’s head in midline, this is your safest option.

If you want to make sure that baby rotates their head to their non-preferred side, you can definitely make that happen in the carseat. If your seat allows it, and several explicitly don’t, so consult your manual, you can hang a soft toy (like, literally made of a material and so soft you would throw it directly at your child’s head and they wouldn’t be injured) from the handle, offset towards the side you want baby to look. I had one creative parent who tied a few ribbons on the non-preferred side of the handle. They presented no risk to baby, but were bright and got baby to rotate his head that way. Other options include, if you have another backseat passenger that baby will like to look at, seat that person on baby’s non-preferred side. Or if baby is not sitting in the middle seat, and you can get a good installation and feel comfortable with baby outboard, place their seat so that they have to look towards their non-preferred side to see out the nearest window.

Most of all, any baby, but especially a baby with torticollis, will benefit from the least possible amount of awake time in any baby device that puts pressure on baby’s head like a swing, bouncy seat, cradle or carseat. Babies need a lot of floor time when they’re awake so they have room to learn to roll and sit and crawl and they especially need time on their tummy to strengthen their necks, which will help correct torticollis.

If you think your baby may have torticollis or plagiocephaly, talk to your pediatrician about it and see if a referral to a physical therapist in your area might be appropriate. And if you’re worried about carseat positioning with a baby with torticollis and/or plagiocephaly, find a CPST near you to check your set up and see if there’s anything else that can be done to keep baby safe and keep baby’s head nice and round.

2019 Britax Advocate ClickTight Review- With Anti-Rebound Bar!

Britax Advocate Convertible Carseat Review

We have reviewed many Britax seats over the years and honestly, they’ve never failed to knock our socks off. Britax has been on the front line of car seat technology for many years and they have devoted themselves to constantly making their new seats better and safer than the previous ones. The ClickTight system is the latest and greatest example of this and thousands of families use these seats every day.

In a lot of ways, this particular review will just be a bit of an update to the already very thorough review of the Britax Boulevard Clicktight, but for a few small differences.

First, and most obviously, it’s an Advocate ClickTight not a Boulevard CT, but the only significant difference between the two models is the external side-impact cushions on the Advocate. Now, that’s not to say they are not significant, as they provide an extra layer of energy-absorbtion and side-impact protection, it’s just to say that the interior of the seat is essentially identical to the Boulevard CT, so there’s not much to add there. Second, this particular version of the Advocate comes with an anti-rebound bar (ARB). You can also purchase a Boulevard ClickTight with ARB if you prefer the Boulevard model. If you already own an Advocate or Boulevard model with ClickTight, you can order the ARB separately for your seat.

What IS an Anti-Rebound Bar?

Some of you may be wondering what an anti-rebound bar is, so before we jump into the review, it’s worth reviewing the function of an ARB. The anti-rebound bar is a U shaped piece of metal that connects to the foot area of the car seat and rests against the vehicle seat back in rear-facing mode only. The anti-rebound bar prevents the seat from rebounding or bouncing back into the vehicle seat back during the final stages of a frontal crash. In Britax’s private crash tests, they found that their ARB reduces the rebound of their seats by 40% and provides improved stability for front, rear-end and side-impact crashes. It may seem like an unassuming car seat accessory, but this chunk of metal does more than meets the eye.

What Comes With the Advocate CT and What Comes Separately?
The Advocate with ARB comes out of the box with the anti-rebound bar, energy absorbing HUGS, the EZ-Buckle System, infant body cusion and strap covers.

There are additional accessories available including a cupholder and a vehicle seat protector, which were manufactured and crash tested by Britax.


Advocate CT Specifications:

  • Rear-facing 5-40 pounds, head 1 inch from top of fully extended headrest (which is very tall- one of the tallest rear facing seats on the market)
  • Forward-facing 20-65 pounds, 49” or less, a least 1 year old (Britax recommends children rear face to the limits of the seat)
  • Lower LATCH anchor limits: 30 pounds rear-facing, 35 pounds forward-facing
  • 10! Year! Expiration!
  • FAA approved for use on airplanes

Advocate CT Features:

  • ClickTight installation system- a built in lock off that installs the Advocate so easily you will think you’ve done something wrong, except it’s rock solidly installed and you have done everything right. It’s that amazing.
  • 14-position headrest with no-rethread harness
  • 2 crotch buckle positions with EZ-Buckle System, which keeps the crotch buckle out of the way during loading and unloading. Once you have this, you will wish every seat had it.
  • Steel reinforced frame
  • 3 layers of side impact protection:
    1. energy absorbing shell
    2. Foam lined headrest
    3. External side impact cushions
  • Impact-absorbing base – contains cells that are designed to compress down during a crash and reduce forward head excursion for the child.
  • Energy-absorbing Versa-Tether for forward facing
  • 7 recline positions with easy to read angle indication bubble for  rear facing angle. It has 2 zones- newborn and toddler to allow for more upright, but still safe, positioning for older rear facers. There’s no “too upright” when rear facing a toddler in this seat!


