Before leaving the hospital, premature or smaller babies have to pass a car seat tolerance screening, basically making sure they can lie in a car seat without experiencing problems breathing or a lowered heart rate. Sometimes these tests also are conducted in newborn nurseries. A recent study in the journal Pediatrics finds there’s a lot of variety in how hospitals conduct such screenings.
“Each hospital is kind of on their own to come up with the appropriate vital signs,” Dr. Natalie Davis, an author of the paper and an associate professor of pediatrics at University of Maryland School of Medicine, told TODAY Parents. “We are looking … to move forward with an understand of what the appropriate criteria are.”
The American Academy of Pediatrics (AAP) recommends that hospitals conduct a car seat tolerance screening for all premature babies, those of lower birth weight, those with lower muscle tone and those who might have certain heart conditions, for example. The test lasts anywhere to about 90 minutes and staff monitor the baby’s oxygen levels, heart rate and how often they stop breathing during sleep. This helps them understand if the infants can ride safely in the car seat home.
“In that semi-upright position in the car seat (we need to know) if the baby will be likely to experience lower oxygen saturation in the blood and also lower heart rate,” Dr. Lana Gagin, a pediatrician at Helen DeVos Children’s Hospital in Grand Rapids, Michigan, told TODAY Parents.
Davis and her coauthors looked at car seat tolerance tests conducted at newborn nurseries in 35 states in 84 nurseries. Of this sample, 90.5% performed tests in newborns but the evaluations varied from nursery to nursery. One hospital might require oxygen saturation levels at 85% while another requires 90% to pass, for example.
“The AAP policy on transporting premature and low birthweight children tells us that we are supposed to monitor them, But it doesn't lay out the limits at a certain percentage of oxygen saturation or bradycardia, which is slowing of the heart rate,” Carrie Rhodes, a passenger safety program coordinator at Nationwide Children’s Hospital in Columbus, Ohio, told TODAY Parents. “It's really up to each individual institution based on what their institutional policy is so there's variance.”
Testing small or premature babies in car seats remains important because they are not strong enough to hold their head up and move it if they slump forward. That means if they slide out of position, they could compromise their breathing or heart rate, which can be deadly if babies are stuck too long.
“This is a test we are doing not to scare families but to reassure them and make them feel comfortable that their baby fits in the car seat and they’re breathing effective,” Davis explained. “At that moment (of a failed test) the baby isn’t breathing right then we need to do something different.”
That something different can be anything from finding a smaller car seat, making an adjustment to the seat so the baby isn’t slouching or observing or treating the baby a little longer in the hospital.
While the paper examines car seat evaluation for babies leaving the hospital, it serves as a good reminder that car seats are not safe places to sleep. Babies either lie flat on their backs in a crib or they are being held up by someone, which requires a certain level of supervision.
“It is not a natural position for a newborn to breathe. The biggest risk is their head flopping forward and occluding their breathing,” Davis said.
That’s why experts want babies only to be in car seats during travel.
“When you look at sleep-related infant deaths and sitting devices, the vast majority of them do actually occur in a car seat but most of the time it’s actually outside of the car,” Rhodes said. “We want to make sure that these kids are safe in a vehicle but once they come out of the car we want them coming out of the car seat.”
Davis hopes this encourages standardized recommendations so every hospital understands what babies need to pass to be safe in a car seat.
“We are working with the AAP to come up with guidelines to be more universal,” she said.