I received the April 2007 issue of Advances in Neonatal Care and was reviewing the article on SAFE discharge and the accompanying handout for parents describing infant safety at home. I know it is very difficult to catch all details emphasized in the accompanying photos, but I think attention to those details is important since many times a parent may use a photo as an example of good practice.

The photograph in Figure 2 noting infants should ride in approved car seats has several significant violations of proper car seat usage illustrated in the photograph. Specifically, the harness straps are not on the infant's shoulder, partly due to the large oversized outerwear the infant has on. As pictured, this infant could be ejected from a vehicle or receive significant cervical injury due to the lack of shoulder and upper body restraint. Also, the retainer clip is not at the armpit level, as recommended by manufacturers; it looks like it is actually over the abdomen and was not positioned at all.

Since car seat safety is so important and evidence indicates that the majority of parents (70%-80%) do not use a car seat correctly, I think it is a significant issue. Also, it would be helpful for parents and professionals to know that car seat safety checks are offered in or near their community by car seat technicians trained by the National Standardized Child Passenger Safety Training Program. Parents can access a location near them by entering zip code information at http://www.seatcheck.org.

Debbie Thompson, MS, RN, PNP

Pediatric Nurse Practitioner Children's Medical Center Dallas, Texas