• What makes a seat fit a preemie well?
• Isn't it true that most infant seats have a 5 pound minimum?
• What is the Car Seat Test?
• Who should get a Car Seat Test?
• Tips for passing the Car Seat Test
• Who needs a car bed?
• Which car beds are available?
• Traveling with medical equipment
• Tips for physicians and nurses

What makes a seat fit a preemie?

A few things:

• Going home on an apnea monitor
• Going home on oxygen
• With craniofacial deformities--like Pierre Robin sequence--that may make it harder to breathe in a semi-upright position
• For whom the pediatrician is concerned that the baby may not tolerate the semi-upright position

• Buckle the baby into the safety seat exactly as you would if they were to ride in the car. Make sure of the following: the straps are snug the baby is not swaddled, and nothing that did not come with the safety seat, including blankets, infant positioners, pillows, etc, is in the safety seat.once the baby is buckled in snugly, you can put receiving blankets alongside their head and/or body to provide extra support if you'd like.
• Make sure the car seat is reclined to 45 degrees.
• Wait at least 30 minutes after a feed to do the test.

• Angel Guard Products Angel Ride Infant Car Bed. This goes from birth to 9 pounds and 21.5 inches. Babies with taller torsos may need a longer harness, available from the manufacturer.
• Dorel Cosco Dream Ride SE. Goes from 5 to 20 pounds.

• Secure these devices in the vehicle so that they do not become flying objects in a crash or sudden stop. At this time, there is no single product available to secure medical devices. Try wedging the equipment on the vehicle floor with pillows or securing it with seat belts not being used by a passenger.
• Make sure that any devices that use batteries have enough power for your entire trip.

• What makes a seat fit a newborn well?
• How should I position my newborn in the car seat?
• Can I use a head support device?
• Can I swaddle my baby in the car seat?
• How do I calm my baby? He cries when I put him in the car seat!
• Can I use a convertible child safety seat for my newborn?
• My baby weighs less than 5 pounds. What should I do?

• 1.  Money is tight and baby will typically be riding in just one vehicle. If you are using multiple vehicles and/or taxis, the convenience of the infant carrier makes it a better choice.
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• 2.  The second parent or the grandparent wants a child safety seat in his/her car, but won't be taking the baby frequently in the first months. Buying a second base for an infant carrier which a baby will use only a few times does not make sense.
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• 3.  You plan to use a sling to carry the baby instead of carrying them in the infant carrier car seat. 

• Britax Chaperone (6.5"). Starts at 4 lbs. 
• Chicco KeyFit and KeyFit30 (6.5"). Starts at 4 lbs.
• Combi Shuttle 33 No minimum weight.
• Cosco Comfy Carry Starts at 4 lbs.
• Cybex Aton Starts at 4 lbs.
• Graco Snugride 30 Starts at 4 lbs. 
• Maxi Cosi Pria (convertible car seat)  Starts at 4 lbs.
• Safety 1st Comfy Carry Elite and Elite Plus  Starts at 4lbs
• Safety 1st onBoard 35 and onBoard 35 Air   Starts at 4 lbs.

• Move the front seats up as far as possible so that you have lots of room to work in the back seat.
• If possible, recline the vehicle seat where the car seat will go before starting your installation.  Make the seat upright once you've finished.  This will help you get the seat installed tightly.
• Pull the seat belt or latch belt from inside the car seat, not from outside the seat.  This means that if you dropped the latch belt, it should fall down on top of where the child goes, not outside the car seat.  This rule applies to most car seats except for the following:
  
  
  • Britax Classic convertible models, older Britax convertibles (i.e. Marathon, Boulevard, Roundabout, Decathlon--those that go up to 40 or 65 lbs)
  • Chicco KeyFit and KeyFit30
  • Recaro Signo
  • Sunshine Kids Radian models

For Infant Seats specifically:

• Put your weight on the base when you pull the seat belt or latch belt tight.  Do not just use a hand on the base, this generally won't be enough weight to get the seat installed tightly. In this photo, Alisa has her left knee in the base and her right foot on the ground. If you are short and flexible, like all three Car Seat Ladies, you can probably get your foot in the base--this works even better.

