Car seats, two-wheelers and travelling with a baby

Yes, your baby needs a proper car seat for every car ride, including the first trip home from hospital. Holding a baby on your lap is not safe, even on short city trips. Below, Dr Dutta answers the questions Kolkata parents ask her about car seats, scooters and bikes, autos and taxis, and flying with a baby.

Does my baby really need a car seat in India?

Yes. A correctly fitted child car seat is the single best way to protect a baby in a crash. The WHO says child restraints can cut deaths among infants by 71%.¹

Worldwide, road crashes kill more children and young people aged 5 to 29 than any other cause.¹ City traffic in India is unpredictable. Sudden braking alone can throw an unrestrained child into the dashboard or seat in front.

Car seats are still uncommon in Indian families. In a study of families of children aged 1 to 5 years in Puducherry, seat belt use in cars was among the safety habits most often skipped.² Many parents told the researchers they thought such steps were unnecessary.²

Why can't I just hold my baby on my lap in the car?

Because in a crash, no adult can hold on. The baby flies forward with huge force, and the adult may crush the baby against the seat in front.

Even at city speeds, the forces in a crash are far greater than your arms can hold. Wrapping a seat belt around yourself and the baby together is also dangerous, because your body weight presses into the baby.

Feeding a baby on the move is another common habit. If your baby needs a feed, pull over safely and feed with the car stopped.

Which car seat should I buy for my newborn?

Buy a rear-facing seat: either an infant carrier seat or a convertible seat that can be used rear-facing from birth.

The American Academy of Pediatrics advises rear-facing seats for babies, for as long as possible.³ A rear-facing seat spreads the force of a crash across the baby's whole back, head and neck. A baby's neck muscles are weak and the head is heavy, so this support matters a great deal.

Check that the seat meets a recognised safety standard and fits your car. Practise fitting it before your due date, so the first ride home is calm.

Until what age should my child face backwards?

Keep your child rear-facing for as long as possible, until they reach the highest weight or height the seat allows.³

Rather than naming an age, the American Academy of Pediatrics advises rear-facing for as long as possible. It points out that each move to the next stage gives a little less protection, so parents should delay each change as long as they can.³

Many convertible seats now allow rear-facing use well into the toddler years. Bent legs touching the back seat are usually fine and are not a sign that the child has outgrown it.

When should my child move to a forward-facing seat and then a booster?

Move to a forward-facing seat with a harness only after outgrowing the rear-facing limits. Most children should use it until at least 4 years, then a booster seat until at least 8 years.³

The American Academy of Pediatrics sets out four stages:³

1. rear-facing seat as long as possible
2. forward-facing seat with a harness, for most children until 4 years or older
3. booster seat with the car's lap and shoulder belt, for most children until 8 years or older
4. lap and shoulder belt alone once the booster is outgrown

A booster lifts the child so the seat belt lies across the hips and chest, not the tummy and neck.

Can my baby or child sit in the front seat?

No. All children under 13 years should ride in the back seat.³

Never put a rear-facing car seat in front of an active airbag. The airbag opens with enough force to strike the back of the seat where the baby's head lies. The American Academy of Pediatrics technical report covers airbags and children in detail.⁴

The middle of the back seat is often the safest spot if the seat fits well there.

How do I fit a car seat correctly?

Fix the seat firmly to the car, then fasten the harness snugly over your baby. The seat should hardly move when you tug it where the belt passes through.

• Follow both the car seat manual and the car manual.
• Use the ISOFIX or LATCH points if your car has them, or the seat belt routed exactly as shown.
• Harness straps lie flat, not twisted, and you cannot pinch a fold of strap at the shoulder.
• If your seat has a chest clip (common on US-style seats), it sits at armpit level.
• Take off thick sweaters or jackets first. Put a blanket over the harness instead.
• Recline a newborn's seat at the angle marked on the seat, so the head does not flop forward.

The American Academy of Pediatrics technical report covers correct installation in detail.⁴

Is it safe for my baby to sleep in a car seat?

It is fine for a baby to doze in a correctly fitted car seat during a trip. Do not use the car seat as a bed once you arrive.

A US review of 47 deaths of children aged 2 or under in sitting and carrying devices found that 31 happened in car seats. About half of the car seat deaths were from strangulation by straps. The rest were from the baby's position blocking breathing.⁵

The authors advised that car seats should not be used for sleep outside the vehicle, and that children should never be left in one with straps loose.⁵ When you reach home, move your sleeping baby to a flat cot, on their back.

Is a second-hand or old car seat safe?

Only if you know its full history. Do not use a seat that has been in a crash, has missing parts, or is past the expiry date on its label.

