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 lets the doctor know how well your baby can handle sitting in his or her car seat for travel.

Why the test is done

Car seats put babies in a semi-reclined position, (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 a semi-reclined position.  Infants who are born premature have a low weight at birth (less than 2.5 kilograms).  Very small and special needs infants like premature babies are at a higher risk of these problems.  It is important for you and the 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 or her on a monitor and secure him in the car seat.  During the test, your 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 or her closely when in a 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 do the test again in a different car seat.
  • Remember, the Car Seat Challenge shows how well the infant tolerates being in a semi-reclined position.Other infant equipment, such as “bouncy seats”, swings, and even slings, also put infants in a position like this.Babies should be watched closely while in any semi-reclined infant equipment.
  • 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. You must know how to properly position your baby in it and know the right way to install it in your car. The car seat should stay rear-facing until your baby is 2 years old.Even if the baby’s feet touch the back of the seat, this is okay.
  • If your baby’s head is within an inch of the top of the car seat shell, or if he or she weighs more than the highest weight limit of the car seat, you will need to get a larger car seat. Larger rear-facing car seats are available.Check with the doctor before placing your child in a forward-facing position.
  • Some children with special needs may need to stay 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 go to a nearby car seat check location, or contact your local fire department or health department to make sure your child is safe in his or her car seat.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 1/18 Copyright 2010, Nationwide Children’s Hospital