Tuesday, July 3, 2012

The Bossy Nurse is IN

Okay. So.  I'm pulling the bossy (I prefer to think "informative") nurse card and doing a blog post about car seats.   A lot of people are having a baby soon. Or already had one. Or want to have one.  And if there's one thing that all of them have in common, it's that to my knowledge none of them drive a horse and buggy.  So, in some way, you'll have to obtain a car seat and need to know how to use it.  And if there's anything I've learned in the past...ummmm....ten? years of being a nurse for new parents, one thing is very clear: we love to prepare for our babies.  We love decorating, sewing, shopping, planning, cute-i-fying...but somehow, how to use that car seat is not on most people's radar.

So.  Let me help you out.  I promise I'll be way less dry than the instructions that you won't read anyway, my pictures are cuter than the drawings, and you'll probably find out something you didn't realize you needed to know.

I am NOT car seat certified. I would like to be.  There are great resources online, and car seat inspections are FREE at most police departments and fire stations, and take about fifteen minutes.  This is one of THE most important things you need to know as a parent, so please take that time on a Saturday or evening to do that.

First up: try to get a new seat.  Hand-me-downs and those bought at a garage sale may NOT be safe.  They should be no older than five years and NEVER in an accident. You don't know the exact history of a hand-me-down or second-hand seat.  Granted, there are many people who can't afford a brand new seat, and a hand-me-down is better than none at all. But for the heavy investing that we all do in stuff to make the nursery cute, cut some of that out and splurge on the good seat instead if at all possible.

Second: Take the car seat out of the box and look at it.  Before the baby is born.  Put a teddy bear in and practice adjusting the straps.  Legally, your nurse at the hospital can't do this for you, so you need to know what you're doing.  Install the base (if you have one with the LATCH system and a car manufactured since...oh crud, I think 2002????, it's way easier than you think).  Grind your knee into that base and pull the straps HARD.  There should be no more than 1" of wiggle room either way.

Okay, so now your baby is born and you're looking at it and the car seat and don't quite know what to do.  Here's a visual to help you:

WHO is that chubby-faced newborn? It's two-day-old Levi Gouveia!!! :)  Levi's in a Chico (say "KEY-co!") Keyfit 30, which means he could still use it up to 30lbs, but I think he'd be pretty ticked if I put him in it now.  The Chico is one of the most popular and well-rated ones on the market, but there are a lot of great seats out there.

So, notice a handful of things going on here:

1.  Notice how tight the straps are.  And not twisted.  I tell parents, if it seems like you're strapping them in too tight, you're doing it right. You should not be able to pinch ANY strap on their shoulders or by their legs.  Yes, he or she will cry and protest and make you feel awful.  I prefer that to the alternative in an accident.

2.  Notice where the chest clip is. It is NOT a belly clip and belongs between the armpits at the nipple line.  It is designed to absorb energy in a crash and MUST be on the breastbone.  If it's over the belly (where I see a lot of people position them), at best it won't do its job well, and at worst it can puncture the internal organs.

3.  No after-market products to position his head.  You know, those soft upside-down U-shaped things so their head doesn't bobble. Most infant seats come with one, and that's fine. But if it didn't come IN the box with the seat, the manufacturer does NOT want you to use it, and use of any positioning device - especially if you have to place it under the straps - will void any warranty on the seat.  Pretty much any owner's manual will tell you not to use it.  There are a lot of things on the market that make you feel like you need it, but don't do it.  The same goes for those fleecy J. Cole (or whatever the name is) things that people insert in the seat for the winter.  Get one of those covers for the seat that fits over it like a shower cap, but NOTHING that goes under the straps.

If your seat does NOT come with a positioning type of device, roll up receiving blankets and put them on the side of your baby's head.  As long as nothing goes BEHIND the head or under the straps.

Soooo...what to do in cold weather?  First, do not put your baby in a bunting, snow suit, coat, or anything like that.  They are too puffy, will interfere with you adjusting the straps, and will decompress in a crash and some babies (yes, what I'm about to say is true) will fly right out of their coat and straps.  Place your baby in his or her normal clothes in the seat, put on a hat and cover with a blanket. That's all you need.  Your mom and mother-in-law (note: this was not the case with MY mother and MIL, but I hear a lot of grandmas protest when I tell my patients this) will think you're being cruel for not putting a big snow suit on the baby while she's in the car seat.  Too bad. Not safe.


