Sitting comfortably

By Caroline Roberts on 24 November 2017 Safety Midwives Magazine

Every new parent wants to get their baby home safely, but choosing the right car seat can be a headache. How can midwives help?

The largest proportion of deaths and injuries among road users are car occupants. They account for 46% of all those killed (Department for Transport, 2016). A baby travelling in a car is particularly vulnerable: its head accounts for a quarter of its total weight, and its neck muscles are yet to develop. So they need to be properly restrained: it’s a legal requirement that babies are transported in rear-facing seats that support the head and distribute the force of a collision through the shoulders and back.

The law says all children must travel in appropriate car seats until they are 12 years old or 135cm tall. But if a seat is to prevent injury, it has to be the right size for the child and properly fitted. Good Egg Safety, a community interest company that runs car seat checking events across England and Scotland, found that of more than 4000 seats checked in 2016, 66% were incorrectly fitted. Mistakes ranged from slack straps to wrongly routed seat belts – a potentially lethal error found in one in 10 seats checked (Good Egg Safety, 2016). 

Car seat confusion

Currently, baby and child seats can be fitted using the seat belts or the ISOFIX system, installed as standard in most cars since 2007. ISOFIX is considered safer as the seat clips are plugged into the corresponding fitting points in the car, reducing the risk of incorrect installation. However, it’s still important to check compatibility between a seat and car.

When it comes to the seats themselves, it’s confusing for parents that two standards run concurrently: the UK child-seat standard R44/04, introduced in the 1980s, and the Europe-wide R129 (known as the i-Size seat) introduced in 2013. The old standard is being phased out, as the i-Size seat protects against side impacts as well as frontal and rear, and has ISOFIX-only fittings. It also keeps babies in the safer rear-facing position until they are at least 15 months old and is measured according to a child’s height rather than weight, which tends to be easier for parents.

Training for midwives

Emily Maclean, a midwife on the maternity ward of a London hospital, believes it’s important for midwives to be well informed about car seats, so they can advise parents. ‘It’s something I get asked about a lot,’ she says. ‘NHS maternity care has a public health role and we are seen as an authority on a whole range of things. We have a duty to make sure people are transferred from hospital care to the community in a safe way. Car seat safety might seem like common sense but there’s a lot of technical information that parents need to know, such as how to choose the correct size and how to fix the seat in the car.’ 

However, as Jayne Marshall, professor of midwifery at the University of Leicester, points out, initial midwifery training rarely contains anything on car seat safety: ‘It’s part of health and safety, and is something that I feel needs to be addressed. It should form an important part of CPD.’ 

She has worked with the Mum & Baby Academy and seat manufacturer Britax Römer to produce a new education module (see resources, below) that will equip midwives to advise parents and count towards CPD requirements. Approved by the Child Accident Prevention Trust, it covers the types of car seats, fitting and other safety advice, and answers frequently asked questions. Module evaluation has found that 91% of practitioners felt more able to advise parents after completing it, compared with 38% beforehand. One participant said: ‘I feel not having had children myself can sometimes be a hindrance in this job, as personal experience is lacking. However, now I have completed this module I can offer impartial advice with confidence.’

Buying advice for parents

Retailers should have trained staff who can advise parents and show them how to fit seats. But Jan James, chief executive of Good Egg Safety, warns that, despite accredited training schemes, the level of staff expertise has been shown in the past to be patchy. The company has produced a consultation form for retailers to check they ask all the right questions, such as getting details of the child and every car the seat will be installed in. A version of this form for parents is also available on the Good Egg Safety website. ‘If a retailer doesn’t ask all those questions, we strongly advise parents to leave and find one that does,’ says Jan.

Top tips for car seat safety

  • Never buy a second-hand car seat, it may have internal damage that isn’t visible.
  • When buying a seat, take along the Good Egg Safety retailer consultation form and ask for a fitting demonstration. Ensure the seat will also fit cars belonging to grandparents and other carers.
  • The seat should feel secure, not wobbly, and you should be able to fit just two fingers between the baby’s shoulders and the strap.
  • Don’t strap babies in while they are wearing padded clothing as this will interfere with belt operation. Fasten belts and put a blanket over the top for warmth.
  • Install the seat in the back of the car – the middle space is safest. If a seat is installed in the front, deactivate the air bag. Parents should check the car manual for guidance.
  • Parents who use taxis should identify a reliable company that provides properly fitted seats.
  • Seats are designed for travel, not sleeping, so do not leave a baby to sleep in the seat for longer than 90 minutes.


Mum & Baby Academy car seat safety module:

For downloadable advice and guides: 

The law on child car seats:

For car seat safety and fitting videos: