Installation Misuse Observed During Virtual Car Seat Safety Appointments

Katie Downie, RN
Carlos J. Hernandez-Morfin, BS, CPST
Mubeen A. Jafri, MD, FACS, FAAP
Amber Kroeker, MPH,
Scotti Reed, CPST

The Injury Prevention Program at Randall Children’s Hospital in Portland, Oregon pivoted to virtual telecommunications following the COVID-19 pandemic beginning in March 2020. We were able to use this unique opportunity to examine the efficacy of virtual car seat safety education appointments compared to in-person appointments. We sought to compare observed virtual seat appointment misuse with documented in-person car seat misuse rates. Our examination shed light into challenges of proper car seat installation prior to baby’s arrival and demonstrated the potential for using virtual seat appointments even when in-person activities are safe to resume.

We examined all expectant caregiver car seat installation data from virtual car seat appointments performed from January 2021 to December 2021. Over 98% of these appointments (N=206) were for rear-facing only infant car seats with a stay-in-car base; only 3 families planned on using a convertible car seat from birth. Car seat appointments were conducted by a certified child passenger safety technician via FaceTime, Zoom, or Skype. Detailed information regarding the initial and final installation were entered into a spreadsheet for tracking and data collection purposes. No personally identifying information was tracked. Calculations were performed in Microsoft Excel.

In the 206 car seat installations that were observed, 83.5% of car seat installations (ie, non-harnessing components) required adjustments to be suitable for a newborn infant. On average, a misused seat had 1.5 individual misuses. Most common misuses were recline angle (62.8%), seat-specific violations of the manufacturer’s instructions (20.3%), use of both lower anchors and seat belt (15.7%), loose lower anchor webbing (15.1%), and use of lower anchors in a prohibited position (11.0%).

We observed high rates of car seat installation misuse over 12 months of virtual car seat appointments. This data does not include seat misuse that may occur after baby arrives. Access to education for car seat installation and proper use are essential components of a hospital based injury prevention program. The ability to continue this service in a virtual format has been effective in identifying and correcting car seat installation misuse and should remain an option for families in the community, both in preparation for and after baby’s arrival.

Understand the efficacy of virtual car seat safety education appointments by comparing misuse data discovered during in-person check appointments to misuse observed during virtual sessions.
Examine the rate of car seat installation misuse for expectant caregivers.
Identify the most common rear-facing only car seat use errors and installation trends.