This is two-month-old Levi, which would be at the end of December.  See?  He's neither freezing nor unhappy.  Your bundle won't be, either. :)

There's a handful of other things I could tell you, but that's a good start.  When (WHEN!) you get your car seat inspected by a certified person, they will tell you even more. :)

Now.  Your kid is 12 months old.  Yay!!!  Time to turn them around and forward face, right?

*Scoreboard buzzer sound*  Maybe not so much.

Yes, according to most state laws, 12 months (or 20lbs, whichever comes first) is the legal time to turn them around forward facing.  But the American Academy of Pediatrics recommends rear-facing for at LEAST two years. Facing your buddy forward has nothing to do with a rite of passage or being more mature. It's just something you can now legally do, but it's not necessarily the best thing.

Now, if you don't like this, don't shoot the messenger.  I'm not judging you, calling you names, or pulling you off my FB friends list if you forward-face your kids.  If you have protests or other thoughts about extended rear-facing, take some time to look up the research and decide for yourself what is best for your kiddo.  I'm only informing.

The same rules apply to how to adjust the straps and chest clip.  Levi is in a Britax (say "BRIGHT-ax") Marathon 70 from Target. It's not the super-duper-space-shuttle-ready car seat, but it got high scores on consumer and safety reports, and Britax is a great brand.

Q: Why rear face?

A: A toddler's head is still proportionally large to the rest of the body.  For quite some time. It's the heaviest part of their body, and in even a minor rear-ending, will snap forward, and can even cause internal decapitation (look up "internal decapitation" on YouTube...it's a quick 1 or less video).  When rear-facing, the seat cradles the body and head and absorbs the impact, rather than the limbs and head flinging forward. No whiplash.

Q: But the legs are all crunched up.  They'll break in a crash.

A: It doesn't matter if their knees are against their nose.  There is no evidence cited from any study indicating that rear-facing children break their legs in a crash...and these studies are typically done in Europe, where in many countries it is completely normal for kids to RF until four years old.  Levi is a long kid and he sits criss-cross-applesauce, puts his feet all the way up on the back seat, or just sits spread-eagle.  He's never complained.

And if you think of it, think of how you drive. Or sit as a passenger.  Especially as the driver - and especially if you're tall - you don't get the luxury of extending your legs much. It's just the way it is.  We deal with it; so can they.

Furthermore, and this sounds perhaps rather crass, but it's what sold me: Broken leg - cast it. Broken neck - casket.

Q: But my kid cries.

A: Too bad.  You're the parent.  Sometimes I have to have wrestling matches with Levi to get him in his seat, because he can push his feet against the back seat and levitate himself off the seat.  So I tickle or blow on his tummy, or just plain old wrestle it out because I'm mom and I really don't care what he thinks about his position. I'd rather have him alive and not in a halo....of any sort.

There IS one huge disadvantage to rear-facing that I've seen:

Levi has never seen a train.

He's always facing the other way.  Oh well.  Someday, when he's in junior high and finally gets to see what's coming instead of what's already gone by, he'll see a train crossing.  But he does sit high enough to see out the back window and the side windows, and very much enjoys wow-wow-wowing at trucks, cars, dogs, people, and everything else. He in no way rides in a deprived manner.

There is a LOT more that can be said about rear-facing and the physics of crash forces that support extended rear-facing, but I'm not nearly on the uptake enough to speak to all of it, but I will say that it's compelling enough that I would not be surprised if it became law soon to rear-face your kids until the age of 2.  YouTube it, Google it, ask the car seat inspector about it WHEN you go for your initial (free!!!) inspection.  For all the energy we put into their cuteness and their diet and their discipline and their social-ness and their intelligence, this is definitely worth the small time investment to learn what's safest for all the time they will spend in the car.

I'm sorry for the long and boring post, but I don't spend precious Levi nap time blogging about things that I really don't care about.  I really, really, REALLY feel strongly about car seat safety, so please take this info to heart.  If you look around there are TOO many babies and toddlers incorrectly secured and it IS a matter of life and death for them, and if we as parents can spend however much time on Facebook, we can spend time researching what keeps them safest.  Right?


Kristina Wright said...

This really is helpful information. I had no idea about some of the risks. My oldest is 2.5 and we changed him to forward facing at 13 months because his legs were pressed against the back seat and he seemed uncomfortable. I'll plan to keep my 10 month old rear facing longer! Thanks for sharing!

Jan said...

Amen!! (and nicely written too!)