Babies Archive

Today is National Heatstroke Prevention Day. It started 6 years ago to bring attention to children dying in hot cars. With every instance of a child left alone to die in a hot vehicle, we’re shocked, saddened, angered, and left wondering how a “good” parent could possibly forget their child. Many armchair parents are quick to comment about how they’d never forget a living, breathing child in a car while experts plead again to take steps so that it doesn’t happen again. This is a relatively new phenomena since frontal passenger airbags moved rear-facing children to the back seat; however, children have been dying in hot cars for much longer than that.

In the first 10 minutes a vehicle has been sitting in the sun, the temperature inside rises about 19°. After 20 minutes, it has risen about 29°. Before long, the inside temperature can be well above 140° depending on the outside air temperature. Cracking a window doesn’t matter: the sun’s rays heat the interior fixtures of the vehicle: the dash, steering wheel, seats, etc., which cause the air molecules to heat up. It’s science we all learned in grade school but have probably long forgotten. Hyperthermia, or high body temperature, occurs when the body’s temperature goes over 104°. A temperature over 107° can be deadly and it happens very quickly with children, whose bodies heat up faster than adults’.

So far this year, 24 children have died in hot vehicles. While we don’t have specifics for this year, historically 54% were forgotten and 26.3% got into an unlocked car and couldn’t get back out. The numbers trend upward with 2018 being the deadliest year, but there’s no rhyme or reason to each year’s count. Two things are certain: heatstroke deaths rise during the warmer months—though to be sure, deaths do happen during cooler months—and parents are distracted to the point where their brains forget there’s a child in the car.

Have you ever forgotten to take a daily pill? What about grabbing your lunch or drink on your way out the door? Have you set your phone down, walked out of the room, then forgotten where you put the darn thing? (No? Must be an age thing. Just wait—it’ll happen!) Perhaps you’ve gotten home from running several errands and left the bags in the car. If you have done any of these things, then you are not immune to forgetting a child in the back seat of a car. You can be as high and mighty as you want, but the same brain processes that go into remembering these routine daily things are the same processes that go into remembering the child in your back seat. And if you have a child, you probably have some level of sleep deprivation to add in as well.

Try this the next time you drive a routine route: pay attention. Pay attention for the entire drive of that routine route. Do you remember driving past that stop sign? How about making the 2 turns? I will fully admit that sometimes as I drive routine routes—from the store, for instance—I look, but I am not seeing. As I drive I make sure there are no obstacles in front of me or vehicles coming at me, but I don’t remember how I got from point A to point B. And this is how children get forgotten.

Read this Pulitzer Prize-winning article: Fatal Distraction: Forgetting a Child in the Backseat of a Car Is a Horrifying Mistake. Is It a Crime? It’s long but it’s well-worth the read and will give you understanding into what happens when someone forgets a child in the back seat. As University of South Florida professor of psychology David Diamond explains, “Forgotten Baby Syndrome” is a real thing and it has to do with the way our brain memory systems interact. He offers 2 situations and explains how brain structures interact:

Condition 1: Parent 2, who may not normally take child to daycare, is tasked with daycare drop-off duties. The basal ganglia (the habit- or repetitive-based memory system—the one which allows us to remember how to tie a shoe or braid hair) suppresses the hippocampus and prefrontal cortex, which are the decision-making and multi-tasking systems that work together to make new memories. The hippocampus analyzes the situation for new information and the prefrontal cortex takes information and allows us to make new plans (e.g., need to swing by the daycare and drop off the baby). Since the habit-based memory system is in control (brain: must get to work), the parent is in auto-pilot mode and forgets there’s a child in the back seat.

Condition 2: Parent is under stress and forgets child in the back seat. In this instance, the amygdala (consider this “emotional” memory) activates under high pressure conditions which causes interference with the hippocampus and prefrontal cortex (see how we need the hippocampus and prefrontal cortex to make new memories?). When the parent is thinking about an extraordinarily busy day or errands they need to run before work, or they receive a phone call, etc., that may be enough to stress the amygdala. Further, sleep deprivation may cause the basal ganglia to go into overdrive and make habit-based memories, such as driving to work and forgetting there’s a child in the back seat, come through.