Plastic can weaken with age and heat, and safety standards change. Check the label under the seat for the date of manufacture and expiry. Make sure the instruction manual and every strap and buckle are there. If you cannot be sure the seat has never been in a crash, do not use it.

Can I take my baby on a scooter or motorbike?

Dr Dutta strongly advises against carrying babies on two-wheelers. If a young child must ride, Indian rules require a crash helmet, a safety harness and a speed of no more than 40 km per hour.⁶

Rules notified by the Ministry of Road Transport and Highways in February 2022, in force a year later, cover children aged 9 months to 4 years riding pillion. The child must wear a crash helmet and be strapped to the rider with a harness vest.⁶ Indian law also requires helmets for two-wheeler riders aged 4 years and over.⁷

In practice, few children wear them. An observation study at Bengaluru schools found that only 4.5% of children riding pillion wore a proper helmet.⁷ Never seat a baby in front of the rider or on a mother's lap side-saddle, and never carry more than one child on a two-wheeler.

How can I travel safely by auto, taxi, bus or train with a baby?

Use a car seat in taxis and cabs whenever you can. In autos, buses and trains, sit well inside, hold your baby firmly, and keep the baby away from open doors and windows.

• Many cab apps let you book larger cars. Carry a light infant seat that fits with a seat belt.
• In an auto, sit in the middle of the back seat, not at the open side.
• On trains, keep the baby away from the doors and do not let toddlers hang out of windows.
• In a car, never take your baby out of the car seat to feed while moving. Stop the car first.
• Never leave a child alone in a parked car, even for a few minutes.⁴ Cars heat up fast in the sun.

Are baby carriers and slings safe?

Yes, if your baby's face stays visible and the chin stays off the chest. A badly positioned sling can block a baby's breathing.

In the same US review of deaths in sitting and carrying devices, 5 happened in slings.⁵ The authors advise that a baby in a sling should have the face uncovered and above the edge of the fabric, with the chin not pressed into the chest.⁵

A simple check: you should be able to see your baby's face and kiss the top of their head without bending far. Look down at your baby often, especially in a crowd.

What should I check before buying a pram or stroller?

Look for good brakes, a five-point harness, and a seat that lies flat or nearly flat for young babies.

• Always use the harness, even for short trips.
• Put the brake on whenever you stop, especially on slopes and railway platforms.
• Do not hang heavy shopping bags on the handle. The pram can tip backwards.
• Keep fingers clear when folding.
• Do not leave a baby to sleep unwatched in a stroller.⁵

On Kolkata's broken pavements, a sturdy carrier is often more practical than a stroller.

When can a newborn fly?

There is no single safe age that applies everywhere. Each airline sets its own minimum age for babies, so check with yours before booking.

Cabin air in flight holds less oxygen than air on the ground, and trapped air in the body expands. A review of fitness to fly in children names low oxygen, expanding gas, dry air and limited medical help on board among the main risks.⁸ Children with long-term heart or lung problems should be checked by their doctor before flying.⁸

Dr Dutta advises waiting until your baby is at least past the first week and feeding well, and avoiding flights during any illness.

How do I stop my baby's ears hurting during a flight?

Feed your baby, or offer a pacifier, during take-off and especially during landing. Sucking and swallowing help open the tubes that balance pressure in the ears.

Ear pain comes from the change in air pressure in the middle ear, mostly as the plane comes down. Trapped air expanding is one of the known effects of flying on the body.⁸ Keep your baby awake for the descent if you can, so they swallow often.

A baby with a bad cold or ear infection is more likely to have ear pain. If your baby is unwell, ask your doctor whether to delay the trip.

Can a premature baby travel by plane?

Most premature babies without ongoing lung disease can fly safely once they are a few months past their due date. Babies who had lung disease need a fitness to fly check first.

A UK study tested babies in low oxygen air like an aircraft cabin. Ex-premature babies without chronic lung disease, tested at 3 or 6 months past their due date, did no worse than term babies. The authors concluded routine testing was not needed for them.⁹

It is different for babies with neonatal lung disease. In an Australian study, 81% of such babies referred for testing, most only weeks past their due date, dropped their oxygen levels enough to need oxygen on the flight.¹⁰ If your baby was in the NICU on oxygen or a ventilator, talk to your neonatologist well before you book.

When should I see a doctor before or after travelling with my baby?

See your doctor before you travel if:

• your baby is under 1 month old, or was born premature
• your baby had breathing problems, needed oxygen, or has a heart condition^8,10
• your baby has a cold, ear infection, fever or diarrhoea
• you are travelling somewhere with malaria, dengue or other infections, or need vaccines

Get urgent help during or after a trip if your baby:

• breathes fast or with effort, or looks blue or grey
• is very sleepy, floppy or hard to wake
• feeds poorly and passes much less urine, especially in the heat
• has any fall or crash, even if they seem fine