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Carseats for premies

NICU   (2,304 Views 11 Comments)
by nicunana nicunana (New Member) New Member

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What is your hospital doing (if anything) about carseats for infants that weigh less than 5 lbs? Some of our nurses are very uncomfortable sending home babies that weigh less than 5 lbs in a carseat that is clearly labeled 5 to 20 lbs. I'm talking about babies that have passed their carseat challenges and do not have other problems that would contribute to airway obstruction. A large segment of our population is economically challenged and unable to replace the carseat that they already have with a more expensive model. Our carseat technician really feels that carbeds are not as protective in an actual crash as a carseat, so we are hesitant to recommend or provide those to infants without airway or other medical issues that would require a supine or prone position. Thanks for your input!:)

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6,297 Visitors; 355 Posts

The Chicco Keyfit and Safety First Onboard start at 4lbs, but I don't work in a NICU, so I'm not sure how many more babies that would help, with the extra pound. I have heard from techs that these seats fit premies well. (I know this doesn't help with the $ part of it, though)

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SteveNNP has 9 years experience and works as a Neonatal Nurse Practitioner.

2 Articles; 25,561 Visitors; 2,512 Posts

If we send a preemie less than 5 lbs home, we recommend a smaller car seat. We will, however at parental request, send them in a regular infant seat with additional rolls on each side of the baby.

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aerorunner80 has 8 years experience and works as a NICU nurse turned FNP student class of 2019.

13,346 Visitors; 579 Posts

We have a carseat program at our hospital that is sponsored by the state I live in. We will give a really nice car seat to parents who can't afford them and if we are sending a teeny tiny one home (

I don't remember the name of the company who makes them but I'm sure you could google it and come up with something. They are actually really neat. The baby is still buckled in, 5 point harness style, but is laying down.

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1,969 Visitors; 90 Posts

Thanks so much for your replies, so far. I'd also be interested in knowing if your NICU has any certified carseat technicians on staff to assist the parents with their questions and help them with installation, or if you have access to one from a different department, like PT? What is your actual responsibility, if any, to ensure a safe ride home?

Thanks in advance for your answers.

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BabyLady works as a RN.

14,621 Visitors; 2,300 Posts

Thanks so much for your replies, so far. I'd also be interested in knowing if your NICU has any certified carseat technicians on staff to assist the parents with their questions and help them with installation, or if you have access to one from a different department, like PT? What is your actual responsibility, if any, to ensure a safe ride home?

Thanks in advance for your answers.

We have a certified carseat person on our staff.

However, they sent her to the training to educate the staff/parents only.

Hospital policy requires us to witness the infant being placed in the car so we know a car seat is being used, however, for liability reasons, parents are told in advance that we cannot help them place an infant in a car seat and we encourage them to read the instructions and stop by the nearest fire department/police department for instruction.

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aerorunner80 has 8 years experience and works as a NICU nurse turned FNP student class of 2019.

13,346 Visitors; 579 Posts

Thanks so much for your replies, so far. I'd also be interested in knowing if your NICU has any certified carseat technicians on staff to assist the parents with their questions and help them with installation, or if you have access to one from a different department, like PT? What is your actual responsibility, if any, to ensure a safe ride home?

Thanks in advance for your answers.

We have several people who are on staff that are certified car seat people. Most work days.

As far as our responsibility goes, we have to teach teach teach and do carseat trials. Other than that, it's on the parents. We are not required by law to watch the parents place the carseat in the car with the child in it on discharge.

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BabyLady works as a RN.

14,621 Visitors; 2,300 Posts

We have several people who are on staff that are certified car seat people. Most work days.

As far as our responsibility goes, we have to teach teach teach and do carseat trials. Other than that, it's on the parents. We are not required by law to watch the parents place the carseat in the car with the child in it on discharge.

The law doesn't require you to watch them put the baby in the car seat, but it is important to verify that a car seat exists (not all NICU infants need a car seat challenge).

Any parent that doesn't have a car seat on discharge and cannot provide one, even if the hospital issues one, is a social services consult, because that is a basic need of an infant that the parents were unable to meet.

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BittyBabyGrower works as a Nurse of course!.

12,649 Visitors; 1,823 Posts

We will use rolls and head supports as necessary. It is hard to get those kids fit sometimes, even with the smaller ones. We have only used a carbed once in all the years I have worked. They are usually only good for the small kids and they are hard to get in tight enough in the seat.

We are not allowed to touch the carseat at all...the parents have to adjust the straps, etc prior to discharge or carseat challenge.

You can not hold a discharge because they do not have a seat, we are only obligated to tell them the law, and document it. I have seen some horrendous things in my time...like the family that took the baby to the car, put him in a box on the floor and left. yeah, that made my hair stand on end. Reported it to social work, who said, well,once they are discharged they can do whatever they want. I've seen them take the baby to the car in the seat, then take baby out and hold them as they drove away...and these were educated, middle class people that you would never think would do something like that.

We tell parents to call the firehouse near their house to see if they do carseat checks....we have kids from all the over the state, so to keep a list would be hard!

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BabyLady works as a RN.

14,621 Visitors; 2,300 Posts

We will use rolls and head supports as necessary. It is hard to get those kids fit sometimes, even with the smaller ones. We have only used a carbed once in all the years I have worked. They are usually only good for the small kids and they are hard to get in tight enough in the seat.

We are not allowed to touch the carseat at all...the parents have to adjust the straps, etc prior to discharge or carseat challenge.

You can not hold a discharge because they do not have a seat, we are only obligated to tell them the law, and document it. I have seen some horrendous things in my time...like the family that took the baby to the car, put him in a box on the floor and left. yeah, that made my hair stand on end. Reported it to social work, who said, well,once they are discharged they can do whatever they want. I've seen them take the baby to the car in the seat, then take baby out and hold them as they drove away...and these were educated, middle class people that you would never think would do something like that.

We tell parents to call the firehouse near their house to see if they do carseat checks....we have kids from all the over the state, so to keep a list would be hard!

We actually hold up discharges due to no car seat.

So far, I have seen this happen once. Of course, the hospital social worker was called. The parents were like, "If you don't let us take the baby, we are going to call the police."

That is when the social worker said, "Absolutely, and we agree, but you do realize that when they come and walk you down to your car, they will issue you a citation for putting the baby in a vehicle without a car seat plus a social services consult?"

In our state, the citation with no car seat is a similar penalty to a DUI. The same points on your license, your insurance goes up sky high, a huge fine ($1,000), and a parent can get their license suspended....and everyone here knows it.

The social worker told me that once the parents get wind of that, the car seat miraculously shows up.

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mvg rn has 12 years experience and works as a RN.

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no we don't have anyone who is car seat certified.

we show our parents a video about car seat safety and educate them about the laws. we also tell them that they need to read their car seat manual. we can't legally stop them if they don't have a car seat, but we also don't tell our parents that it is an option.

we have them put the baby in the car seat in our unit so they can adjust straps and we use rolls for the smaller babies. we them watch them buckle in the car seat in their cars. if they do refuse any of these steps, we document their refusal to cover ourselves. our social worker is also good about reporting to cps for us.

i had a couple of very young parents show up once with a doll carrier to take a baby home. i explained to them the dangers/laws of not using an actual car seat and that they need to get one. after about an hour, a very embarrassed grandparent showed up with a car seat and an apology. he thought he was teaching them a lesson about responsibility, but never thought of the safety of his grandchild.

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