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Neonatal Intensive Care Unit (NICU) Car Seat Safety

Car Seat Safety for Neonates

The Basics

  • Choose an infant car seat with a 5-point harness. There should be a least 3 shoulder strap levels for adjustments. Be careful about purchasing a car seat, not all car seats work for all infants.
  • Do not purchase or accept a second-hand car seat (typically found at garage sales or consignment shops).
  • Car seats expire 6 years after they have been purchased. You can find the expiration date on the manufacturing label affixed to the underside of the car seat.
  • ALWAYS follow car seat instructions and car owner's manual.
  • NEVER install a car seat in the front seat that has an air bag. The back seat is safer for all children.
  • The straps should fit snuggly.
  • All infants should remain rear facing until 2 years of age OR until he/she reaches the height or weight limit for the seat.

Correct Car Seat Use

  • Always use your car seat when in the car even if you are just driving around the corner.
  • Only use the car seat in the car. Your baby needs to sleep lying flat on his/her back.
  • Dress your baby in clothes with legs so the harness straps fit between the legs.
  • Avoid a thick snowsuit or wrapping baby in a blanket. You may add blankets over the straps.
  • Avoid thick padding under or behind your baby. It could make the harness too loose, so your baby could be thrown out in a crash. Using after-market products such as head positioning devices that do not come with the seat will also void your warranty on the car seat.
  • A support pad that came with the car seat can be used if it does not push the baby's head forward.
  • The shoulder straps should fit at or below the baby's shoulders. If the lowest position makes straps come out near baby's ears or higher, use a different seat.
  • Your baby's bottom should be flat on the bottom of the seat with their back against the seat.
  • For support, it is okay to use small rolled baby blankets and place them on either side of the baby. Do not place them under the baby or the straps.
  • Put the harness over both shoulders and between baby's legs. Make it snug, so you cannot pinch any slack in the shoulder straps.
  • The chest clip should be at armpit level. Do not put it close to the neck or too low.
  • Install the car seat tightly. It should not move more than an inch forward or side to side.
  • ALWAYS follow car seat instructions and car manual.
  • NOTE: If baby has a breathing monitor, oxygen, or other equipment, secure it so it will move as little as possible in a crash. Use a seat belt or wedge it on the floor of the car.
  • You will receive a car seat booklet during your stay in the NICU that will help guide you in purchasing car seats, installing car seats and fitting your baby in the car seat. You will also be required to watch a car seat video prior to discharge. A car seat technician and/or advocate are able to answer any question you may have about car seats.

Car Seat Safety for Tiny Babies

  • Some car seats are safety rated for smaller infants (less than 5 lbs), and fit many preemies well. This kind of car seat can be easy to use and easy to carry.

Look for these features:

  • A low weight limit to match your baby's weight. Many car seats are limited to babies 5 pound or more, but some start at 4 pounds.
  • 5 point harness (shoulder, hip and crotch straps) to keep baby in position best.
  • Front harness adjuster.
  • Low shoulder strap position will help make sure the harness fits well.
  • Harness chest clip that is easy to see and understand.
  • Level (recline) guides that are easy to see and understand.
  • Level adjuster that is easy to use to change the tilt of the car seat. Look for an adjuster that has many positions.

Angle Tolerance Test

  • Most babies can ride safely in a semi-reclined, rear-facing car seat with low harness slots. However, some premature babies may show signs of trouble when sitting up.
  • The American Academy of Pediatrics (AAP) recommends monitoring each baby born earlier than 37 weeks in a car seat before the baby goes home. The monitoring is called Angle Tolerance Testing. This is to check for signs of trouble, such as slow heartbeat, too little oxygen in the blood, or periods of not breathing.
    • If your baby shows any of these signs, he or she may need to ride lying flat in a crash-tested car bed. Use the car bed until the doctor tells you your baby can sit up safely. Also, avoid using a baby seat or swing at home during this time.

What happens during angle tolerance testing?

The Angle Tolerance Testing is done within 7 days of infant going home. The infant is placed in the actual car seat that will be used after going home. The baby is monitored for a minimum of 90 minutes or the length of the car ride home, whichever is longer, for changes in heart rate, oxygen level and breathing.

Tips for Car Bed use:

  • Place baby's head towards the middle of the vehicle.
  • Baby should lie on his or her back unless doctor says otherwise.

Using a Car Bed Correctly:

  • A car seat technician will instruct you on installing the car bed.
  • Place the bed so the infant's head is near the center of the vehicle.
  • Use the seat belt to secure the bed. Tighten the belt. Due to the length, some car beds use two seating positions. A car bed will not fit as snug as a car seat.
  • Secure the baby on his back unless the prone position is medically necessary.
  • Performing another angle tolerance test is suggested prior to the baby riding in a rear-facing car seat.
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New Parent Planner - Neonatal Intensive Care Unit (NICU) child care guide.

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