Car Seat Safety and Feeding Considerations with The Car Seat Lady Alisa Baer, MD

Alisa Baer (1s):

So the first thing you want to make sure of is the person that you're seeking advice from is a nationally certified child passenger safety technician or instructor. And not only that they're certified, but that they're currently certified.

Katie Ferraro (13s):

Hey, there, I'm Katie Ferraro, registered dietitian, college nutrition professor, and mama of seven specializing in baby-led weaning. Here on the Baby-Led Weaning Made Easy Podcast. I help you strip out all the noise and nonsense about feeding, leading you with the competence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. Hello, and welcome to another episode of the Baby-Led Weaning Made Easy Podcast. I have a special guest today talking about something a little bit different for us on the baby-led weaning podcast. It's about car seat safety. And that's because this episode is going live during child passenger safety week.

Katie Ferraro (58s):

So since we are not just feeding our babies in a bubble and a lot of us, to be real, are not going anywhere, but in the event that the global pandemic ends and we get back in our cars and go places, we need to be safe about how our children are sitting in their car seats and then how their car seats are installed. So I have the car seat lady Alisa Baer with me today on the podcast. She is a pediatrician who her mom is the OG car seat lady, her mom's a labor and delivery nurse. Who's been doing this like together and her business partner, Emily who's like her childhood friend. Those three ladies combined actually make up the car seat lady team. So you might know them from Instagram, @thecarseatlady. They have a very popular YouTube channel.

Katie Ferraro (1m 39s):

They've got a really amazing website with tons of information, but like not too much information. What I love about Alisa and she shares it in this episode, she just boils down her suggestions based on her. Again, their team has done 50,000 car seat installs. Their collective knowledge about safety, about the different seats, and they give you like three options. That's what I need in my life. Less is more. I think if you have a child who's in a car seat, you really do need to listen to this episode. So with no further ado, I want to introduce you to Alisa Baer again, pediatrician, but also otherwise known as the car seat lady. Well, hi Alisa. Thank you so much for being on the podcast with us today.

Alisa Baer (2m 14s):

It's my pleasure. Thanks for inviting me.

Katie Ferraro (2m 16s):

All right. We're here today. It's a little different episode topic for us, cause we're talking about car seat safety. Now we have a lot of pediatricians on the show, but you are a board certified pediatrician. And I, for one don't know of any pediatricians who are also car seat safety experts. Could you tell us how you came to be involved working in this line of work?

Alisa Baer (2m 33s):

Yes. I owe it to my mother. She is the OG car seat lady. She got involved early 1980s and car seat safety back in the days when the state laws were just passed. And the goal was just to get people using car seats, using them properly, that was a pipe dream at that point, just getting the kids into the seats and then over time that evolved to once people start to use them, then making sure they use them properly. I really got involved my senior year of high school. I did an internship for a month all of us were required to do, and I didn't know what to do. And my mother kept saying, just volunteer and do your internship at the hospital where she's a labor and delivery nurse, work on the nursery floor and teach the parents what to do with their car seats. And I couldn't think of what else to do.

Alisa Baer (3m 14s):

Everyone else was shadowing someone like a doctor, a lawyer, an accountant. And I couldn't do that for a month. I had to fill out what I was going to do and I had no other ideas. So I put down that I would do exactly what she said, that where I would work on the nursery floor. I did that and we are now 22 years later. And that totally changed my life. I always knew I was going to be a pediatrician. I did not think I was going to be a carseat lady, but life takes you in strange paths. So I continued with the car seats through college and medical school. I did my residency at the children's hospital of Philadelphia and have been back in New York city for about 12 years now, helping families, both one-on-one in person as well as lots of families.

Alisa Baer (3m 56s):

I'll never meet in person via our social media, as well as virtual consultations that we do.

Katie Ferraro (4m 2s):

I think a lot of our audience can identify, but one of the most terrifying things that happened to you in the first few days of being a parent is well they let you leave the hospital with this baby, but then they walk you out. And at least in the United States and the nurse observes you putting the baby in the car seat. But if I recall correctly, I'm in California. I don't know if it's different state by state. They won't actually do it for you. Are they just making sure you know how to do it or the seats installed safely? What are they really checking for?