There are ways to make sure children aren’t forgotten in back seats; you can get around your brain’s dysfunctions. It’s by setting up layers of protection so that if you do forget, you can be reminded.

1. If your child is missing, check your pool first, then your vehicle (including the trunk!) – check neighbor’s pools and vehicles second
2. Arrange to have your childcare provider contact you when your child doesn’t show up that day. Make sure they have multiple contact numbers to call/text and that they keep calling until they reach a live person.
3. Keep all vehicles LOCKED at all times, even when they are in the garage and keep your keys/key fobs out of reach
4. Keep your wallet AND cell phone in the back seat when you are driving
5. Another option, put one shoe in the back seat when you are driving—you’re not going to walk away from your vehicle without your other shoe!
6. Make it a habit to always look in the back seat when getting out of the car
7. Teach your children that it’s NEVER okay to play in the car or to go into the car to get something without a grown-up
8. Teach your children NEVER to hide in the car or inside the trunk
9. However, also teach your children to blow the horn repeatedly to attract attention if they are ever trapped inside a vehicle
10. Use available technology: Some Evenflo carseats, the Cybex Sirona M, and the Baby Trend Secure Snap Fit have technology available to let you know if your child has been left in the carseat. Some vehicles also have backseat reminders, and Hyundai has a rear seat sensor system in some 2019 model year vehicles. Other vehicles, like Teslas, have air conditioners that will automatically come on if the interior temperature reaches 105° and they can be set to stay on after the vehicle is parked (Tesla states not to leave children unattended in their vehicles).

Let’s make it clear that cars aren’t babysitters: children shouldn’t be left in them to nap for any amount of time unattended and they shouldn’t be allowed to play in them either. Kids can get trapped too easily in vehicles or can put a vehicle in gear and a tragedy can happen in a split second. This goes for pets too!

And if you choose to leave a comment, which we always encourage, please do not be judgmental or we reserve the right to remove it.

If you’d like to read more, here are some links:

Ray Ray’s Story

Safe Kids Heatstroke Page

Kids and Cars Heatstroke Page

National Highway Traffic Safety Administration (NHTSA) Heatstroke Page

5 Common Carseat Mistakes Parents and Caregivers Make

Most parents think, “I got this,” when they look at a carseat. I mean, really, it’s just some straps that go over your kid, right? Everyone who has a kid has to use a carseat, and we all know there are some parents out there barely qualified to have kids in the first place who are able to get from point A to point B and keep their offspring alive, so it’s not rocket science, right? Wrong. Sometimes we make mistakes that we look back on and say, “I can’t believe my child survived my parenting!” It’s a saying in our house that we’re not saving for college; we’re saving for the therapists’ bills, lol. Let’s look at some very common carseat mistakes and see their simple fixes so your offspring can ride safely enough to make it to college… or therapy sessions—whichever way your family sways.

1. Loose Installation

Whether using the lower LATCH connectors or the seat belt for installation, your carseat moves more than 1” when you give a tug at the belt path. Make sure you tug at the belt path only; that’s the only place where the carseat is connected to the vehicle. If you check for tightness anywhere else on the carseat, it’s going to move more than 1″. There’s nothing holding it to the car there, right?

Let’s define “tug”. A tug is like a firm handshake or a shake on a shoulder that doesn’t move someone’s head back and forth (heh, you don’t want to give them whiplash). You use your non-dominant hand to give this tug so you’re not tempted to shake the rivets out of the seat.

1a. Can’t Lock the Seat Belt (Loose Installation Corollary)

Sometimes your installation is loose because you can’t figure out how to lock your seat belt to keep it tight on the carseat. Seat belts lock either at the retractor or at the latchplate. All model year 1996 and newer vehicles must have locking seat belts and some vehicles manufactured before 1996 have them as well. The retractor spools up all the length of the belt and is hidden inside the wall of the vehicle or inside the vehicle seat back. At least 90% of all modern vehicles have switchable retractors that can lock the seatbelt to hold a carseat tightly in place.

This is how you test for a switchable retractor: Pull the shoulder belt portion of the seat belt out of the retractor slowly and smoothly until you reach the end and can’t pull it out any further. Then feed a few inches of the belt back into the retractor. You may hear a ratcheting sound as the seatbelt feeds back into the retractor in the locked mode (although some retractors are very quiet most will make a noticeable clicking sound once they are switched into locked mode). Stop after feeding a few inches of the belt back in and try to pull it back out again. If it won’t come back out, it’s locked and now you know that this seat belt has a switchable retractor that you must switch to the locked mode if you are installing a carseat in this seating position.

