Appropriate use of a car restraint (car seat) significantly reduces the risk of injury to a child in the event of a car crash.

Australian law regulates that babies under six months of age must be restrained in a rearward facing child restraint when travelling in the car.

This can be either a baby capsule or a rearward facing car seat (often labelled 0-4 years convertible car seat). 

All car seats available to purchase in Australia must meet the Australian and New Zealand Standards for Child Restraints Used in Motor Vehicles (AS/NZS 1754). If you have purchased your car seat from overseas, you should check that it meets these standards. Car seats also have an expiry date on them – 10 years from the date of manufacturing. You can find this information stamped on the plastic underside of the car seat.

Choosing a car seat

• Was my baby born premature or very small? If so, an infant capsule or a convertible car seat with good padding will be most appropriate.
• Is it important that I can lift baby in and out of the car without disrupting their sleep? If so, then a capsule which clicks into your pram might be most appropriate.
• Will my baby have ongoing complex medical needs after discharge? If so, then a capsule may be a better option so you can correctly position and fasten the baby into the restraint before heading to the car. 
• How many car seats do I need to fit across the back of the car? Consider the width of the car seat and if a slimline car seat is more appropriate.
• How can I check on my baby while travelling in the car seat? Some parents prefer to travel with one parent sitting next to the baby in the back seat. If so, make sure there is enough room to do so (particularly if you have another car seat in the back). Otherwise, use of a mirror on the head rest in front of your baby allows for intermittent visualisation of baby in the car seat, via the rearview mirror. 
• Am I comfortable installing this car seat myself, or do I want it professionally installed?
  There are several services around Melbourne who provide professional installation of car seats, usually costing <$100, including:
  - Baby Bunting – various locations, see: https://www.babybunting.com.au/installmycarseat/
  - Care Plus Automotive – 27 Racecourse Rd, Flemington (around the corner from RCH) – 9329 6000.
  - Hire for Baby – a mobile installation business who can come to you, see: https://www.hireforbaby.com/hire-products/child-restraint-fitting-service/
  - Or check here for other options: https://www.kidsafevic.com.au/find-a-fitter/ 

Securing your baby

• Ensure that your baby is wearing only lightweight clothing to ensure a good fit underneath the harness. If needed, you can add a blanket over the top once you have secured the harness.
• Make sure your baby’s bottom is positioned all the way back in the car seat, and there is no empty space behind their pelvis or lower back. Use your hands to feel around their bottom to check the position. This will prevent them from slumping down in their car seat.
• Make sure the harness height is at the baby’s shoulders or slightly above. If the harness isn’t in the right spot for your baby’s height, it will impact on how it supports your baby’s position and safety in the event of aa car accident. The harness may need to be re-threaded or adjusted with buttons on the car seat. Refer to the car restraint instruction manual on how to adjust this. Keep an eye on this harness position over the coming months – as your baby grows, the harness will need to be re-adjusted.
• Loosen the harness all the way out so that you can easily thread the chest strap over your baby’s arms. The harness should be loosened all the way out every time you get your baby in or out of the car seat, to prevent awkward positioning of their arms as you try to place the harness.
• Clip the harness into the buckle and pull the strap so the harness fits firmly over your baby’s pelvis and chest. You should still be able to put one finger between the harness and your baby’s body, but there should not be enough laxity to “pinch” the harness over your baby’s chest.
• It is important to remember that babies and toddlers should not be left unsupervised if sleeping in their car restraint. When you return home, the safest place for baby to sleep is in their cot or bassinet. NEVER leave your baby unattended in a car, even for the shortest time.
  

Planning for the future after discharge 

• There is very good evidence to show that babies and young toddlers are safest in the car when they remain rearward facing for as long as possible, often up to 2 or 3 years old. Rearward facing car seats have been shown to limit the amount of musculoskeletal damage to an infant or toddler when they are rearward facing, in the event of a car crash.
• Convertible car seats have markers on the inside of the seat which prompt you for when it is appropriate to turn your baby/toddler around to front facing. This should never be before 6 months old, and should only be once your child’s shoulders reach the maximum height for rearward facing. 
• Children need to be restrained in an appropriate car seat or booster seat until they are 155cm tall. VicRoads has further information on this - https://www.vicroads.vic.gov.au/safety-and-road-rules/vehicle-safety/child-restraints.
  

Extra support or assessment for babies on NICU 

Some babies may need extra support in their car seat, depending on their individual medical and postural needs. 

• At the time of discharge, some babies who are still very small (<2.5 kgs) may benefit from an Occupational Therapy review of the baby in the car seat, to ensure they are adequately supported. 
• Some babies who are discharged home on respiratory support may also need an Occupational Therapy review of the baby in the car seat, to ensure they can manage the more challenging seated position and may need additional support. 
• Some babies who have low muscle tone (e.g. “floppy”) may also benefit from an Occupational Therapy review of the baby in the car seat, to ensure they are adequately supported and safe with their breathing in the car seat. 

Your baby’s bedside nurse or care manager will refer your baby for an Occupational Therapy review of the car seat if it is deemed necessary. For legal and safety reasons, only an Occupational Therapist is allowed to make recommendations for modifications of a mainstream car seat.