Child Passenger Safety: Infant Car Seat Challenge

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Your baby’s doctor has ordered a Car Seat Challenge. This is a test that gives the doctor valuable information about how well your baby might be able to handle sitting in his or her car seat for travel.

Why the test is done

Car seats place babies at a semi-reclined angle, (from 30 to 45 degrees). The Car Seat Challenge is a way used to identify babies that might be at higher risk for problems such as trouble breathing while in these semi-reclined angles. Infants who are born premature have a low weight at birth (less than 2.5 kilograms). Very small and special needs infants have more risk of these complications. It is important for you and your doctor to know if your baby will have problems before going home.

How the test is done

You will need to bring your baby’s car seat to the hospital several days before going home. The test will be done at the bedside, usually after a feeding and diaper change. Your infant’s nurse will place him on a monitor and secure him in the car seat. During the test, the baby’s heart rate, breathing and oxygen level will be watched for 90 to 120 minutes. If there are changes in these levels during the test, the test will be stopped. Your baby will be taken out of the car seat and the doctor will be notified.

After the test

If your baby passes the Car Seat Challenge, you still need to watch him closely when he is in his car seat. If your baby did not pass the test, the doctor may repeat the test in the same car seat on another day or test him again in a different car seat.

Remember, the Car Seat Challenge shows how well the infant tolerates being at a semi-reclined angle. Other infant equipment (such as “bouncy seats”, swings and even slings) also place infants at a similar angle. Babies should be watched closely while in any semi-reclined infant equipment. Also, only put your baby in his car seat to travel. Do not let your infant sleep in the car seat when not traveling.

Please learn about your baby’s car seat, how to properly position your baby in it and how to properly install it into your vehicle. Your child should stay rear-facing until he is 2 years old. Even if his feet touch the back of the seat, this is okay. If the baby’s head is within an inch of the top of the car seat shell, he is too big for the car seat and must be moved to another seat. Check with your child’s doctor before placing him in a forward-facing position. Some children with special needs may need to remain rear-facing longer because it better protects the head and neck. Nationwide Children’s Hospital has a Passenger Safety Program that can help answer some of your questions. You can also go to a nearby car seat check location, or contact your local fire department or health department. Go to to find one near you.

If you have any questions, be sure to talk to your nurse or to your child’s doctor.

Child Passenger Safety: Infant Car Seat Challenge (PDF)

HH-IV-119 11/10, Reviewed 9/13, Copyright 2010, Nationwide Children’s Hospital