What is a Car Seat Test?
A car seat test, often called an “angle tolerance test” is where a baby is strapped into a car seat for 90 minutes while hooked up to a monitor that can make sure the baby maintains his heart rate, breathing rate, and oxygen level during the test.
Who should get a Car Seat Test?
The American Academy of Pediatrics recommends that all babies born before 37 weeks and those weighing less than 2500g get a car seat test before going home from the hospital. Other babies who should get a car seat test are those who are:
- Going home on an apnea monitor
- Going home on oxygen
- Known to have craniofacial deformities–like Pierre Robin sequence–that may make it harder to breathe in a semi-upright position
- Considered to be at increased risk — by the pediatrician or other members of the healthcare team — of not tolerating a semi-upright position.
During the car seat test (often called an “angle tolerance test), the baby will sit properly strapped into her car seat for 90 minutes to make sure that her heart rate, breathing, and oxygen levels stay in a normal range. The semi upright postion of the rear-facing car seat is a stressful position for a baby, compared to laying flat. A baby “fails” the test if her heart rate drops (bradycardia) OR her oxygen level drops (desaturation) OR she stops breathing (apnea).
What if my baby passes the car seat test? The AAP recommends that babies who “pass” their car seat test go home in a rear-facing car seat.
What if my baby fails the car seat test? Babies who “fail” their car seat test may be retested in their car seat in another day or two to see if they pass. Babies who continue to fail their car seat test should not be automatically sent home in a car bed; rather, they should have a “car seat test” in the car bed to see if the apnea, bradycardia, and/or desats continue to occur in the car bed, or if the car bed seems to resolve the problem. If a baby is discharged home in a car bed, there should be a plan in place for retesting the baby in the future so that the parents know when it is safe to transition back to a regular car seat.
Car beds should only be used for infants who “fail” the car seat test – i.e. they can not maintain their heart rate, oxygen level or breathing rate while in the rear-facing car seat – as the protection provided by a rear-facing car seat is better documented than that for car beds.