BEHAVIOR:
ASK THE EXPERTS

CAR SEATS—TORTURE FOR SOME

Q Several families in my practice are concerned that their infants and toddlers scream relentlessly while sitting in a car seat in the family vehicle. The behavior started at 3 to 5 months of age. It persisted past 1 year, even when the car seat was turned to face forward. These are healthy, happy, thriving children who display the behavior only while in the car seat.

The families have tried without success to distract the children with music (singing, tapes, or CDs), pacifiers, books, and toys. Some parents have even resorted to reaching into the back seat to touch and try to comfort the child, but that doesn't seem to help either. The constant screaming causes a great deal of stress to parents and siblings riding in the car.

Two of the children are now older than 2 years, and the problem has resolved spontaneously with age. Unfortunately, I do not have advice to offer families of younger children who are in the screaming stage. What strategies do you recommend?

Lisa D. Ryan, DO
Bridgton, Maine

A

Safety first. A car safety expert made three main points when I asked her about this situation:

• Make sure that the car seat is correctly installed and that it is the right size. Does the infant's positioning in the seat afford an adequate airway?

• Be sure that the child is not overdressed. Bulky clothing may make the infant uncomfortable under the restraining straps. It is safer to dress the infant lightly and turn up the heat in the car.

• Do not turn back to attend to the infant while driving. That is dangerous. It is better to pull over to the side of the road if the driver must intervene. The parent could also bring along another person in the back seat to pay attention to the infant, if necessary.

If the problem persists after attending to these matters, consider recommending the following behavior management techniques designed to help children adapt to annoying but necessary situations:

• Avoid unnecessary challenges—such as frequent or long drives when you could have left the infant at home

• Ease the necessary adaptation to the car seat by having the child sit in it for some pleasant activities at home, such as eating, playing, or sleeping

• Maintain reasonable expectations for adaptation.

The techniques of advance warning and praise for compliance, which are useful for older children, might not apply to infants under 1 year of age.

William B. Carey, MD

DR. CAREY is clinical professor of pediatrics, University of Pennsylvania School of Medicine, and director of behavioral pediatrics, division of general pediatrics, Children's Hospital of Philadelphia.

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Behavior: Ask the experts. Contemporary Pediatrics 2002;8:35.