Alisa Baer (4m 28s):

That's a very good question. That's going to vary by hospital. It's not a state issue. It's a hospital issue. The problem is most hospitals have some policy where they want the nurse to observe the baby in some way in the car seat. But very few hospitals have actually deemed it important to train the nurse and what to look for. So the vice that's offered. It's always very well-intentioned, but often, typically very incorrect. It's important that parents know who is giving them the information and what their training is. Ask the nurse Are you a certified child passenger safety technician? If they say no, then take with a large grain of salt what they're telling you with regard to car seats, they do have extensive training in other aspects of caring for your newborn before discharge.

Alisa Baer (5m 14s):

But this is something that without special training with the misuse rate amongst healthcare professionals for their own children is the same as amongst parents who are not healthcare professionals. The studies show that about 95% of car seats have at least one error and half of all seats have at least five errors with something

Katie Ferraro (5m 32s):

Thats's not the actual seat right? Its like user error?

Alisa Baer (5m 36s):

User error, correct. The car seat as it came in, the original box was safe. It passed all the government crash testing, but the installation of the seat in the car and/or the harnessing of the child in the seat, as well as like the setup of the seat, maybe you rethread the straps improperly. There's a lot of room for error, unfortunately.

Katie Ferraro (5m 54s):

Okay i'm going off script here but now that you've entered this, I'm like, I have all these questions. So don't judge me. But when I had my baby quadruplets, they're in the NICU for a month, they came home one by one and I didn't, it was such a high risk pregnancy. I didn't even buy car seats because I didn't know what was going to happen as they were starting to come home one by one again, please don't judge. I went on Craigslist and I bought car seats. And as I understand it, it's totally illegal and you should never buy a car seat. Do they all like, a used one. Do they actually expire?

Alisa Baer (6m 19s):

There are expiration dates. It varies by seat. It typically ranges between six to 10 years, but you do have to check your specific car seat, but there's more than just checking the expiration date when getting a previously used seat. A car seat that's been in a crash, most of them should not be used again. There are some seats that can be your reused after what's considered a minor crash of which there are certain criteria for that, but most manufacturers do not want their seats reused after any type of crash. And that's not something that you can tell by looking at the seat. When purchasing a previously used seat, you have to be careful that you can fully trust the person you're purchasing it from, especially in that they might have a financial interest in not being as honest as they should be.

Katie Ferraro (6m 59s):

Getting a car seat, let's say your sister had a baby a year before you. And she's like, I'm done with my infant seat. Instead of putting it in my garage, do you want to use it for your baby? She's going to be much more trustworthy to answer. Was she in a crash in an honest way? Rather than someone who has a financial stake in you buying it. That would be my caution with buying a previously used seat also to make sure that all the parts are there and in good working order, especially with infant seats, a lot of times, parents that sell them forget to give you the infant insert, which might be required on that seat and needed to fit a preemie well, or even a regular size newborn as well as, did they misroute the straps? I often see that when parents come with the seat for their second child, they'd used it previously and this was just their own seat, but they hadn't had routed the straps properly.

Alisa Baer (7m 47s):

They weren't aware of it. And if they had sold it to someone else, they might not have noticed that it didn't come to them set up properly. You need to be very careful, but it's best done amongst family and close friends rather than strangers.

Katie Ferraro (7m 59s):

When you mentioned the crash, my sister was recently in a car accident and the kids were not in the car, but she had two car seats in the back. And her car was so old that when the insurance company found out what had happened, he actually sent her two brand new Diono car seats because she had had old ones in her backseat. The value of the two car seats combined was more than the value of the car that she basically had to turn in.

Alisa Baer (8m 19s):

Yes, for very old cars. That can definitely, especially once you get up to two or three car seats, yes, that can be an issue. And so that highlights one thing where even if the child is not in the car seat during the crash, the seat still needs to get replaced. The child being in it does not affect the replacement criteria.

Katie Ferraro (8m 37s):

Our audience consists primarily parents and caregivers who have babies who are around six to 12 months of age. They're not coming right home from the hospital. They've been doing this for a few months. Of course, they're still going to be in rear facing car seats from your experience. Cause I know you and your team have done more than 50,000 car seat installs. Give us the three most common mistakes that you see parents and caregivers of six to 12 months making when it comes to car seat, safety.