Other seat belts lock at the latchplate (male end of the seat belt). These are mostly found on Chrysler, Dodge and Jeep vehicles. To see if your seat belt locks in these vehicles, buckle the seat belt and pull up on the lap belt. If it holds tight, your latchplate locks.

If you can’t get your seat belt to lock because your car was made before 1996, you have to use either a carseat with a built-in lockoff or a locking clip. If you want to read more about locking clips, you can click here. Lockoffs that are built into certain carseats are much easier to use than a locking clip and worth the extra price. Read about which carseats have lockoffs here.

2. Loose Harness

Yeah, you can’t just buckle the harness, it has to be snug on the kid or they’ll go flying out of the seat. If you can take a pinch of the harness above the chest clip, the harness is too loose so pull it tighter.

3. Chest Clip or Belly Clip?

You know those plastic pieces that clip together across the kid’s middle? That’s called a chest clip. Some carseat manufacturers’ get all uppity and call it a harness retainer clip. Call it what does and where it goes and you’ll never forget! Chest clip. The top of the chest clip is placed at the armpits. Any higher and it’s at the kid’s throat, especially for babies. Any lower and it may not be able to do its job as a pre-crash positioner.

4. Trusting Your Pediatrician for Carseat Advice

Do the initials “CPST” follow your pediatrician’s MD after his name? If not, he’s not qualified to give you carseat advice. Just like I’m not qualified to give you medical advice on your child’s rash (gee, that really does look like Ichthyosis en confetti—you should have that checked out), your ped is not qualified to give you advice on vehicle safety matters. Between charting, keeping up with ever-changing youth medicine, and making hospital rounds, most peds simply don’t have the time to keep up with the dynamic field of child passenger safety unless it’s a special interest. That’s why you come to us for answers on vehicle safety.

5. Turning Forward Too Soon

You may not admit it online, but turning your wee one forward before age 2 is really dangerous. I’ve heard all the arguments in my 18 years of tech-ing: my child’s legs hurt because they’re scrunched, my best-friend’s-mother-in-law’s-phlebotomist’s-daughter’s-pediatrician told her to turn her son forward at 9 months because of a risk of hip injury, my child has to be able to see the iPad screen we spent top-dollar for, and so on. The truth is, if you turn your kid forward before age 2, *you’re* the one who is uncomfortable with the idea of rear-facing, not your child. Studies and years of rear-facing children have shown that rear-facing is not only safe, it’s loads safer for kids.

It’s so important to rear-face your toddler that some carseat manufacturers now mandate it, at least for some of their carseat models. Britax requires a 2-year and 25 lbs. minimum on all of their forward-facing harness-2-booster seats. And Evenflo says that your kids must be 2 before they can be turned forward-facing in their convertible seats. I’m not pulling your leg—it’s right there in the manual.

Commercials on TV claim that the best way to start your baby’s life is to use the best diapers or best formula (if you can’t breastfeed, of course). We feel the very best thing you can do for your kid in the child passenger safety world is to use an appropriate carseat or booster on every single ride. After the infant seat is outgrown, continue to rear-face your child until they reach the rear-facing height or weight limit of their convertible carseat. And install the seat tightly. And tighten the harness appropriately. And make sure the chest clip is properly placed. The crazy thing about kids and carseats is that there are so many things that can go wrong with them that we need an entire profession to help parents get it right! I remember making some of these mistakes—and more. Aye yi yi. It’s amazing we’re all still here.

Carseat 101

You’ve peed on the stick and found out you’re pregnant. Yay! (Or not. Who am I to say?) You’ve gone to Target, Buy Buy Baby, and Amazon.com and registered for every single baby item under the sun that’s plastic and can be sanitized and trust me, it all coordinates, right? Now you’ve come down to the final weeks and it’s panic time when you realize this baby is coming out one way or another and you have to get it home. You just stick Baby in the carseat and go, right? No. Nope. No way, new parent. You are now attending Carseat 101 and there will be a quiz at the end. I have no doubt you will pass with flying colors!