• Put weight on the right side of the seat, and then the left side, then the right side again, etc, as you pull the latch belt or seat belt tight. This will help you get the belt as tight as possible. In the photo, see how Alisa is pushing with her hand and her knee on the right side of the base. After she pulls the latch strap, she'll move her knee into the left side of the base and push there as she pulls more slack from the latch strap.

• Unless you are installing a Chicco Keyfit, pull the latch strap or the seat belt from inside the base, as Alisa is doing in the photo. 

For Convertible Seats specifically:

• To tighten the seat belt or latch belt, go behind the car seat, between the car seat and the front seat.  Use your stomach to push the car seat into the back of the car and sway from side to side as you pull the seat belt or latch belt tight. You will have to lean over onto the car seat. Note how Alisa is leaning over onto the car seat and pushing it with her belly as she pulls the lower latch straps tight.  Also note that the vehicle seat is very reclined. She will move the vehicle seat upright after she has installed the car seat. 

• If you don't fit behind your rear-facing convertible seat or if you don't want to use your belly to push the car seat into the vehicle seat, you can stand or kneel beside the car seat and push down with one hand on the seat (put your hand where your baby's bottom would go) and pull the latch strap with the other hand. Sway the car seat as you do this. Then switch to the other side and repeat. You may have to switch a few times before you get the car seat completely tight.

• Make sure your child really needs to sit forward-facing.  Remember, kids who sit rear-facing are 5 times safer than those who sit forward-facing!
• Before installing your forward-facing car seat, move the front seats all the way up.  This will give you more room to move around the back seat.
• If your car has tether anchors:  Place your car seat on the vehicle seat.  Before attaching it, set up the tether strap by attaching the hook to the tether anchor. Don't tighten it, just make sure the strap and tightening mechanism are accessible, and keep an eye on them as you install the car seat using the lower anchors or the seat belt.  This way the tether strap won't get caught under or behind the car seat during installation.  

• Check your vehicle owner's manual and your car seat instruction manual to make sure that you are attaching your car seat in an approved seating position and using an approved method.  For example, not all forward-facing seats can be used with the lower latch anchors in every vehicle seating position.  Many require that you use the seat belt to install the car seat in the center seating position.  
• Pull the seat belt or latch belt from inside the car seat, not from outside the seat.  This means that if you dropped the latch belt, it should fall down on top of where the child goes, not outside the car seat. We have found this especially helpful with the Britax Frontier and Frontier 85. This rule applies to most car seats but not all--exceptions include the older Britax seats (not the models with "70" after their names), the Sunshine Kids Radian, Recaro Signo, and Graco Safe Seat Step 2. 
• As you pull the seat belt or latch belt tight, put pressure on the car seat. Generally we find that putting one or two knees in the car seat helps sink it down into the vehicle seat.  Don't get out of the car seat until you have finished installing it 
• If you are in an SUV, hatchback, station wagon or minivan, you may find it easier to tighten a Y shaped tether strap if you pull from inside the trunk area.  

Keeping Your Kids Happy

We've all been there: You're on a long car trip, or even just on the daily carpool route, and your kids are NOT HAPPY.  They scream and cry and don't want to be in their car seats.  Think about it--Would you want to be strapped down in the car for long periods of time every day?  Kids get bored and uncomfortable just like adults. Here are some ways to keep your kids happy, or at least happier, in the car.