Alisa Baer (8m 60s):

Loose and loose. So that means that the child is buckled too loosely in the straps. Everyone is so afraid of making the straps too tight. When the reality is basically every single parent is making them too loose. On most seats, there's so much friction involved in just getting the straps properly snug that even if you wanted to make them too tight, it's physically impossible. That affects the child's safety and the tighter the straps are to the body, the more the child comes to a slow gradual stop during a crash. Whereas if the straps are loose, the child comes to a jolting stop. And that jolt is what helps to increase the risk of injury. So we want the child to move with the straps rather than into the straps.

Alisa Baer (9m 43s):

You can think of it kind of the forces in a 30 mile per hour crash or similar to jumping from a third story window, which you would be crazy to do. But if you had to, and someone offered you to land with a parachute or to land on your feet, you'd pick the parachute because it gives you a slower, gentler stop. Cause that's what we're trying to do with a car seat where the straps are snug to the body. And also importantly, when I mentioned the other loose that's that the car seat is installed to loosely in the car and the car seat is too loose, it too comes to a jolting stop. And it also prevents the child from taking advantage of many of the safety features that the car has built in to help manage the crash energy. For example, in a frontal crash, the front end of the car crumbles in that absorbs a tremendous amount of the energy of the crash.

Alisa Baer (10m 28s):

And therefore, if the people in the car or tight to the car, which for kids requires that their car seat is really tight to the car, then they can take advantage of that. And less of the crash forces will be put into the child's body and in so doing, it lessens the risk of injury we want to have. Tighter is better. The child's straps should be snug and the seat should be tight to the car.

Katie Ferraro (10m 49s):

You have a third one that you could add just to round it out?

Alisa Baer (10m 52s):

Third one, there's a whole wide variety, but I would say in this age category, it's usually forgetting to make the adjustments to the infant seat as your baby's been growing. Typically on many of the infant seats, there's an insert that needs to be removed under the child's bottom. Often that gets removed long before six months. But if you haven't taken out by six months, basically every infancy definitely need to do that. And also moving the shoulder straps up, the shoulder strap should come from just a teeny bit below the shoulders, like a backpack strap. But oftentimes parents have forgotten just because you're sleep deprived and there's a lot of other things going on and the straps are coming very low and often poorly fitting as a result they're sliding off the shoulders.

Katie Ferraro (11m 34s):

Can we talk for a second about eating in the car seat? Because my audience, this is a feeding podcast. They're getting increasingly confident in their baby's ability to feed themselves. And then the next question they'll ask is give me some ideas for some cars or some car snacks or some safe travel snacks. Could you talk a little bit about feeding your baby solid food in the car prior to 12 months of age?

Alisa Baer (11m 55s):

Prior to 12 months of age in any situation, the babies should always be supervised the entire time that you are feeding them . A car, even if they are supervised, I would not recommend giving an under 12 month old food in the car and that they're still working on learning how to eat. And if God forbid you were to need to do the Heimlich maneuver, a car is not the correct environment to do that in, in that number one, you'd have to take them out of the car seat, which now introduces a whole nother level of risk, which is getting into a crash with a child of their car seat, but also doing the Heimlich in the backseat with the child on your lap. This is not the situation you want to be in the best way to prevent this is to simply not give kids in this age group, solid foods in the car.

Katie Ferraro (12m 39s):

I always remind parents too, that if your car seat is properly installed and it's real rear facing and you're babysitting it properly, they're reclined in such a matter that the angle is at the perfect angle where your baby could potentially choke. We always want our babies sitting upright at a 90 degree angle with their feet resting flat on the hard surface that is their foot rest in order to facilitate the safest swallows. And since you can't achieve that in a car seat, we just advise you to only feed your baby outside of the car seat when they're sitting properly. How about older kids though? Once they're more confident eating, let's say we're forward facing at four years old. Now, how do you feel about eating in the car?

