Written by: Elissa Lauber on September 4, 2023
In this post I'll go over some of the car seat basics, the NICU car seat test, and some helpful tips.
Car Seat Types
There are 3 primary types of car seats:
Infant
Convertible
Booster
*Note. You may also see 3-in-1 models, which have the functionality of a Convertible + Booster.
This is just a general estimate, but plan to have child or children in the following car seat types for these age ranges.
Infant: 0-1 year
Convertible: 1-5 years
Booster: 6-9 years
NICU Car Seat Test
Before a baby can be discharged from the NICU, the baby will have to pass a car seat test. For the test you will be asked to bring in the baby's car seat, and the baby will have to sit in it for 90-120 minutes. The baby's heart rate, breathing, and oxygen will be monitored by medical staff. This is typically done a week or two before discharge.
If the baby experiences any significant apnea, bradycardia, or desaturations (ABDs), this is considered a "fail," and the baby will have to do another test a few days to a week later.
Something I want to point out is that it is common for preemies to fail car seat tests, so don't be discouraged if this happens to you. In fact, many full-term babies would also fail the car seat test if they were required. Car seats are, in general, not great for babies' breathing, which is why when traveling with a newborn it is recommended that you take the baby out of the car seat every 30 minutes to 2 hours. *Note. I would definitely err on the side of more frequent breaks/repositions when traveling with a premature baby. Babies simply do not have the head or neck control to keep their heads up, which is why breathing is affected. This is also why you should not leave your baby to nap in a car seat.
If your preemie has failed the car seat test multiple times, you can consider a Car Seat Bed. *Note. I do not know how extensive car seat beds have been tested for safety, so I personally would not recommend traveling long distances with your preemie in one.
*Personal Story. My twins had horrible acid reflux, and one of my twins had a significant ABD episode during his first car seat test due to this, which led to him failing the test. So if your preemie has failed a car seat test, ask the medical staff if the baby was fed shortly before the test or not. You may want to kindly request that your preemie not do the car seat test until 1 hour after a feed.
Car Seat Reviews
Whenever I have purchased car seats for my kids, I've always read reviews on Consumer Reports. I love that they provide ratings for different categories such as: Crash Protection, Ease of Use, Fit-to-Vehicle Latch, and Fit-to-Vehicle Belt. You can add different car seats to a "Compare" sheet, and see how different car seats compare to one another side by side.
Car Seat Installation
*Note. The information below is also included in My Favorite Baby Items post.
Far and above what brand of car seat you decide to buy, the most important thing you can do to protect your baby or babies is to make sure it is/they are installed correctly. Estimates vary, but between 46-85% of car seats are installed incorrectly! The CDC's Child Passenger Safety website lists the most common problems with car seat installation, which include:
Incorrect recline angle for rear-facing car seats
Loose installation for all car seats
Loose harness for all car seats
Harness behind child’s arms, legs, or back in forward-facing car seats
Improper lap belt position for booster seats
Improper shoulder belt position for booster seats
Additionally, current car seat guidelines recommend that children stay rear-facing up to the height and weight limit of the car seat, which is typically between 2-4 years old. Note. Your child or children should start with (an) infant car seat(s) until the child or children reach(es) the max height and weight, and then move to (a) convertible car seats. Next, children move to a forward-facing car seat up to the height and weight limit of the car seat, which is typically until at least age 5. Finally, you should expect your child or children to be in a booster seat until they reach the height and weight limit of the car seat, which is typically between 9 and 12 years old. To read current guidelines, check out the website from the CDC on Keeping Child Passengers Safe on the Road.
Note. Expect to purchase 3 car seats/boosters over your child's or children's lifetime(s). You will start with an infant car seat, move to a convertible car seat, and, depending on whether or not the convertible car seat can covert to a booster seat, you will then need to purchase a booster seat.
For information related to car seat type, installation, etc., I recommend following @safeintheseat on Instagram, or going on to the Safe In the Seat website to read car seat reviews, view recommended car products, etc. Safe in the Seat also has affordable courses you can buy for additional information.