Infants
Toddlers
Kids Who Act Up in the Car

Infants

• Make sure your newborn's straps are tight enough.  Newborns are comforted by a tight 5-point harness, since it mimicks swaddling, and may drift off to sleep once the car starts moving. 
• Make sure your infant is not too cold OR too hot.  Babies have trouble regulating their own temperature and can overheat easily, even in winter if they are bundled up and then put in a warm car.  Read more about keeping your baby warm Cold Weather Tips and cool Warm Weather Tips.
• Many older infants become unhappy in the car seat around 6-8 months.  Babies this age are just becoming more aware of their surroundings and don't want to be confined in the car seat.  Early sitters and movers will be more unhappy than kids content to stay in one place.  Many of these children are happier once they transition to a rear-facing convertible car seat, because convertible seats sit higher up off the vehicle seat and are more upright, allowing the child to perhaps see out the rear-window, and at the very least to sit up.  See how your child likes to rest outside of the car seat and take that into consideration when deciding if its time to move into a convertible seat.  
• Check to see that the sun isn't shining into the baby's eyes.  A stick-on sunshade or adjusting the car seat's own built-in sunshade may make the baby happier.
• While your child can’t see you when you're driving, even very young babies can recognize the voices of their parents. Talk to your baby – or play music and sing to it. You don’t necessarily need to listen to “baby” songs – kids like music with a beat, so many of your favorite songs might become the baby’s favorites too!
• It is developmentally appropriate for older infants to dislike the car seat and other forms of restraint (like high chairs or strollers). These restraints limit a child's mobility and freedom; most kids would much rather be crawling around exploring the world around them instead of strapped into a car seat. But while its disconcerting to hear a baby cry, it's also important to realize that it's unlikely that the baby is crying out of pain. Crying is the baby's only form of communication. He might be trying to ask "Are we there yet? I want to get out and play!" As any pediatrician can tell you, the crying baby is the most reassuring baby, because you know his airway is open.

• Toddlers are even more apt to dislike the car seat and other forms of restraint, like the stroller and high chair.  You can bet that your unhappy kid wants nothing more than to be out of the car seat.  An older toddler can understand simple directions and can be reminded (perhaps constantly) that "We need to be in the car seat if we are in the car.  The car seat will keep you safe." 
• Distraction works wonders.  Set aside some soft toys (ones that pass the ouch test) that are only for use in the car.  Soft books, blocks, cards, dolls, etc, are all great toys and if they are only allowed in the car, they become "special," making a ride in the car something to look forward to.  Stickers are great for older kids who won't try to eat them.
• Play music and sing with your toddler.
• Older kids who can be trusted with food will enjoy eating cereal and other non-chokeable treats in the car.
• If your rear-facing toddler can see out the rear-window, talk to him about what he sees out there. 
• It often helps to NOT sit in the back seat with your toddler.  Many children can't understand why they can't come out of the car seat and sit with Mommy or Daddy.  These kids will often entertain themselves if left alone with a few soft toys and some music, albeit after a short amount of protest. 

• As you are walking to the car,  give your child clear instructions as to how they should behave in the car - outlining your expectations and the consequences should they misbehave.  For example "We are going to get in the car to go to school. You must wear your straps in the car.  We do not take our straps off until Mommy says so.  If you take your straps off you will get a time out when we reach the school parking lot."  
• Kids will work for attention - whether it is positive or negative attention.  Not only that, but kids, unlike adults, have trouble distinguishing between positive attention and negative attention. Reinforce the behavior you want, which means FREQUENTLY praising the child for good behavior.  If you are buckling your child in and she is cooperating nicely you should say somthing like "Mommy is so proud of you for getting buckled like a big girl."  If it's two minutes into the car ride and she's still sitting nicely; yup, you guessed it, praise her again.  Two minutes later, praise her again.  Kids have very short attention spans - so the praise, especially in the beginning, needs to be VERY frequent. 