Alisa Baer (13m 16s):

I think some of this depends on each parent's knowledge of their child. Also what the child might be eating. The safest thing is to not feed the child in the car, but as someone who has given my niece and nephews food in the car, I'm not going to tell anyone not to do it at the age of four, because I found it necessary, especially on longer drive sometimes, but there's ways to do it more safely and to minimize the risk. The first thing is you need to think about what food you're giving them. You're not going to feed them grapes, hotdogs, baby carrots, peanuts, popcorn. Those are significant choking hazard. So one thing I often find, and I'm finding a lot in younger kids' car seats are popcorn and hard nuts.

Alisa Baer (13m 58s):

Those are foods that we never recommend that young kids eat really not under the age of six and that they don't chew enough and increases the risk of choking, but especially not in a car, you want to be giving the child foods that are the least likely to need to be chewed extensively. So that would be one thing I would think about. So like a cheese stick, especially the ones that are square, not rounded could be something good. They don't require a lot of chewing. Pouches can be risky from a cleaning perspective,

Katie Ferraro (14m 26s):

You're talking to the wrong audience about pouches. They don't feed them anyway.

Alisa Baer (14m 33s):

Yeah so just from the mess is, can be a nightmare. Other foods, certain fruits. I think if they're cut up in the right way, but you also have to think about besides the risk of choking, which obviously gets lower as kids get older is what is the mess factor in that do you have a car seat where you can wash the cover? What happens if they get their straps dirty? Because most car seat straps, they don't want you washing them in anything but water. And some manufacturers don't even want you submerging them. Some seats, you can replace the straps. If the child gets them disgusting. Others, you're just stuck with disgusting straps. And not only can it be yucky, but it can also affect the safety.

Alisa Baer (15m 13s):

So when thinking about giving kids dry crumbly foods, like some crackers and other types of food that crumbles the one thing to be very careful about that is a safety risk related to the car seat is that oftentimes those crumbs meander, not just into the child's mouth, but all around their seated environment. And when they get on the tail, the strap that you use to tighten the child's harness straps, they can also get the crumbs embedded into that strap. And the crumbs make the strap slippery. And I've seen on numerous occasions where the parent calls me up and says, I buckle my child. I tightened their straps. And then I turn around and they're loose. The child is leaned forward. The straps loosened and what's happened is the food has made the strap slippery and it doesn't lock properly.

Alisa Baer (15m 57s):

And then in a crash, the child would not be able to benefit from the car seat because the straps are not locking. So make sure you're keeping the straps very clean and free of debris.

Katie Ferraro (16m 6s):

And I always try to remind parents do that choking is going to be a silent event. So if you're driving the car and your child is choking and not just not babies, older children can choke as well. You're not going to hear it happen. So when in doubt, leave it out as far as the mess goes. But certainly, and I will say, if you guys need to take a snack break, then pull over and take a snack break, but don't try to do two things at once. You should always be focusing on driving and not worrying if your kids are going to be choking in the back.

Alisa Baer (16m 33s):

Correct. And yeah choking is silent cause choking is blocking off all passage of air through the airway. And when you block all passage of air, it also blocks all passage of sound, because what makes sound is the passage of air.

Katie Ferraro (16m 45s):

You mentioned the washing of the carseats. I'm a total clean freak, but one thing I've learned from car seat installation safety events is that you actually shouldn't wash most of the car seat fabric because isn't there some sort of flame retardant or there's a safety mechanism built in that you could essentially wash away if you wash it too much?

Alisa Baer (17m 3s):

Just like people feel strongly about pouches, some people feel strongly about flame retardants. And so if a parent is looking to remove some of the flame retardants in the cover of their car seat, some of them don't have any flame retardants added, but if there are some that are added, washing them with detergent does remove some of the flame retardant. So a parent could see it one of two ways in terms of the flame retardants actually reducing the risk of the child's injury. Should the car catch fire due to how much other flammable materials are in the car? The child's car seat having claimed returns actually does not really affect the child that much. And there's a push to get flame retardants removed from car seats because of that.

Alisa Baer (17m 44s):

But currently there is a requirement that the seat meets certain flammability standards and most seats choose to use flame retardants to comply with the state.

Katie Ferraro (17m 53s):

I never knew that. Another thing I learned as a new parent, I always thought the car seat base was for safety. And then when I started traveling, like I remember the first time I went on an airplane with my oldest and I had the car seat and the base and this other, like they had older kids looked at me like with this weird look and this dad nicely was like, you know, the base, like you should just leave the base if you're traveling, you don't have to take it with you. It has nothing to do with safety. It's just for ease of getting the baby in and out of the car. Is that true?