Additionally, check out the National Highway Traffic Safety Administration's (NHTSA) website to find a local car seat inspection station. We did this with our eldest son, and it was great to have someone walk us through how to correctly install our the car seat step-by-step.
For our family, we have purchased the following car seats/boosters.
Infant: UPPAbaby Mesa
Convertible: Britax Marathon Clicktight (Currently unavailable, so I linked the Britax Boulevard Clicktight, which has the same safety score)
Toddler Booster: Britax Growth With You Clicktight
Note. Britax, Chicco, Clek, Graco, and NUNA, all consistently have high ratings for car seats.
Car Seat Installation Tips
Pull the car's seat belt out the furthest it goes until you hear it click before installing it around the car seat. This will ensure the safety belt won't loosen over time.
Make sure the car seat is in the appropriate leveling zone for rear-facing or forward-facing positions. On the side of the car seat, you should see a bubble leveler denoting whether the car seat is level or not based on whether the seat is in the rear- or forward-facing position.
Rear-face as long as possible. Current guidelines are that your baby should be rear-facing in your car until at least age 2. Read your car seat's manual, but best practice is to leave your child rear-facing until they hit the maximum height and weight. *Note. If your child has long legs, the child can sit cross-legged in the car seat.
Buckle the bottom piece(s) first. Once the bottom piece(s) is/are buckled, pull to tighten, and THEN buckle and slide the top piece up to armpit level. This will ensure that the buckle is tight enough to secure your baby. If you do the top piece first and then tighten, it creates a lot of extra space between the straps and your baby, which is incorrect and unsafe.
Ensure top piece is at armpit level. The most common mistake I see when I view photos of babies in their car seats is that the top piece is either too high or too low. Please ensure your baby's top piece is at armpit level to prevent the baby from being strangled or slumping over.
Make sure straps are not twisted. Remember, safety ratings are based on proper installation. Twisted car seat straps are unsafe.
Remove infant inserts once weight limit/height is reached. I recommend reviewing the car seat's manual so you know whether or not your baby needs the infant inserts.
No coats. Remember, you need to remove your baby's jacket when putting the baby in a car seat. The puffiness of the jacket prevents the straps from being snug against the baby's chest, which is unsafe.
Do the pinch test. To ensure the baby's straps are tight enough, try to pinch the straps. Your fingers should slide off of the straps. If you are able to pinch the straps, they need to be tightened.
Other Tips
Use mild soap and water to wash a car seat. Some chemicals can compromise the integrity of the car seat (e.g., bleach). Your best bet is to use only mild soap and water to spot treat a spill or stain. Be sure to review your car seat manual for proper cleaning. Buckle Up for Life has some tips for proper car seat cleaning.
Never leave your baby in a car seat in the car. Approximately 39 babies die each year from being left in a car. Please always take your baby out of the car whenever you are parked. *Personal Story. Whenever I would drive with my twins, I would always open up both backseat doors to ensure there was airflow through the car while I was taking each of my twins out of the car. I didn't shut the doors until everyone was out of the car. I actually still do this even though my children are 6, 4, and 4. Now that my kids are older, I frequently remind them that we do not ever go into a car unattended.
Consider a car seat app, alarm, or smart car seat. There are different tech options available to remind you that your baby is in the car seat. Kars 4 Kids has a phone safety app. The website, Safewise, list different alarm options. Cybex offers a SensorSafe buckle that works with their car seats.
Do not let your child sleep in a car seat post car ride. Remember, car seats do not put your baby in the correct position for sleep. Always remove your baby from the car seat upon arrival at your destination.
Replace your car seat after an accident. If you are involved in an accident, be sure to contact your car insurance to receive money to purchase a new seat.
Check the expiration date. Every car seat is different, but most can be used for ~6 years.
Car Seat Trade-In. Find a car seat trade-in program to recycle your old car seat and receive a discount toward a new one. Target, for example, offers a 20% discount to use toward a new car seat, base, stroller, or home gear.
Summary
The best car seat is the one that's installed and cared for properly. Please invest effort into understanding how to use your car seat to ensure your baby (and later, child) is protected.