• Use a sticker chart. Kids love visual reminders of their good behavior - and it only encourages them to continue that behavior so they get another sticker.  If your child is worst behaved when you are buckling them in, talk to them on the way to the car about the behavior you expect and the reward for such behavior (i.e. a sticker, or getting to read a story with you, or something else that is NOT FOOD).  If they behave well while you buckle them in don't make them wait til the end of the car ride for a sticker, give them one right then.  If they also typically misbehave during the trip, talk to them on the way to the car about the behavior you expect, and give them a sticker at the end of the car trips that they behaved nicely.  Keep your sticker chart in the car if it helps!
• If your child has a favorite book or small toy, save it for the car - this way it makes them look forward to riding in the car as they get to play with that toy or read that special book. 
• Let kids who are fascinated by the buckles and/or straps buckle and strap themselves in.  As the child buckles and straps herself in, tell her what a good job she's doing using the car seat the right way.  This allows the child to feel in control of her car seat and feel like she's accomplished something. 
• Make a story about using the car seat  (with your child) and read it to your child often.  To you it may seem like routine that everytime you go in the car you strap your child in - but perhaps your child doesn't understand the routine (even though you do it 5 times a day!).  Making things routine - and helping your child understand the steps to the routine - alleviates some of the anxiety associated with transitioning from one activity to another.  Picture books are a great way of teaching your child the routine - while also making it fun as most toddlers love reading books, especially ones about them!  Here is an example of a story you can write with your child - print it out and read it with them as you go to the car and buckle them in.  If you have a digital or cell phone camera, take a picture of the steps and incorporate that into your story so your child can see exactly what is going to happen.  Page 1: Mommy and I walk to the car. Page 2: Mommy opens the car door. Page 3: I climb into my seat like a big girl! Page 4: Mommy puts the straps over my shoulders and over my hips. Page 5: I help Mommy with the easy part (the chest clip).  Page 6: Mommy does the hard part (buckles between the legs). Page 7: Mommy makes my straps snug so they give me a hug. Page 8: Mommy gives me a high five and a hug. Page 9: Mommy sits in her seat and wears her seat belt snug so it gives her a hug. Page 10: Mommy starts the car - I like the sound of the engine!  Page 11: Off we go!
• If your child starts misbehaving, STAY CALM.  Your goal is to give her NO ATTENTION for her misbehavior - this means that you don't show her any facial expressions in reaction to it (typically people show an angry face or laugh - both of which encourage the child to continue screaming).  For wigglers and unbucklers, you will obviously need to find a safe place to pull over and tighten the child's straps or rebuckle the harness- and I would recommend giving the child a time out right then or immediately when you get to your destination. 

• The Original Cold Seat
• Baby Bee Cool Car Seat Cooler Pad

Cool Down your Child

Wet Your Kid: Using cool water, wet your child’s hair & exposed skin (and you may even want to wet his shirt somewhat) before putting him in the car seat.  If you'll be going into an air-conditioned space at the end of the car ride, you'll want to avoid getting the child’s clothes wet, since he may become too cold in the air conditioning.

Spray bottles and fans: Toddlers and older children might enjoy holding a spray bottle filled with water that they can use during the car ride to keep cool.  Older kids might like the spray bottles that have fans attached (make sure the child is old enough and trustworthy enough that they won’t try to chew on the fan blades – even though they are soft, they could be a choking hazard).

Cooling towels and bandanas: A few products also exist for use in the car seat.  Note that all of these products are for use OVER the car seat harness straps, never under the straps.

• Frogg Toggs Chilly Pad Super Cooling Towel
• Frogg Toggs Chilly Dana Cooling Bandana
• Ergodyne Chill-It's Cooling Towel
• Ergodyne Chill-It's Evaporative Bandana

 
Cold Weather Tips

Keeping Baby Warm
Keeping the baby warm is very important.  Unfortunately, products designed to keep the baby warm can also make your baby unsafe in the car.  Even winter coats can be dangerous in the car!  Here's why:

The Parachute Comparison
The whole idea of the car seat is to act as your child’s parachute in a crash.  30mph feels the same to the body as if you jumped from a 3rd story window and landed on the pavement.  You would be absolutely crazy to jump – but if you had to, you’d rather land with a parachute, since you would land as slowly and gently as possible.  If your child’s car seat is secured tightly to the vehicle, and the straps are snug to the child’s body, the child will come to the slowest, gentlest stop possible in a crash.  If, however, the car seat is loose to the vehicle and/or the straps are loose to the child’s body, the child still needs to come to a stop – but it becomes a much more jolting stop, like landing on your feet, and that's what hurts and causes injuries.  
 