Alisa Baer (18m 20s):

So yes and no. So the base is a convenience feature. There are some seats that are safer without the base than with the base and some seats that are pretty equivalent either way and some seats that are going to be safer with the base than without. So let me explain. When you're using a seat without the base, as we were saying with any car seat, you want it to be installed as tightly to the car as possible. So for infant seats, there's two ways that the seatbelt can route around the car seat. One's called an American belt path. And one is called a European belt path, just for the countries where you're more commonly find it. But there's lots of car seats in the US that now feature a European belt path. So when you take an infant carrier without the base, taxis, Uber's, rental cars on vacation, I realized all that sounds weird in the era of COVID, but go with me here.

Alisa Baer (19m 7s):

I, you always start out the same way where the baby's buckled in the carrier. You take the vehicle lap belt, you pass it up over the lap area of the infant seat. There's guides on either side to hold the lap belt and you buckle it in. The American belt path stops there. It doesn't really use the shoulder belt, but there's a reason that all of us wear shoulder belts. It provides much better protection cause it holds our body much better, not just at our lap, but it holds our head and chest back. And so the European belt path takes advantage of the shoulder belt and it wraps it around the back of the car seat. So kind of giving the car seat a hug with the shoulder belt that significantly reduces how much the car seat moves in a crash. It reduces and basically eliminates the car seat from being able to recline any more during a crash.

Alisa Baer (19m 53s):

European belt path will reduce by half the forces on the child's head and neck and a crash compared to an American belt path in most situations. And this ties in with thinking about some of the bases as well. So in any situation we want the car seat to move as little as possible. So when using a seat without the base, the European belt path will give a tighter installation in basically any situation compared to the American belt path. So the European belt path is a safer installation method. If you have a seat that has an American belt path, you can feel free to still use it. So as long as you can get a secure installation in the car you're trying it in. With the base, if you have a car seat and you're looking to travel with it, and the seat has an American belt path, your base might give you a more secure installation than your carrier does with that American belt path.

Alisa Baer (20m 43s):

So one of the things we strongly recommend, and if you look on our website on our recommended infant seats, all of them feature a European belt path. So if you do want to go in another car, you don't have to bring the base. You'll get a very tight, very secure installation without the base. On the base, the feature to look for that limits the motion of the car seat the most possible are two things. One is what's called a load leg, which is a metal pole that comes down from the edge of the base and wrestle on the floor of the car. And that does the same thing that the European belt path does where it makes it so the car seat, the rear facing seat does not move to the front of the car and doesn't recline any further during a crash. And by restricting that movement, it allows the car seat to absorb more of the energy into its shell and put less of the force into the child's head and neck.

Alisa Baer (21m 29s):

So it will depend on your seat, but if you have a carrier with a European belt path, that's a very safe installation without the base. And your base is also a safe feature to use. It's very convenient. Just make sure you've installed it properly in your car. And if you're looking for the most safety features on a base look for a load leg and the other connection method that ups the ant in terms of the protection is a rigid latch connection. Most car seats will connect using belts, the seat belt, or the lower anchor strap, but one car seat here in the U S offers a rigid connection, no straps involved to connect the seat. And that seat will move the least in a crash compared to any other seat and in, so doing reduces the force on the child's body, more than the other seats in the US.

Katie Ferraro (22m 17s):

And for the rigid latch. I also learned that latch. There's an, it's an acronym. What does it stand for?

Alisa Baer (22m 22s):

Stands for lower anchors and tethers for children.

Katie Ferraro (22m 24s):

I just thought it was the noise that it makes when you click it in. But clearly there's more to it than that. This is all amazing information I know for our audience. Like you don't realize you don't know what you don't know until you hear about it on a podcast, but the episode that we're doing today, Alisa, is going to go live during child passenger safety awareness week. So I know a lot of our moms caregivers, everyone's living in this social media age, where if you know anything about car seats on Instagram, everybody is a freaking expert according to them. Could you please tell us what we should be looking for when seeking help with safe and proper car seat installation?