First, let’s go over some vocab you’ll need for the next, oh, decade or so. Yeah, baby, your precious is going to be in a seat for a loonngg time. In chronological order, please:

Rear-facing only infant seat:

This carseat is used for newborns to sometimes toddlerhood. It’s easily identified by its handle, canopy, and left-in-the-car base. The carrier portion fits onto the base.

Convertible seat:

This carseat can be used for newborns, but is often used after a child outgrows a rear-facing only seat. It rear-faces, then converts to forward-facing for older kids.

Combination (harness-to-booster) seat:

This carseat is for older kids, the kind who order combo meals at fast food restaurants (and yes, you too, will succumb to buying your child a grease-loaded meal item at some point). A combo seat FORWARD-FACES ONLY. It has a harness to keep wiggly kids safe, then the harness comes off (many store on the seat itself now) and it can be a belt-positioning booster. See why it’s for older kids only? It combines a harness and a booster into one seat. You don’t always need a combo seat. Sometimes your child can go straight from a convertible seat to a belt-positioning booster, depending on which convertible she uses and how old and big she is.

Belt-positioning booster seat:

This carseat is for kids who nearly have gray hair. Just kidding. Barely. The purpose of a booster seat is to boost a kid up higher so that the vehicle’s lap and shoulder belt will fit them superbly over their bones, not their soft bellies. Kids have to have a certain amount of maturity in order to sit still in a vehicle seat belt and that comes around ages 4-6, depending on the child. Most parents find their kids transitioning out of a harness around ages 5-6, when “real” school starts, not that “pre-“ stuff. There are highback and backless varieties of boosters. Highbacks are great for the younger crowd because they provide head and torso support for sleeping. Backless boosters are harder to see from outside the car, so older, image-conscious kids like them better. Kids use booster seats until they can 5-step—fit in the belt like an adult—which is when they get to be the size of a small adult, around age 10-11.

Let’s identify that you’ve gotten the right carseat for you. It used to be that an infant seat was an infant seat was an infant seat. Basically, all the carriers did more or less the same thing—it was the bases that distinguished them. Now we have carriers that fit small babies very well, some that don’t, some that have no-rethread harnesses, some that have canopies that disappear, and some still hanging around that fit kids up to 40 lbs. There’s quite a variety from which to choose and that can cause more confusion than ever! What’s my very first piece of advice to you in this area? Don’t insist on a travel system. Pick the very best rear-facing only seat that will work for you, then pick the very best stroller you can afford and put them together. Many strollers come with adapters and with a little bit of research on their website, you can find if the infant seat you want will fit on the stroller you want. The patterns may not match perfectly, but you will get a much better stroller this way usually unless you buy a high-end infant seat/stroller combo to begin with. I speak from experience: you don’t want to be stuck with a stroller you hate for years because you wanted to be all matchy-matchy with an infant seat you use for months. To help you in your search, we have both thorough, professional reviews and a list of our favorite seats.

Most of the time you will know if you’re going to have a small, average, or large baby by the end of your 40 weeks. If you and your partner are small folks and come from small families, genetics won’t let you down. Look for a rear-facing only seat that starts with a low birth weight of 4 lbs. It’s the same if you’re having a difficult pregnancy or if you’re having multiples. Fortunately, there are lots of rear-facing only seats that now have a minimum weight limit of 4 lbs., but they don’t always fit the preemie-sized babies well. We have a list of our favorite seats that fit preemies and multiples. If you’re having an average- or large-sized baby, any infant seat will do, though you’ll get more bang for your buck with a larger one. The size of your vehicle also has to be factored in since the larger the infant seat, the more space it takes up in the vehicle.

Now for some answers to common questions:

You may have heard that the American Academy of Pediatrics (AAP) recently updated their recommendations on rear-facing. As usual, there’s some good news and some bad news. As with our carseat reviews, we will discuss both the good and the not-so-good and try to offer some perspective lacking in national news coverage of this update.

The Good News: The basic recommendation for rear-facing has NOT changed. “The Academy continues to recommend that all children ride in a rear-facing car safety seat as long as possible, up to the manufacturer’s stated weight and length limits.” This updated guidance from the AAP now better matches NHTSA’s policy for consistency in messaging. The authors of CarseatBlog have strongly supported Extended Rear-Facing (ERF) for over 15 years and continue to support this practice.

