All babies need a proper car seat for their first ride home from the hospital. Babies who are born before their due date or with breathing problems may need to be tested in their car seat before they go home.
This handout will help parents of preterm babies learn about the following:
how to choose a car seat;
how to make sure it is safely installed in your car;
how your baby will be tested before leaving the hospital; and
how to make sure your baby is secure in the seat.
HOW TO CHOOSE THE RIGHT CAR SEAT
Before your baby leaves the hospital, you’ll need to make sure you have a car seat that is both safe and the right size, and that it is installed correctly.
Make sure that your car seat meets current Canadian Motor Vehicle Safety Standards (CMVSS 213.1 for infant carriers). If it does, it will have a CMVSS sticker.
Always follow the manufacturer’s instructions for your car seat.
Use a rear-facing car seat (one that faces ‘backwards’) until your baby is 10 kg (22 pounds) – usually about one year old.
For smaller babies, make sure the car seat is not too big.
Look for a restraint with a distance of less than 25 cm (10 inches) between the lowest shoulder strap slots and the seat bottom (Figure 1).
Also look for a car seat that has a space of 14 cm (5.5 inches) or less between the crotch strap (the strap that fits between the baby’s legs) and the car seat back (Figure 1).
Figure 1).
Correct size of car seat for smaller babies. Illustration used with permission of the American Academy of Pediatrics
If you are not sure, measure these areas yourself.
HOW TO SAFELY INSTALL A CAR SEAT
Before installing any car seat, read the manufacturer’s instructions, as well as your car’s manual. If you don’t have the car seat’s instructions, contact the manufacturer for a copy (the address or phone number should be on the label on the seat).
The back seat is the safest place for children. Babies should be in a car seat that faces the rear, and is placed in the middle of the back seat of the vehicle. Never place your baby in front of an airbag.
Follow the manufacturer’s instructions for your vehicle regarding lap and shoulder belts. Many combination lap and shoulder belts need a locking clip. Check your owner’s manual to see if this is necessary.
Keep the car seat tilted backwards at a 45 degree angle. A firm roll of cloth under the car seat, below the infant’s feet, can be used if necessary.
If your baby needs to use a portable oxygen tank or other equipment, anchor the equipment to the floor of the vehicle or under the seat.
HOW WILL YOU KNOW WHEN YOUR BABY CAN SAFELY LEAVE THE HOSPITAL?
Babies who are born prematurely or full term babies with breathing problems may need to be tested in a car seat before they go home from the hospital.
These babies may have trouble breathing when they’re in a car seat, even if they are not slouching. However, you may not be able to tell just by looking at them.
Your baby’s breathing may be tested with a special machine (called a pulse oximeter or saturation monitor). The machine can tell whether your baby is getting enough oxygen into his or her blood.
- If your baby cannot get enough oxygen into the blood while in the car seat, the following may happen.
- – Your baby’s doctor may recommend a special car bed. Your baby’s nurse will explain how to get one and how to use it.
- – Your baby may have more tests or treatment, and then be tested again in the car seat.
- – Your baby may need to be in the hospital longer.
Some babies may also have trouble breathing in slings, swings and snugglies. Preterm babies should not be placed in these devices until one month after the date that they were due to be born.
Slings, swings and snugglies should not be used for babies with breathing problems until the babies can sit on their own.
PLACING YOUR BABY IN THE CAR SEAT
Place your baby in the car seat, then put the harness over the baby’s shoulders. Make sure the baby’s back and bottom are up against the seat.
Make sure your baby’s clothes, eg, bunting bag, don’t get in the way of the ‘between the legs’ strap.
Tighten the harness. It should be tight enough to keep your baby safe. You should be able to fit one of your fingers between the shoulder harness and your baby’s collarbone.
Small babies may need an infant insert, designed to help give them more side support: Make sure when rethreading restraints that they go through the slots of the inserts as well as the car seat itself.
To prevent your baby from slouching in the seat, roll up a receiving blanket and place it between the front of the baby’s diaper and ‘between the legs’ strap.
When your baby is safely in the seat, secure it with the vehicle’s seat belt. Make sure it is tight.
THINGS TO REMEMBER
Never leave your baby alone in a car seat.
Use the car seat for travel only.
Try to avoid long car trips with a baby in a car seat. If you do make long trips, take a break at least every 2 hours and take your baby out of the car seat.
Never use household carriers or feeding seats as car seats; they are not strong enough to protect a baby in a car crash.
Never use a car seat that is more than eight years old.
Never use a car seat after it has been involved in a car crash.
FOR MORE INFORMATION
Talk to your baby’s nurse.
Contact Transport Canada by phone at 1-800-333-0371 or visit their website at www.tc.gc.ca/roadsafety/childsafe/cindex_e.htm
Contact the Child Restraint Safety Network, through the Canadian Automobile Association (CAA). Call your local CAA for details, or visit their website at www.caa.ca/CAAInternet/trafficsafety/frames13.htm
Figure 2).
Rear facing infant safety seat (used from birth to 9 to 10 kg [20 to 22 lbs]). Always follow the manufacturer’s instructions for your car seat. Infants are always safest in the centre back, they should never be in front of an airbag.
Footnotes
Adapted with permission from the Calgary Regional Health Authority and the Calgary Injury Prevention Coalition.
This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
This information may be reproduced without permission and shared with patients and their families, and is available on the Internet at www.cps.ca
Reviewed by the Canadian Paediatric Society Board of Directors.
Internet addresses are current at the time of publication.
Canadian Paediatric Society, 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8, telephone 613-526-9397, fax 613-526-3332, http://www.cps.ca