Alisa Baer (22m 59s):

So the first thing you want to make sure of is the person that you're seeking advice from is a nationally certified child passenger safety technician or instructor. And not only that they're certified, but that they're currently certified. So just because they took the course 10 years ago and didn't re-certify, that's really not the person you might be wanting to trust unless you ten-year-old advice. So the second thing that you'll want to look for is that if something doesn't sound right, they should be able to provide you with a source to back up what they're saying, either the manual to your car seat, or a research paper, or something in that this is a trained profession, like anything else. And some people have better training than others.

Alisa Baer (23m 41s):

And so if something doesn't sound right, always trust your instinct and ask questions, and if they cannot provide a source to support what they're saying, and you're thinking, oh, I'm not sure about that. Consult the manufacturer of your car seat, or seek the advice from a different trained technician or instructor.

Katie Ferraro (24m 1s):

You mentioned on your website, you have a lot of different resources. Could you tell our audience where they can go to learn more about your work and your team's work as well as those resources?

Alisa Baer (24m 13s):

Yes. So our website is thecarseatlady.com. On Instagram, we're @thecarseatlady. And we also have a large YouTube channel as well, which is The Car Seat Lady with the number one at the end. So on our website, you'll of course find a lot of information about car seats. We have a car seat buying guide that will walk you through the different stages, how to know when your child is appropriate for the next stage. A lot of parents have questions about when to transition. And then next question after when, is to what, and so we'll recommend seats. One of the things we do really differently than others is that you'll find that we don't mention every seat on the market on our website. There's a lot of, sure you've faced decision overload in many aspects of making parenting decisions.

Alisa Baer (24m 55s):

We've decided that when you come to our site, we are the experts. And we've decided to leverage that and give you just a few choices. Knowing that if you select one of these three seats in this category, those are going to be most likely to be the best ones for your child and your car.

Katie Ferraro (25m 9s):

And I do want to point out that all of the brands that you work with, you are not sponsored or endorsed. You don't receive any paid endorsement from these brands. These are, this is your objective opinion based on your expertise.

Alisa Baer (25m 21s):

Correct, that's a really important point. So we're very different from most others in that we do not do any sponsorships. We have no ads. Even our YouTube videos have no ads. This is we can make a lot of money on the part. Yes, you have to, you have to actively take them off, but that was a conscious decision we've made and might change in the future. But that's something that we just want parents to know that they're getting our expertise. I attend the leading research conferences on vehicle and child car safety throughout the US and Europe each year. And I base my recommendations on what I learned there, as well as my experience installing. I personally have installed more than 15,000 car seats.

Alisa Baer (26m 1s):

One of my areas of expertise is also three across which I'm sure is a topic that you're very familiar with. And so the other thing that parents will find on our website is not just help selecting the best car seat for their child, but also the best vehicle for their family. And that a lot of times the issue isn't that you picked a car seat, that's not so ideal for your car. It's sometimes that people chose the wrong vehicle

Katie Ferraro (26m 23s):

That just happened to be today. I was on a call with the car seat company, and we have a sprinter vans of seven kids in car seats and four across in the back. And I was like, I'm going to have quadruple. I'm going to put them all in the back. It's like, oh, you have this car seat forward facing. There's only two. There's actually more tethering spots. Now I have a 12 passenger van. I get it. But people don't have seven kids, but in a 12 passenger van, only four of the seats in that van, it's a sprinter van are quote on quote, eligible to do the top tether. And you can't do like aftermarket installation and stuff. So I'm up a Creek.

Alisa Baer (26m 55s):

Yeah. So it is, this is one of the things we help families navigate. So even in minivans, so not even getting into like 12 passenger vans fall into a weight class that is out of the realm of requiring lower anchors and tethers anchors, but even just a regular minivan, parents typically expect that every seating position will of course have a tether anchor and are often surprised to find that two, three or more of the positions don't have them. It's only required to have tether anchors and three seating positions and lower anchors in two so vehicles that are oriented towards families are often not built well for families with car seats. And just because a vehicle is big on the outside, does not mean that it's big on the inside.