ERF in 2003 – now off to college!

The Bad News: As we reported a year ago, a major study from 2007 was found to be flawed. This study was the main source of injury data to compare rear-facing child restraint systems (RFCRS) to forward-facing child restraints (FFCRS) in the USA, for children up to 23 months old. It was also the basis for the erroneous ‘Rear-facing is 5x safer’ statistic. Newer research found some contradictory data, causing the original study to be retracted. A revised study, by some of the authors of the original 2007 study, concluded, “Non-US field data and laboratory tests support the recommendation that children be kept in RFCRS for as long as possible, but the US NASS-CDS field data are too limited to serve as a strong statistical basis for these recommendations.” This led to the evolving AAP advice that, “…while the trend was for rear-facing to be superior to forward-facing for children under 2 years, the numbers were too low to reach statistical significance.” Definitely not as compelling as 5x safer.

More Good News:  The reason there is no significant real-world information is because the sample size of injuries to children in car seats is so low during the 22 year study period that there simply isn’t enough data to compare rear-facing to forward-facing conclusively. In fact, all these studies included less than severe injuries just to do an analysis, because there are so few data points for severe/fatal injuries to kids in child restraints. According to the revised study, “NASS-CDS data indicate an extremely low injury rate in children up to 2 years of age in both RFCRS and FFCRS.“ It turns out that both rear-facing and forward-facing car seats do a very good job of protecting children within the relevant age/weight/height limits!

Because the real-world injury data in the USA no longer supports that rear-facing is significantly safer for kids up to 23 months old, the AAP removed the portion of their policy statement recommending that kids remain rear-facing until at least 2 years old. Also, since the original study is retracted, we have to pretend that it never existed. Therefore, we can no longer claim that rear-facing is proven to be five times safer than forward-facing. We can’t even say that statistics prove that rear-facing reduces the real-world risk of serious injury for kids up to 2 years old [or to any age] in the USA.  On the plus side, the 2011 AAP policy on rear-facing to at least age 2 led to a lot of awareness about the safety advantages of rear-facing.

Let’s take a step back and examine the most recent AAP policy statements to put these minimum age recommendations in perspective. Fundamentally, the policies on rear-facing haven’t changed, except for the inclusion of minimums. For over 15 years, the AAP has continued to recommend that kids remain rear-facing to the limits of their car safety seat. In essence, “as long as possible.”

AAP 2018: All infants and toddlers should ride in a rear-facing car safety seat (CSS) as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer. Most convertible seats have limits that will permit children to ride rear-facing for 2 years or more.

AAP 2011: All infants and toddlers should ride in a rear-facing car safety seat (CSS) until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their CSS.

AAP 2002: Children should face the rear of the vehicle until they are at least one year of age and weigh at least 20 lb. Infants younger than one year who weigh 20 lb should still face the back of the car in a convertible seat or one that is approved for higher weights. For optimal protection, the child should remain facing the rear of the car until reaching the maximum weight for the car safety seat, as long as the top of the child’s head is below the top of the seat back.

Clearly, this is not the end for extended rear-facing. The retraction of the main study supporting ERF in the USA is indeed a big loss, but not a total surprise because this study had known flaws long before this retraction. Again, the fundamental guidance HAS NOT CHANGED. We still recommend kids remain rear-facing, preferably for 2 years or longer if they are within the rear-facing height and weight limits of their carseat. In particular, parents should pay close attention to the seated torso height limit of the rear-facing seat (which typically requires 1″ or more of shell above the head).

As always, we like to remind parents that these recommendations from the AAP are safest practice guidelines. They aren’t rules or laws. The rules a parent must follow are those printed in their car seat and vehicle owners manuals, on the car seat labels and in any relevant state law. CarseatBlog endorses the AAP guidelines for added safety. We also like to offer perspective by looking at the BIG picture. The biggest reductions in risk come from the following simple steps:

1. Drive unimpaired and undistracted
2. Keep all passengers properly restrained according to the instruction manuals and state law
3. Kids under 13 years in an appropriate rear seating position

So please, buckle up and drive safely!

See our Rear-Facing Links Guide for additional information.