Car Seat Considerations for Low Muscle Tone

monitorWe collected very few things in anticipation of Hope’s arrival for a variety of reasons. For one, it wasn’t until I was about 24 weeks into my pregnancy that we were convinced our baby would survive through birth. Also, the idea of having a baby shower felt completely inappropriate when we were preparing for a NICU stay and months of watchful waiting for Hope’s heart defect to take a downward turn.

But the purchase we were most proud of making, for all the research that went into it, was her Britax B-Agile 3 car seat and stroller system. We were so confident in our decision that we threw away the packaging in a dumpster right there in the store parking lot and installed the car seat base before Thanksgiving.

So once Hope was stable in the NICU, support being taken away little by little until she was just a regular baby breathing room air in an open crib, we were ready to move on to the car seat test. How hard could it be? Our NICU neighbors who were born much smaller than Hope were all passing the 90-minute test—meaning their respiratory rates were stable and their oxygen saturation held steady near 100%—and going home without looking back. Surely we were next.

We had proudly brought our car seat with us when I delivered 5 days earlier in anticipation of discharge day, and we felt like we were now part of an elite club, where parents are no longer in fear of the what-ifs and are instead elated to leave their hospital stay behind them. We were about to cross to the other side.


So Hope was strapped into her seat, hooked up to all her monitors, and we were told we could go back to the room and relax. But about 15 minutes later, we were brought back in and told that Hope failed the test. We could not take her home, and they could not repeat the test for a few hours. Protocol.

Later that night, the nurses tried again; there was no medical reason for Hope to remain a NICU patient. But again, she failed. A few more hours passed, bringing us to NICU day 6, and we were told this was the last time they could do the test before we had to consider other transport options. So they administered the test again, and again she failed.

How were we going to get our baby out of the hospital? She’s ours, and we had no idea how to get her home. The nurses, one in particular, steered us toward a different brand. She said babies fail the test all the time in the Britax seat and we were better off trying a Graco, due to its shallower angle. My husband ran out immediately in the frozen December rain and bought the Graco SnugRide, while I desperately called around to every medical supplier in the area to find a car bed, in case the Graco seat didn’t do the trick. (Nobody had a car bed, and the retail stores hadn’t even heard of it.)

The fourth car seat test was the charm—Hope was so safe and so comfortable in her SnugRide that the nurses let her sleep in the seat well past the 90-minute mark. After all, she was being monitored, and who wakes a sleeping baby?

The moral of the story is that our babies are built a little differently, and even a robust 7lb 9oz NICU giant might have trouble keeping her airway open due to low muscle tone. But nobody had talked to us about this before Hope was born, and had she not been in the NICU (i.e., required to pass the car seat test), we could possibly have taken her home in a seat with too steep an angle for her to be safe and been stranded on the NJ Turnpike with a blue baby…or worse.

So although the car seat remains unused, collecting dust in our basement in anticipation of Hope’s future baby sister or brother, the stroller has been wonderful and has facilitated much fun and many peaceful naps.


Hope taking a brief snooze at the Zeppelin Hall Biergarten in Jersey City on Father’s Day.

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