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The Car Seat Challenge

By Sharon Scott, RN MSN

The Car Seat Challenge

You won’t be able to leave the hospital without transporting your new baby in a safe infant car seat, but what if your baby was born premature, or before 37 weeks? Will a typical infant car seat work for such a small baby?

Because preemies are at risk for low oxygen levels, slow heart rate (bradycardia) or stopping breathing (apnoea), the AAP recommends that infants weighing less than 4 pounds, 4 ounces undergo a car seat challenge test to ensure they can safely and healthfully ride home. Ideally, the hospital will use the car seat you have purchased for your infant to test your baby’s ability to ride safely in it.

To do the car seat challenge, your newborn will be buckled into her or his infant car seat. The seat will be positioned at the same angle as it would be in the car and monitors will be used to measure your baby’s heart and breathing rates, as well as oxygen saturation. The test usually lasts 90 minutes but can take up to 120 minutes.

The test will be stopped early should baby encounter any problems and your healthcare providers may recommend that you purchase and use a special flat-lying infant car bed, which will allow your baby to lay fully extended while being protected during transportation. If your baby requires the use of a car bed, the AAP advises that he or she undergo a car seat challenge test again when transitioning to a semi-upright infant car seat.

Safe use

Always choose a rear facing car seat with a 3-point harness system or convertible car seat with a 5-point harness for your infant. Other key recommendations include:

  • Position your baby with her back and buttocks flat against the car seat; you can place rolled blankets around her to keep her from slouching or sliding.
  • The harness straps coming out of the car seat should be at or below your baby’s shoulders.
  • The harness should be snug with just enough room to slide your hand between baby’s chest and the retainer clip, which should be positioned mid-chest.
  • Always place your baby rear facing for the first year of life, and for up to 2 years for maximum safety.
  • If possible, have an adult sit in a rear seat with the infant.
  • Never leave an infant unattended in a car seat and never use your car seat for baby’s nap.

Sharon Scott, RN MSN, is an expert advisor to Healthy Mom&Baby and Health4Mom.org.

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