September 22, 2016
NICU Car Seat Decision Algorithm for the Infant Car Seat Challenge Test
Instructions
Refer to Car Seat guideline for full details
Complete car seat assessment and guidance within 3 days prior to discharge
Provide parents with information about car seat safety from About Kids Health or the Canadian Pediatric Society
The infant has been reviewed by the medical team to determine if an infant car seat challenge test is required and:
A car seat challenge test is required if required refer to NICU guideline for completion and documentation
A car seat challenge test is not required
Decision Algorithm for the Infant Car Seat Challenge Test
INFANTS AT POTENTIALLY INCREASED RISK FOR ADVERSE CARDIORESPIRATORY DECOMPENSATION IN THE UPRIGHT POSITION
(E.G. CAR SEAT, SWING)
Airway maintenance concerns
(e.g. tracheostomy, stridor, previous airway surgery)
Receiving supplemental oxygen
Neuromuscular disorders (e.g. hypotonia, hypertonia)
Conditions that affect positioning in the upright position (e.g. omphalocele, large abdominal or back dressings)
Infants assessed to be at risk for cardiorespiratory compromise in the seated position
No
Yes
Provide parental guidance
(see Section 6.0)
1. Staff physician assessment to determine if the following
should be completed:
a. Car seat challenge test
b. Occupational therapy (OT) consult for car seat
positioning assessment
NOTE: an OT consult to assess positioning is recommended
for at risk infants even if a car seat challenge is not completed
Medical team orders a car seat challenge test
and/or OT consult
Perform car seat challenge test
(see Section 9.0) and complete
documentation in patient record
(see Section 7.0)
Confirm that OT consult completed
Exception
Infants being discharged with a “No CPR” order may not require an infant car seat challenge test. This should be
discussed with the medical team with the decision documented in the health care record. Whether a car seat challenge
test is completed or not, parents should be provided with instructions on what to do if their child stops breathing in the
vehicle. Please see Cardiopulmonary Resuscitation (CPR) Hospital Policy and Procedure
http://policies.sickkids.ca/published/Published/CLINH66/Main%20Document.pdf
Complete documentation
in patient record
(see Section 7.0)
If NO to
a and b
September 22, 2016
NICU Car Seat Safety Checklist
Parent Resources
Canadian Pediatric Society, Caring for Kids http://www.caringforkids.cps.ca/handouts/car_seat_safety
About Kids Health www.aboutkidshealth.ca
Parachute Canada (formerly Safe Kids Canada) www.parachutecanada.org
Transport Canada, Child car seat safety https://www.canada.ca/en/services/transport/road/child-carseat-safety.html
Car Seat Clinics (from Transport Canada) https://www.canada.ca/en/services/transport/road/child-car-seat-safety/child-car-
seat-clinics-other-resources.html
Parents/Guardians have been educated on the following:
Why the car seat is required
Many injuries or deaths can be prevented with the right use of car seats
A rear-facing car seat supports a baby’s neck in a sudden stop or crash
Babies have large heads and weak necks; car seats are angled backwards because babies need extra support
while riding in a car
It’s the law
Provincial law (Ontario’s Highway Traffic Act) requires the use of a rear-facing
infant restraint car seat placed in the rear/back seat of the vehicle until infants
weigh at least 9kg (20 lb.). This is the minimum requirement
One parent/guardian may need to travel in the rear seat to observe infant
positioning and safety during transportation
The manufacturer’s instructions should be followed including ensuring the infant
meets the weight and height requirements
The car seat must have a National Safety Mark and must not be expired
The National Safety Mark indicates that the child car seat is certified to Canadian safety standards
The car seat must have a National Safety Mark. The label should not be older than 10 years
Check the expiry date posted on the car seat. Only use a car seat that is not expired
Expiry dates are in place because of “plastic fatigue” (parts get more brittle or break easily)
Only buy car seats from a Canadian retailer: This ensures the seat meets Canada’s rigorous safety regulations
Only use car seat for travel in a motor vehicle
Infant’s should only be placed in a car seat for travel in a moving vehicle and removed promptly once the destination is
reached
Due to the risk of slippage leading to airway compromise and asphyxiation, car seats should not be used as sitting devices
when not being transported in a motor vehicle
The car seat should not be used as a crib
Infant car seats are NOT cribs and/or temporary cribs
Infant car seats do not meet the safety requirements for a crib or a swing
Cribs, swings and other devices have their own safety standards to keep infants safe (Transport Canada)
When an infant is placed in an infant car seat outside of a vehicle, the centre of gravity is raised making it top heavy and
unstable. The movement of the baby can result in the infant car seat tipping over and the harness system can then exert
sufficient pressure on the infant's neck to cause asphyxiation (strangulation)
Rear-facing
infant restraint
car seat placed in
the rear/back
seat
September 22, 2016
NICU Car Seat Safety Checklist
No padding should be placed behind or under the baby
Don’t use any add-on features that are not provided by the manufacturer, such as a bunting bag, head-hugger, tray or
comfort strap. These can affect the safety of the seat and can be dangerous in a collision.
During a motor vehicle collision the padding will be compressed and there will be "slack" created in the harness straps
placing the infant at increased risk for injury.
Cold weather: if it is cold, tuck a blanket over the infant after the infant is secured
Do not use a car seat that has previously been involved in a collision
Car seats involved in a collision, even if empty, must be disposed of and a replacement obtained. Do not use a seat that has
been in a crash or seat for which you do not know the history
What if no rear seat is available in the car?
As per Transport Canada, a rear-facing infant seat must never be placed in the front passenger seat unless the air bag is turned
off. A permit from Transport Canada is required to have this deactivation completed
https://www.tc.gc.ca/eng/motorvehiclesafety/tp-tp13178-page4_e-184.htm
B. Assessing Infant for Correct Harnessing
Infant is seated at a 45 degree angle to simulate positioning in vehicle
The chest clip is at the armpit or nipple line level
Harness straps are lying flat, are sung and are threaded at or just below the infant's shoulders
Assessing for harness for adequate tightness: Do the ``pinch test``
Pinch the harness strap at the shoulder
The straps are tight enough when you can no longer grab any excess webbing/slack
If more than one finger fits between the shoulder harness and the infant's
collarbone, the harness is too loose
The seat handle is in the position recommended by the manufacturer
Do not add additional devices
Do not use any add-on features for car seats that are not provided by the manufacturer, such as a bunting bag, head-hugger,
tray or comfort strap. These can affect the safety of the seat and can be dangerous in a collision
No padding should be placed behind or under the baby because during a motor vehicle collision the padding will be
compressed and there will be "slack" created in the harness straps placing the infant at increased risk for injury
C. Documentation: Health Care staff will ensure and document that:
The infant car seat has a National Safety Mark present and that it has not passed the expiry date
Parent/guardian has demonstrated proper infant securing according to the manufacturer's guidelines and the modifications
The infant has been assessed for the infant car seat challenge testing. If the infant car seat challenge testing is completed,
results are documented in the infant chart