• Infant is positioned semi-upright in his or her own car seat for a period of observation while being maintained on a cardiorespiratory monitor and pulse oximeter.
• The length of observation varies according to hospital policy; however, the infant is commonly monitored for a minimum of 30 minutes or the travel time from the hospital to home.
• The infant is assessed for apnea, bradycardia, and oxygen desaturation.
Direct observation during the CSCT is necessary to assess color changes associated with apnea and airway obstruction and to completely assess severity, associated positioning, and recovery time for physiologic events.
• The CSCT is generally scored as pass or fail. No standard exists for determining what constitutes failure; however, measurements of the frequency and severity of physiologic events and recovery from them aid in individualized clinical determination of the pass/fail score. CSCT guidelines and policies vary from hospital to hospital. 

Semi-upright car seats with small internal 5-point harness systems provide the best positional support. 
• Infant-only car seats with smaller weight limits (4-22 pounds) provide the best fit. Car seats with head or trunk inserts preinstalled by the manufacturer may provide a snugger fit. Never use after-market products that fit behind or beneath the infant in any car seat because they have not been crash-tested for safety or efficacy by the car seat manufacturer. 
• Car seats with a distance of less than 10 inches from the lower harness strap to the seat bottom have a better fit over the shoulders and are less likely to have direct contact with the infant's ears or face.  
• Car seats with a distance of less than 5½ inches from the crotch strap to the seat back limit submarining (sliding down in the seat with chin-to-chest positioning). Submarining constricts the airway by placing pressure on the neck from the harness retainer clip.

• Reduce lateral slumping: position the infant with towel rolls on both sides of trunk and hips. Rolls should be used only if needed. They should never be behind the infant's back or beneath the infant's bottom. 
• Prevent submarining: use a small crotch roll between the crotch and buckle clasp to keep the hips against the back of the seat.  
• Decrease forward head lag: if the infant's head drops forward in the car seat because the position of the seat is too upright, a rolled cloth can be wedged in the vehicle seat crease so that the angle of the seat allows the infant's torso and head to rest further back, preventing the chin-to-chest position.

• For added head and neck support, keep the seat rear-facing to the highest weight and height allowed by the manufacturer's instructions. 
• Avoid car seats with trays or shields; direct contact with the infant's head or neck during impact may cause injury. 
• Use a CSCT-recommended car seat.

• Minimize travel with infants. 
• Infants with special positioning needs are not exempt from car seat safety laws. 
• Use only FMVSS213-approved car seats. (This information can be found on a sticker on the side of the seat and officially designates it as an approved car seat that has passed compliance and performance evaluations.) Make sure that the seat has a sticker identifying the manufacturer, providing instructions for basic use and installation, and giving warnings. Car seats expire 6 years from the manufacture date unless information  imprinted on the car seat indicates otherwise. 
• It is important that consumers complete the warranty information. All car seats are subject to safety recalls. 
• Position the infant in a rear seat with adult supervision. The rear center position is the safest position in any vehicle. 
• Use car seats only for travel, not at home. 
• Use a conventional upright car seat whenever possible.
• Car beds should be used only when upright positioning is medically or surgically unsafe.

American Academy of Pediatrics. (2010). Car safety seats: Information for families for 2010. Retrieved January 11, 2010, from www.aap.org/family/carseatguide.htm.

 

American Academy of Pediatrics. (n.d.). Car safety seats and transportation safety. Retrieved January 11, 2010, from www.aap.org/healthtopics/carseatsafety.cfm.

 

American Academy of Pediatrics, Committee on Injury and Poison Prevention & Committee on Fetus and Newborn. (1996). Safe transportation of premature and low birth weight infants. Pediatrics, 97, 758-760. Policy reaffirmed in 2006: Pediatrics, 117, 1846-1847.

 

American Academy of Pediatrics, Committee on Injury and Poison Prevention & Committee on Fetus and Newborn. (1999). Safe transportation of newborns at hospital discharge. Pediatrics, 104, 986-987. Policy reaffirmed in 2009: Pediatrics, 124, 845.

 

Automotive Safety Program. (n.d.). Automotive safety program. Retrieved January 11, 2010, from www.preventinjury.org.

 

National Highway Traffic Safety Administration. (n.d.). Child passenger safety. Retrieved January 11, 2010, from www.nhtsa.gov.

 

Safe Kids Worldwide. (n.d.) Welcome to Safe Kids Worldwide. Retrieved January 11, 2010, from www.safekids.org.

 

Talty, J. L., Bull, M. J., Havey, J., James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Manary, M., et al. (2007, March). Safe travel for all children: Transporting children with special health care needs. Participant training and resource manual. Indianapolis, IN: Automotive Safety Program.

 

Djuana D. Rivers is a NICU nurse and a child passenger safety technician at Our Lady of Lourdes Medical Center in Camden, NJ.

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