Mythbusters: Can Rear-Facing Car Seats Touch Front Vehicle Seats?


There aren’t a lot of absolutes in child passenger safety. Just when you think something is a hard and fast rule, like, never use lower anchors and seatbelts together, companies (I’m looking at you Clek and Nuna) decide that’s okay for one or more of their seats. Today we’re going to examine another “rule” that is commonly perceived as an absolute.

Last month we ran an article on the new rear-facing law in California and in it, there was a picture of a child in a rear-facing convertible seat that, from the camera angle, looked like it was touching the front vehicle seat. If you actually looked at the picture more closely, it’s not, but it didn’t stop a lot of people from being confused about it and indicating some frustration that the picture showed misuse. But, did it? Even if the rear-facing seat was touching the back of the front seat, does that always mean it’s being used incorrectly?

Myth: a rear-facing car seat is never allowed to touch the vehicle seat in front of it.

I decided the first place to look was the CPS Technician training curriculum. I read through the rear-facing section and the airbag section and…nothing. There is nothing specific in the curriculum that says that a rear-facing car seat touching the front seat is inherently forbidden. This doesn’t mean that it might not be, but it’s clearly not one of those hard and fast rules that we teach technicians to teach to parents.

So, since it’s not in the curriculum, we’ll have to dig into this differently.

Let’s stop and look at why people think it’s forbidden. The first explanation I heard was that it prevents ride down time (time for the crash forces to be dissipated) for the child and the child restraint. I hear that concern, but I’m not sure it’s actually valid. Think about rear-facing seats with load legs that make contact with the vehicle floor. Also think about rear-facing seats which allow what we commonly refer to as “European beltpath routing”. Euro belt routing means the shoulder belt portion of the seatbelt is routed behind the shell of the rear-facing seat, limiting its ability to rotate down in a frontal crash. All of these things essentially do the same thing that a car seat making contact with a front vehicle seat does. We know the crash test data for those seats are almost universally better than seats without load legs or Euro beltpath routing so this theory doesn’t hold water. Touching the vehicle seat back should not result in greater crash forces being directed onto the child.

The second explanation I’ve heard is that it de-activates the front seat’s airbags. My research on this shows many articles without references, but I can’t find any official word on it that speaks for all cars. My very unscientific experiment showed that no matter how hard I pushed against my husband’s passenger vehicle seat, it did not cause the airbag to turn off with my husband sitting in the seat. Obviously this isn’t hard or fast proof and shouldn’t be assumed to be as much.

Do any car seats explicitly allow touching? The answer is yes.

There are many other seats, more than I could list and more than I have time to verify, that do not mention it at all in their manuals. We have confirmed that Chicco allows their rear-facing only seats (KeyFit & Fit2) and convertible seats (NextFit) to make light contact with the front seat after being properly installed, however this is not stated anywhere in the manuals or on Chicco’s website. Therefore, we suggest you call Chicco yourself to confirm this information since we are unable to provide you with a direct link to this allowance.

Do any seats forbid it explicitly? The answer is also yes. The most significant of these is Evenflo, whose rear-facing only seats, Embrace, Nurture, LiteMax & SafeMax Infant, all require 1.5 inches of space between the child restraint and the vehicle seat when the car seat is installed in an outboard seating position. This information can be found under the subtitle “Location Warnings” (usually on or near page 5 in the instruction manual). This rule does not apply when these infant seats are installed in the rear center seating position of the vehicle. This 1.5″ space rule also does not apply to any Evenflo convertible seat.

Okay, so no clear consensus for car seat manufacturers. What about vehicles?

I looked at my vehicle’s manual (2015 Honda Odyssey). I read the airbag and child safety sections thoroughly and nowhere does it forbid a car seat from touching the front vehicle seat. It DOES say that if there’s no front seat passenger and the airbag light doesn’t switch to the OFF position, it could be because a car seat is touching the vehicle seat back, but it never says not to do this. So it looks like this pressure, at least in my car, will actually prevent the airbag from turning off, rather than resulting in it not deploying if it’s supposed to.

For good measure I checked my husband’s as well, since they are different companies and both have advanced airbags. Unlike my Odyssey, my husband’s Nissan Rogue does seem to forbid it, though not in very certain terms. In a troubleshooting section, they said that if the airbag light is not working as expected, “(m)ake sure that a child restraint or other object is not pressing against the rear of the seatback.” I would assume this is as good as saying don’t do that, but then it also forces the question is touching the same as pushing?

