BABY ON BOARD: Transporting your infant safely

Under most circumstances, where could a baby be more secure than in a parent's arms? But in a moving vehicle, that becomes a dangerous place. In the event of a crash, your body could crush your baby against the dashboard or windshield. Even if you wear a seatbelt, your baby could be torn from your arms by the force of a collision.

Because of this danger, child car seats are required by law in every state. In a collision, these rigid seats — when used correctly — support babies' backs, necks and heads. Unfortunately, many parents unintentionally misuse their infant car seat, dramatically reducing its effectiveness in a collision. By giving careful thought selecting a seat and paying close attention each time you use it, you can help ensure a safe ride for your baby.

Please, have a seat

There are two types of car seats for babies. You'll need to decide whether to select a seat designed specifically for infants (it will have to be replaced when your baby is older), or a convertible seat that accommodates either infants or toddlers. Infant-only car seats accommodate babies from birth to approximately 20 pounds. They are installed rear-facing so that the baby always faces the back of the vehicle — the only safe position for infants in cars. These small, portable seats hold the baby in a gently reclining position. Many models come with a detachable base that remains installed, letting you snap the seat in and out of your vehicle.

Infant-only car seat

"Infant-only seats provide a better fit for a newborn than convertible seats," says Dawn E. Nelson, R.N., pediatric critical care outreach coordinator at Mayo Eugenio Litta Children's Hospital. In a seat that's too big, a young infant may not be properly positioned. This increases the risk of having the head fall forward, possibly interfering with breathing. "It's very important to be sure, after installing the seat, that the baby is reclining at a 45 degree angle, to provide proper positioning for the baby's airway," Nelson says.

Convertible car seat

If you do choose a convertible child seat, use a model that uses a five-point harness fastening system. "Avoid models with a t-shield or tray shield, especially for newborns," Nelson says. "On impact, the baby's body may hit the hard plastic shield, causing head, abdominal and chest injuries."

Nelson recommends trying a number of car seat models in your vehicle before selecting one. Many stores will let you test several seats in your car before making a purchase. If you decide to borrow or buy a used car seat, make very certain that the seat is safe. "Before choosing a secondhand seat, it's very important to know the history of the seat, " Nelson says.

Avoid purchasing a used seat that:

• Was involved in a crash.
• Has no labels.
• Is older than 6 years.
• Has cracks or rust.
• Has any parts missing.
• Has been recalled.

Keep three important factors in mind when selecting a car seat for your child. Choose a seat that:

• Fits your child well.
• Fits tightly into your vehicle.
• Will be used correctly each time.

The following guidelines should help you choose and safely install a car seat:

• Read the labels — Some of the new infant carriers can easily be confused with infant car seats, so be sure to read the label for appropriate use. Check also to be sure it carries the following message: "This child restraint system conforms to all applicable Federal Motor Vehicle Safety Standards."
• Check your rear — A vehicle's back seat is the safest place for any passenger, because it's farther from the point of impact in a head-on crash — the most common type of collision. Be sure the car seat you choose fits securely in your vehicle's rear seat. The center of the rear seat is ideal. However, some vehicle seats are contoured for adult bodies, making safe installation of car seats difficult. You may need to install the seat on the passenger or driver side of your rear seat. Carefully read both your vehicle owner's manual and the car seat instruction manual for useful, specific installation tips. To properly install a child safety seat, make sure the seat is pressed against the back of the vehicle's seat. Nelson recommends that parents climb into the vehicle and kneel into the child car seat while routing the seat belt through the correct belt path on the seat. If you're uncertain which belt path to use, check the label on the child car seat. When the seat is properly installed, you shouldn't be able to move it more than one inch from side to side or front to back.
  

• Cover your bases — Your best bet is to select an infant-only seat with a base, and take the time — generally about 10 minutes — to install the base securely in your rear seat. If you use more than one vehicle to transport your baby, Nelson recommends ordering an additional base from the manufacturer and installing it in your second car, so you can simply snap the seat out of its base when you transfer vehicles. Some vehicle designs may not permit secure installation of an infant seat with a base. To be safe, 80 percent of the infant seat must be positioned on your vehicle's seat; if a base causes more than 20 percent of the infant seat to hang over the edge of your vehicle's seat, you should use a seat without a base.
• The air bag that saves your life could kill your child — Airbags work well to protect larger children and adults who ride facing forward. They aren't safe when used with rear-facing child car seats. A minor collision can cause the air bag to inflate with a force strong enough to seriously injure and even kill a child. In the past several years, nearly 20 serious injuries and deaths were reported in infants who were wrongly restrained in the front passenger seat during a minor impact that caused airbag deployment. In vehicles with passenger-side air bags, rear-facing infant seats and convertible child seats must always be placed in the back seat. Children should not ride in a front passenger seat until they are 13 years old, Nelson says.

Selecting a safe car seat is a crucial first step, but there is still much more to protecting your child:

Register with the manufacturer — Car seats are regularly tested for safety standards and may occasionally be recalled because of a problem. Once you've purchased a car seat, be sure to send in the registration card so the manufacturer can get in touch with you in the event of a problem or recall. "Many parents don't send in their registration cards because they're afraid of being placed on additional mailing lists," Nelson says. If you choose to use a secondhand seat, and you aren't sure if a registration card was sent in, you can call the National Highway Traffic Safety Administration (NHTSA) .

• Before you drive — Seasonal clothing and growth both may affect your baby's fit in the car seat, so it's best to make sure your baby is comfortable and snugly secured each time you drive. The car seat's harness should come up at or below your baby's shoulders. The harness straps should not be twisted, and they should be secured with a harness retainer clip placed at armpit level. If the harness is tight enough, you should not be able to fit more than one finger width between the harness and the baby. Don't wrap your baby in a blanket until after he or she has been secured in the car seat. The carrying handle on an infant-only car seat must be in the down position while in transit. "A lot of parents want to hang toys or mirrors from the handle," Nelson says. "But it's crucial to keep it down, to prevent your baby from hitting the hard plastic handle in a collision."
• Create a safe space — Keep your car's passenger space free of objects that could hurt your baby. Select car toys that are soft and can't easily be thrown, and keep groceries and other loose objects in the trunk or in another safe place away from your child.
• Err on the safe side — Your baby should ride in a rear-facing infant seat until he or she weighs at least 20 pounds and is at least 1 year old. Nelson says that many parents make the dangerous mistake of turning their baby to ride forward-facing too soon. Until babies reach 1 year of age, the muscles in their neck aren't very strong. In a collision, a forward-facing baby is at greater risk of head and neck injuries because its head may be thrown forward.

Nelson also urges parents to discard a car seat after an accident. "Any time your car is involved in a crash — even a minor collision — the car seat should be replaced," she says.

Transporting your tiny baby

A premature baby may have trouble breathing in the semi-reclined position of most infant car seats. Car beds are now available which have been designed and crash-tested, making it possible for a premature infant to ride safely. Ask your health care team whether your baby might need a car bed. They can also help you practice securing your baby safely before leaving the hospital.

Precious cargo

Take the time to make an educated selection when buying a car seat so that every car trip that you and your baby take — no matter how short — is as safe as it can be.