car seats

augigi, CNS · Dec 3, 2006

You might want to try a search of the boards - I remember a thread about this a couple of months ago that had lots of info for you.

BSNtobe2009 · Dec 3, 2006

Say what?????

If it takes a certified tech to figure out how to intall a car seat properly, then how do they expect the parents to figure it out?

RNmommy · Dec 3, 2006

At my old job, we were specifically not allowed to touch the car seats or instruct parents on their installation. We would refer them to "certified car seat inspection stations" but never ever do it ourselves. We were told the same thing, that we were not certified and therefore setting ourselves, and the hospital, up for liability should something horrible happen.

ragingmomster, BSN, MSN, RN · Dec 4, 2006

Same thing here.

It's not so much a matter of us being too stupid to put in a car seat as compared to the parents, but we haven't looked at the manual and can not be familiar with all types of car seats.

God forbid we give information that is wrong because we are not familiar with their particular restraint and then something happens to hurt that child.

Our Fire Dept does inspections every Friday. Parents that come through on the tour are encouraged to stop by and be sure they did a good job.

JenTheRN · Dec 4, 2006

Alright, I can understand the liability part, but doesn't it go the other way? We check the baby in the corificeat when parents are discharged just to make sure the baby is in the seat safely. I've seen babies put in the seats all kinds of ways, with arms and legs tucked in, with the strap not even close to snug...it scares me to think of the jeopardy these parents might be putting their kids in. Even though I'm not "licenced" I feel it's part of my responsibility to make sure these kiddos are leaving the hospital in a safe way.

Yes, they can go to the health department or police department to get the seat checked. Are they going to? Well, my opinion is the ones who probably need it the most won't go.

Our manager is working on getting a few of us licenced next year. I hope that works out.

In the meantime, I'm still going to give patients a little bit of education about safety and corificeats.

Elvish, BSN, DNP, RN, NP · Dec 4, 2006

The way I understand it, there is a 2-day class with the corificeat basics and a 5-day class with the advanced stuff. We have several CNAs & nurses who have been to the 5-day with many more who have done the 2-day. So in that sense we are fortunate to have people who can give the more in-depth advice.

However, I am with Jen who says that she will still give a little education to parents. I work nights so I don't do the fitting/getting it into the car etc. but I do check it for recalls/hx of being in a crash etc. And I let the parents know that the kid has to go facing backwards x 1yr (at least in NC). It is amazing the number of people who don't realize that.

BSNtobe2009 · Dec 4, 2006

I wonder about the "certified experts". I took the advice of the NICU and took the car seat to get an inspection, and I attached it to the letter of the instructions, and they didn't even touch it and said, "Oh, you have this in there wrong.". The took out the car seat, and put it back in EXACTLY like how I had it before. They put my daughter in and said, "You need to pull it snug enough to get a finger under the straps," As I drove away, my daughter immediately started crying. I pulled over to a parking lot to discover that, oh yeah, you could get a finger under, but you had to push in on her skin to get it under there.

I took it out, readjusted it, and that was the last time I took it to the "experts".

babycatcher2B · Dec 4, 2006

You might want to try a search of the boards - I remember a thread about this a couple of months ago that had lots of info for you.

Thanks! I'll definately do that.

See, I'm not even so much concerned with parents having their infant's seat installed correctly (though you'd like to think parents thought it was important enough to do before the arrivial of their child) but to at least have it in where the baby is not going to fly all over the place if, god forbid, they got in an accident on the way home. When I d/c a pt and I see something visibly wrong with the car seat (like the dad who thought that simply clicking the seat in the base was installation enough, no seatbelt to speak of) I'm not going to let them drive away from our facility like that. If something were to happen I could see it come back on us big time.

I wonder about the certified "experts" too. One tech told me once that I had to remove a head support from my ds's seat b/c it made the seat less safe if we were to get into a collision. Then, a different tech at the inspection the other day told me that the one in my dd's rear-facing Britax was just fine. He also didn't mention a thing about the baby mirror.

If I am confused by all the misinformation out there given to me as a parent how can I best educate my pts about the importance of car seat safety??

nicunana · Dec 4, 2006

You don't have to be certified to instruct parents on basic car seat safety. All parents should be taught:

1. It is absolutely necessary to read the corificeat manual as well as the car owners manual before installing the corificeat.

2. The corificeat should be installed rear facing in the back seat until the child is at least 1 year old and 20 lbs.

3. The corificeat should be tightly belted into the car and should not move more than on inch from side to side when you try to wiggle it.

4. The harness straps should be at or below the baby's shoulders in a rear facing position.

5. The chest clip should be connected at the armpit level.

6. Blankets should be used as a covering only after the child is already snugly harnessed into his corificeat.

7. Nothing should be placed under or behind the infant in the corificeat.

8 . The rear facing corificeat should be reclined at a 45 degree angle, to prevent the head flopping forward and causing airway obstruction.