If you were about to jump out of a plane, you wouldn’t wear anything fluffy between your body and your parachute harness.  If you did, you'd be afraid that the harness wouldn’t hold you tight.  The same thing goes for your child – you don’t want to put anything bulky like coats, snowsuits, buntings, Bundle Mes, body supports, strap covers, etc between the back of the car seat and the harness straps, since any of these things will prevent the straps from being snug to the child’s actual body.  

Aftermarket Products
Many parents purchase sleeping bag type devices to keep their kids warm in the car seat.  These products are UNSAFE, since they have a layer between the child and the car seat, a layer that will add too much slack into the harness straps and thus prevent the car seat from allowing the child to come to a gentle stop in a crash.  Many of these devices also have a second problem--the strap slots on the product do not line up with the strap slots on the car seat.  This causes the car seat straps to fall off the child's shoulders, and could lead to the child coming out of the seat during a crash!

Even if the product says it was safety tested, it is still NOT SAFE.  In order to sell a child safety seat in the US, the seat has to pass rigorous crash test standards to prove that it is safe. However, in order to sell a product for use with a child safety seat---but one that does not come with the seat---there are NO standards or crash tests required! Despite what such "aftermarket" products may claim, the child safety seat manufacturers feel that using such products may be unsafe and violates the warranty on the child safety seat.  We have included a chart below with each car seat manufacturer's recommendation regarding these products.

Winter Coats
Have you ever struggled to just get the harness buckled when your child is wearing a coat?  Do you notice the straps sliding off the child’s shoulders when the chlid wears a coat?  Do you notice that when you take the coats off the straps seem very, very loose?  If this happens to you, TAKE OFF YOUR CHILD'S COAT before putting him in his car seat.  Wearing a heavy coat prevents the car seat straps from tightening against the child's body.  The straps may seem tight, but that's only because the child is wearing a bulky coat.                                                            The girls in this photo are UNSAFE!  Their coats prevent the straps                                                               from getting tight and buckling properly.

How can you tell if your child's coat is safe to use in the car seat?
Buckle your child into their car seat with their coat on & get the straps snug.  Take the child out of the car seat, remove their coat, and rebuckle the child into the straps.  Firmly pull upwards on the shoulder straps – you should notice no slack coming up, and only enough room for one finger to fit between the child’s collar bone and the strap.  If the straps are looser than this, then the coat is not safe for the car.

How do I keep my child warm if I can't put his coat on or use a sleeping bag in the car seat?

Newborns and Babies
Dress your baby in thin, tight layers.  For example, put on a long sleeved onesie, footie pants, and a thin sweater.  Put a hat on the baby's head.  Put your baby in the car seat and strap her in properly, making sure you pull up on the shoulder straps to get all the slack out of the legs/stomach area, and then pulling tightly on the adjuster tail.  The straps should be so tight that you can fit only one finger between the baby's body and the straps.  Once your child is in the car seat, tuck blankets around her to keep her warm.  Use as many blankets as you want, being sure to keep them away from her face.  Or use a fleece cover designed specifically for the car seat--see our Car Seat Lady Approved product page for a list of covers that will keep the baby warm and toasty.  As the car warms up, you can pull off blankets or unzip the fleece cover to prevent your baby from overheating. 

Toddlers and Older Kids
Remember, kids get uncomfortable when dressed in bulky layers because they feel restricted and soon overheat when the car warms up.  Dress your child in thin, tight layers under his coat, as if it was 50 degree weather outside.  For example, under his coat, put your son in an undershirt, a long sleeve shirt and a sweater.  Keep your child's coat on until you get to the car.  At the car, take your child's coat off and quickly buckle him into his car seat.  Make sure you pull up firmly on the shoulder straps to get all the slack out of the legs/stomach area and then pull firmly on the tail to tighten the straps.  Have your child stick out his arms and put the coat on backwards.  The best part about this is not only is he safer, but he also won’t overheat as the car gets warmer--he can pull the coat off when he gets hot.


Car Seat Manufacturer's Opinion on Coats and Aftermarket Products
Here is what the car seat manufacturers have to say about coats and aftermarket products. These excerpts were taken directly from the child safety seat instruction manuals.