The car seat test

ChristineN, BSN, RN · Jun 9, 2014

I don't work in OB or NICU, but wondering what they do in urban areas where more people don't own cars or drive like NYC.

klone, MSN, RN · Jun 9, 2014

I don't understand what you mean by being coerced into buying an expensive one? You were free to go to whatever store you wanted and buy whatever brand of corificeat that was appropriate for a newborn, no?

Christine, that's a good point - I'm not sure how they handle it in urban areas. My guess is that the assumption is that all newborns will be riding in a corificeat of some sort, even if it's in a cab, or in those big corificeat/stroller contraptions. So I would guess than even in areas where the family insists they don't drive or have a car, it would still be required.

It's been a few years since I've worked inpatient, and I didn't often work with the babies, but my recollection is we had our own bucket corificeat that we would use for corificeat challenges if the parents didn't bring theirs in. After all, not every family uses a bucket corificeat (some use a convertible right from the get-go) and it wouldn't be possible to do the challenge in a convertible (we would keep the babies under the warmer, hooked up to the pulse-ox, so the corificeat sat right on the warmer table itself).

RescueNinjaKy · Jun 9, 2014

Personally I don't feel like you were coerced into buying an expensive car seat. I mean regardless of whether you had time or not to use your own car seat, you still needed a car seat and you had the option of going out to buy or get the one you already bought. When the baby comes early, they still need to perform the test and see if you have a safe way to bring the baby home. I don't know your location but some places require babies to be in car seats while in a car, so they also probably wanted to ensure that the baby wasn't exposed to any unnecessary risks.

invisiblewounds · Jun 9, 2014

I'm confused...your post went from twins and car seats to son and car seat.

Not_A_Hat_Person, RN · Jun 9, 2014

My daughter, the other twin, had surgery soon after birth. She was discharged about 6 weeks later, after we'd had a chance to go home, get the car, and install the (convertible) car seats we had. Her car seat test was about a week before discharge. The car seat test for my son was 4 days after he was born. He was also 4.5 lbs, too small for the seats we had, which were in our living room at the time.

When we asked if the unit had a seat we would use, we were told they did, but we would have to buy that seat from the gift shop, for $175, for him to be discharged. The price surprised me; my local hospital's gift shop sells car seats for 4 lbs. and up for $55. And yes, this was in a major city.

TiffyRN, BSN, PhD · Jun 9, 2014

I am not surprised they wouldn't release the child without a car seat and a car seat test; that is safe practice. I work in a large urban NICU and we do not sell car seats in our gift shop. We do offer a few (not many) charity car seats provided through a local group but this requires a week or two of planning to get. We suggest shopping at Wal-Mart or Target with driving directions for the multiple out of town families we have.

I myself always monitor those stores for their offerings so I can share that information with our families. For example, Wal-Mart generally has the cheapest plain car seat that used to be $38 but recently I have seen it closer to $50. It is not a carrier, just a car seat. This one though is only rated for 5-20 pounds. At the local Target (about 5 miles away from the hospital) there are car seats that accommodate 4-20 pounds and the cheapest one is around $80.

Doing a car seat test in a "sample" car seat is not suitable as each car seat has quite a bit of variation on how supportive they are to each individual child based on their body shape, tone and weight. This is also why you don't want to borrow a car seat unless it is exactly the same as what you have though the hospital staff can't really say anything about that. Having witnessed several kids have apnea/bradys (death & dying spells) in car seats when they didn't have them before justifies why we do the test. Their immature and therefore soft cartilage is not always capable of keeping their airways open, hence the recommendation from the AAP.

Congratulations on your twins!

NicuGal, MSN, RN · Jun 10, 2014

Where I work we can't hold a baby for not having a car seat. We will do the test with one of our unit ones. Many of our parents use public transportation. All we can do is inform them of the laws, penalties and consequences per our legal department. Do we agree, not really.

TiffyRN, BSN, PhD · Jun 10, 2014

I have a feeling if we lived in an area where people used a lot of public transportation we might have to revise things. The OP however wasn't planning on using public transport. The infant needed to be tested in the seat it was going to be riding in.

BSNbeauty, BSN, RN · Jun 10, 2014

We don't sell car seats, so our parents wouldn't have that option of buying one at the gift shop. I'm still confused on how they forced you to get one from the gift shop. I'm surprised they didn't allow you to refuse the corificeat test. At my job, parents refuse vit k, hep B, and etc. why not the car seat test???

Klone- In my state an infant does not need to be in a corificeat while riding in a cab. Crazy, I know. I guess the assumption is someone will be holding the infant in the backseat.

TiffyRN, BSN, PhD · Jun 10, 2014

At my job, parents refuse vit k, hep B, and etc. why not the car seat test???

There are some items that may be refused such as the ones you mentioned. Some can be refused but will automatically trigger a Child Protective Services consult (eye prophylaxis). Some cannot be refused such as admission to the NICU, AMA discharge and therefore procedures deemed by the medical staff as essential. There have been some showdowns between parents (often the kinds that believe all medical interventions are harmful) where we had to come to an understanding that the infant would be admitted, treated with IVs, glucose, antibiotics etc., for the good of the child or the child would be placed in State custody.

There are some out there that believe they can refuse anything/everything for their child much as they would for their own care (such as happens many times with a laboring woman). Think about what happens when a very preterm infant is born to strict Jehovah's witness parents. . . Little hint here, that child will be getting blood products as needed. Even with all the drama, the child is no more likely to be removed by the State at discharge than any other child, but the State will be taking authority regarding blood transfusions during that neonatal period.

klone, MSN, RN · Jun 10, 2014

There are some items that may be refused such as the ones you mentioned. Some can be refused but will automatically trigger a Child Protective Services consult (eye prophylaxis).

Depends on the state. In every state I've worked in, the parents could refuse eyes, and they had every right to do so, without interference from CPS.