9. The parents should be encouraged to make an appointment with a corificeat technician for a thorough check up a few days before the child is discharged.

None of this requires hands on or even "special training" to convey to the parents. Witholding this information could also be a risk management issue. It's sad that the threat of potential litigation makes it necessary to require that only a certified tech actually install the corificeats, but I certainly understand where the hospital is coming from on that. We still can share some valuable information with the parents that will help to ensure a safer ride home and that will also place the reponsibility on them to make sure that they are doing everything they can to use their corificeat correctly.

CEG · Dec 5, 2006

and that the handle to those bucket seats needs to be down when driving.

Actually this depends on the seat. The one I had for my kids had to be up, I can't think of the brand offhand- maybe Graco?

I have the same problem though. I see people improperly buckling their babies in and I have to say something. I hope I can just chalk it up to being a student if I ever get called on it.

We test drove a car we were thinking of buying a few weeks ago and the family selling it had their two children's car seats fastened in with the seat belt only, not tightened or anything. There was at least a foot of extra seat belt left, I would hate to think of them getting into a crash. I couldn't think of a polite way to say anything so I didn't. I still feel a little guilty though.

snowmountain · Jul 22, 2008

I wonder if I could help clear up some of the confusion about car seats, I am a car seat technician/'instructor and work at a hospital, on the labor and delivery floor. The car seat test that is done in the NICU and/or the newborn nursery is a test to see if the child can tolerate the 30-45% angle that a rear facing car seat sits at and maintain a good oxygen saturation level and heart rate. The parent should be bringing in the car seat they intend to use for this purpose. Although this is a good time to check a few things about the car seat (whether it is used, within the appropriate height and weights for the infant etc.) this is not necessarily a 'car seat check' it is a test to ensure the child is as stable in the car seat as they are in their crib. It is not a test in which the goal is to get the child to 'pass', it is an evaluation of the childs' ability/maturity to withstand the extra abdominal pressure that is created when seated at that angle. Sometimes this test can reveal some anomolies with the child that were previously unseen.

The car seat check is not an 'installation' but more an education for the parent- since using car seats is not necessarily instinctive parental behavior. In fact, technicians are not intended to be installers, since we do not follow the parent or child throughout their lives, just installing the seat for them is a disservice to the family. They learn very little from that, it is the education one on one that is key. The misuse rate for car seats is very high due in great part to the many different sizes of children, car seats and cars. This misuse rate unfortunately translates into the leading cause of death for children from unintentional injury, more than all the childhood diseases combined.

Different designs of car seats appeal to different people and car seat manufacturers have to find a way to mesh all of the safety concerns with what sells car seats. Car seat technicians and instructors are specialists, just like EMT's or other kinds of technicians, they have to go through specialized training and then more hands on training to be able to adequately instruct a family on proper car seat use, for all members of the family, not just the infant.

Fire fighters are not always trained in this area, in some communities it may be law enforcement officers, non profits or hospitals or any concerned group.

Sometimes to the untrained eye, it may look like something is wrong in a car seat or an untrained person may believe something is true about car seats, such as the handle always having to be in this position or that position yet their assumption is not necessarily true. I often find that nurses that are not car seat technicians believe something to be true about car seats or positioning of a child (because that is how they have been doing it with their own families,) only to find out they are part of the misuse group and with the best of intentions actually end up instructing the parents incorrectly.

For those of you that really feel you are seeing misuse (no doubt you are) and kids going home unsafely, handing out flyers or referring patients to 'fit stations' in your community is totally appropriate, most states have organizations at the state level that can refer families to techs in their area, if not, all car seat technicians are trained to the same curriculum by the National Highway Traffic Safety Administration, NHTSA.gov, and there is a tech locator on their website. There are also many great informational handouts in various languages that can be given to patients not only to help the patient, but to give you piece of mind as well. After all, you have just invested part of yourself in that child's care, you would not be in the field you are in if it did not matter to you. Of course it does, that is why you are so good at what you do!

The liability issue becomes a problem when you are working outside of your scope of training, attempting to install or instruct regarding the car seat without really knowing or having the resources to stay current-advising and referring are totally appropriate in this situation for these new parents..as you know, they are usually pretty overwhelmed.

The AAP is currently working on clearer guidelines for nurses regarding car seat instruction and clearer clinical guidelines on the angle test-the first hurdle is what to call the test since it currently has so many different names. The AAP has guidelines currently that address the testing of newborns, the proper instruction of parents and transportation of newborns as well as older children. The AAP has a great website at brightfutures.aap.org. The child passenger safety community has done a great deal to protect children with regards to traffic safety, it only makes sense to have these two groups working together to protect patients better.

I hope this helped clear up some issues and questions. There is a great deal about car seats that is counter intuitive, if handouts or referrals are not an option for you (and even if they are) simply instructing the parent to read their vehicle owners manual and their car seat instruction manual and to read them together is great advice. That is where car seat techs start, good technicians read the manuals with the parents.