This might be the heart of the issue. Is light touching of a car seat likely to change the airbag function? I would argue no. If you’re putting less than 2 pounds of pressure (which seems to be an allowable amount of weight in seat backs for airbags) on the vehicle seat, then you are unlikely to impact the function of the airbags. If you’re unwilling to take that risk, it’s understandable and that’s your choice. But I think we should be clear that there is a difference between forceful touching, where the vehicle seatback is deformed from pressure of the seat, to light contact where the car seat and vehicle seat are merely contacting one another.

So what about crash mechanics? I’d like to make a somewhat unverified assertion here and you can evaluate it and decide if it has merit on your own. A child restraint making light contact with a vehicle seat in a crash seems less likely to cause damage to the child restraint and the child than a child restraint that isn’t close to the vehicle seat and slams into it during a crash. The forces involved in hitting the front seat during the initial downward rotation of a frontal crash seem far more problematic than the front seat limiting some motion of a car seat in a crash. I don’t have any links handy to prove this theory, but it makes sense that slamming into a vehicle seat during a crash will generate higher impact forces than not slamming into it.

Touching vs. Bracing: What’s the difference?

The term “bracing” has been used in many different ways over the years but the consensus seems to be that bracing means more than just light contact. The definition of the word brace is “anything that imparts rigidity or steadiness”. If your rear-facing car seat is “braced”, that means it’s relying on the front seat for support. To my knowledge, no car seat manufacturer allows this as it may alter the recline angle or otherwise affect the installation of the car seat. As stated in the Britax FAQ (pictured above), your rear-facing car seat should be installed securely first and then the front seat should be moved back and/or reclined until it makes light contact.

What about sliding a piece of paper between the rear-facing car seat and vehicle seat? 

Sometimes a CPS Technician will tell a parent or caregiver that if they can slide a piece of paper freely between the back of the [properly installed] rear-facing car seat and the front seat, then it’s not a problem. This is a reasonable comment in many situations since it’s a concept that is easy to understand and visualize even if you don’t literally slide a piece of paper between the two. However, this isn’t a “rule” and it’s not mentioned anywhere in the technician training curriculum or in any car seat manuals that I’ve noticed. This is simply a teaching tool that someone came up with years ago and many of us said, “hey, we like that analogy and we’re going to use that when we educate parents too.

So what’s the verdict?

Kind of busted, but only because I wrote the statement, “a rear-facing car seat is never allowed to touch the vehicle seat in front of it”, as an absolute truth.

Some rear-facing seats cannot make contact with the vehicle seat in front of them because the car seat manual forbids it. Some rear-facing car seats cannot make contact with the vehicle seat in front of them because the vehicle manual forbids it. But, if neither the car seat manual nor the vehicle manual expressly forbid it, your car seat can lightly touch the vehicle seat in front of it.


So the official decree is, as always, read your manuals thoroughly before installing your car seats!

New California Car Seat Law Changes Minimum Forward Facing Age


chicco-nextfit-zip-air-rf-There are a number of reasons why we love living in California and starting January 1st, there’s one more reason to add to the list. On the first day of 2017, California will join a small group of states that require children to remain rear facing until age 2 (with a few specific caveats).

Several existing laws remain in place, including:
1. All children under age 8 must be buckled into a car seat or booster seat in the back seat of the vehicle.
2. All children 8 years or older or 4’9″ or taller may use the vehicle seat belt if it fits them properly.

But the newest component replaces the previous 1 year and 20 pounds rear facing minimum requirement. California law states (Sections 27360 27360.5 27360.6 27363) :

“Effective January 1, 2017, children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. The child shall be secured in a manner that complies with the height and weight limits specified by the manufacturer of the car seat.”

Violating these laws carries a fine that can exceed $500 for each improperly restrained child, as well as having points added to the driver’s license. In short, it’s not worth it, especially when you consider that ignoring this law puts your child at risk of death or significant injury.

SceneraNEXTEmmaRF sideThe law is written so that families of children who are very tall and/or heavy do not have to buy an expensive extended rear facing seat to make it to age 2. To clarify, the 40 pound/inch caveat should not be used to imply that rear facing is somehow less important for a 40 pound or 40 inch 18-month toddler, because it’s not. Science shows us that it is anatomical development (which comes with age), not the height or weight, that makes a young child less at risk for catastrophic neck injuries in a crash when forward facing.

We have known for a long time that rear facing is safer than forward facing for every person, and especially for infants up until at least age 2. It’s nice to see state legislatures like California’s catching up to the research and helping nudge parents to keep their children as safe as possible in the car.  Be sure to see our list of the best convertible carseats for extended rear-facing!