Alisa Baer (27m 39s):

That's something that also surprises families. So I have a whole family vehicle buying guide. And the other thing is sometimes you just want someone to give you some personalized recommendations, like you've narrowed it down. And you're like, I'm between these three cars. Buying a car is a big decision. We offer virtual consultations to families anywhere in the US where we speak on the phone and we'll help you figure out which car, if you're in the market for one, is best for your family's needs, as well as which seats to use for each child and which installation method for that particular seat and that particular seating position, because just like you're, you've encountered a, how you'll install a car seat or where you can put some of your kids will vary based on what the vehicle has in that particular spot.

Alisa Baer (28m 25s):

And we also are offering zooms to check that the installation is correct for the seats that you have in your car.

Katie Ferraro (28m 29s):

And I'm going to link to all of your resources on the show notes for this episode, which is going to be at blwpodcast.com/60. And I, myself am going to sign up for consultation because I came here to learn about car seats, but apparently I need to buy a new car. So this is all very eyeopening activity.

Alisa Baer (28m 48s):

So there's ways to make it work, which some, the solutions to make it work when you don't have as many tethers as you need are not always what people want to hear or do. And so sometimes for that family, choosing a different vehicle is the better option for their needs. But what we would recommend doing in situations where there's no tether anchor. While the seats are required to pass the crash test here in the US the forward facing seats without a tether, they pass a less stringent test in terms of how far the child's head can move forward. And the seats are much safer with the use of the tether that reduces by at least four to six inches, how far the child's head moves forward in a crash, which is easily the difference between the child's head striking something hard, like the seat in front of you or the window versus not.

Alisa Baer (29m 34s):

So we would recommend for families who might find themselves in a similar situation to try rearranging putting rear facing kids in the positions that don't have tethered anchors, or if there's older that at least 40 pounds and mature enough to sit properly in a high back booster to use a high back booster instead. And that rear facing and high back boosters, a booster means that seat where the child wears the seatbelt across them, not the five-point harness. Those do not require tethers.

Katie Ferraro (29m 60s):

Okay. And I have to ask the question because all the parents want to know, could you tell us when it's okay to go from rear facing to forward facing?

Alisa Baer (30m 9s):

Yeah. So the American academy of pediatrics recommends that children remain rear facing in their convertible car seat until they've reached their rear facing limit for that seat. So the first thing is to clarify is they're not saying to max out the infant seat and then turn the child forward facing. So from an infant seat, you then, which parents of six to 12 month olds are either about to make this transition or have already made it usually where the convertible seat is a seat that starts out rear facing and then later turns forward facing. Selecting one that not just the numbers indicate, but that it will take a big child, but also that the internal capacity will fit a big child is important. So most kids are going to outgrow their seats, just like you might be seeing that your baby is getting too tall for their infant seat before too heavy.

Alisa Baer (30m 52s):

And too tall is typically that the head is about one inch below the top of the seat. For the convertible seats, the height is usually the deciding factor for outgrowing it as well. Some seats, it's the weight and obviously depends on the child's proportion, but it's important to consider the height. The child's feet touching the back of the vehicle seat is not an indication that the child has outgrown rear facing either

Katie Ferraro (31m 14s):

Every parent thinks correct legs bent, and they're like, oh, time to move it. And it's not right.

Alisa Baer (31m 19s):

Yes, children are very safe and very comfortable with their legs sitting in positions that we cannot assume. It's safe and that during a crash, if you think about a frontal crash, the physics says that everyone moves to the point of the impact. So everyone moves to the front of the car. Forward-facing kids and adults are all going to be thrust forward. Your chest gets held back quickly by the straps, but your head does not, so it gets whipped forward and back pretty quickly. But for rear facing kids, they moved to the front of the car, but now they're being cradled by the shell of the car seat. And their legs are going to pull up kind of into like a Cannonball position during that frontal crash. So what that means is that during the moment of the crash, your child is super scrunched.

Alisa Baer (31m 60s):

So whenever scrunched, they start, they get even more scrunched during the crash. And we know from studies that we do not see injuries from that. As far as the being uncomfortable, your child's ligaments are very loose. They're joint spaces are wide open. It gives them flexibility and range of motion that your body simply does not have. Even if you do yoga every day and are super flexible, your child is still more flexible because their body is different. So it's safe and comfortable for the legs. The limit is usually that the head is an inch below the top of the seat, but you do need to check your seat. Our goal is to keep kids rear facing. Most convertible seats can take kids depending on the child and the seats somewhere between three to six years of age.

Alisa Baer (32m 41s):

So trying to use the seats as long as is what's recommended. It's also important to note that about a third of all states in the United States now require rear facing until two years of age. But hopefully you would exceed that even like in New York, where I live, two is the bare minimum to turn forward.

Katie Ferraro (32m 59s):

And I think parents, we always talk about like feeding milestones and they're okay. At six months, my baby shouldn't be able to drink out of an open cup that we want to be off the bottle by 15 months. But I think they just want to, like two years, we flip them around and I'd so nice to hear you say, it's okay to be rear-facing, it's actually safest from three until six years old. That's really different than I think what a lot of parents, myself included have heard over the years.

Alisa Baer (33m 21s):

Yes, it is different. And part of our struggle has been changing the cultural norms in much the same way that I'm sure you've encountered for a parent who's choosing baby-led feeding. It's very different. And I'm sure a lot of people like, what are you doing? Giving your child that, you know, this hunk of food, why aren't you pureeing the heck out of the food? You're giving them, it's a cultural thing. And so as we learn more, we can do differently and often better. And the same goes with car seats. So be open to new things and other countries that keep the kids rear facing a long time. So things to look for in a convertible seat. And you'll see on the seats that we recommend. We look for seats that offer the child a lot of room.

Alisa Baer (34m 3s):

Don't take up a lot of room, either side to side, because planning ahead, you might have another child or front to back. Cause oftentimes a lot of people want to flip a child forward facing cause the rear facing seat they chose is eating up too much room into their front seat. And the adult is complaining that they don't have enough leg room. So the seats we recommend take up less room into the front seat, but actually give the child more room in the inside. They also allow the child to sit up higher off the vehicle seat for a better view out the back window. And that can make a child much happier. And that a child who can see out the window is going to be more entertained than a child staring at the roof.

Katie Ferraro (34m 36s):

Well this is so wonderful. And I love the work that you and your team are doing because much like with baby-led weaning, it's like babies can do so much more than we give them credit for, but we do need to normalize what's the safest practice and you guys are doing the same thing in car seat awareness. So thank you so much for taking the time to be here with us today and for sharing all of your time and expertise. This was hugely informational.

Alisa Baer (34m 60s):

My pleasure. This was great.

Katie Ferraro (35m 1s):

All right, bye now. Okay, wow, so I learned a lot about car seats. I hope you guys did as well. I know we went kind of all over the board from infant to boosters and rear facing European seatbelts. I mean, there's a lot in that episode, but I hope you found it interesting. I think Alisa is probably the most knowledgeable person about car seats in the United States. I love that she has the pediatrician background. I love that her and her team have done 50,000 car seat installs. After that interview, I actually stuck around on a call with her for another hour. I kept trying to be like, I'm so sorry, I don't want to take advantage of your time. She's like, no, tell me what your problem is. It's like, oh, I got this many car seats in this car. It's like take your phone out, go out and then FaceTime me, show me what you're dealing with.

Katie Ferraro (35m 41s):

Her one-on-one consultation, you guys is totally worth it. I cannot stress enough how educated she is about car seats and the cars. Cause it's, as she taught us, not just the car seat that we're choosing, it's how does that car seat fit with your existing car? So we avoided the situation of me needing to buy a new 12 passenger van and she showed me how to figure out my seven car seat situation. If you guys want to get hooked up with her again, go to the show notes for this particular episode at blwpodcast.com/60, I'm going to link up her car seat buying guide. Her YouTube channel is awesome. She said "I do to my YouTube a little bit different." She is the one person in the universe who sets it up. So she doesn't have ads on her YouTube. She is totally giving you, her and her team, 70 plus collective years of experience worth and narrows it down to just a few car seats.

Katie Ferraro (36m 27s):

I don't love a million choices. I like someone who's like, Hey, here's my three favorites. Based on my experience, pick one of them. If that's the way you make decisions, then the car seat lady is for you. Check her out again, blwpodcast.com/60. Thanks for listening and stay safe out there on the roads if you're going anywhere. Bye now.