Car safety seats: Tips for parents of preemies

The law requires that you bring your baby home from the hospital in an infant car safety seat. But the federal government's standard for car seat safety has no minimum weight limit. It also does not take into account some of the special needs of your preterm or low-birthweight infant.

Fortunately, a 2009 clinical report provides helpful tips for selecting and safely using car safety seats for small infants. The report was prepared by the American Academy of Pediatrics' Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn. It was published in the May 2009 issue of the medical journal Pediatrics.

Choosing a car seat

When choosing a car safety seat for your preemie or low-birthweight baby, keep these tips in mind:

  • Choose an infant-only car safety seat with a three- or five-point harness system. Convertible car safety seats with a point-point harness system are also good.
  • Don't pick a car safety seat with a shield, abdominal pad or armrest. Your baby might have trouble breathing behind the shield or may hurt his face and neck in a sudden stop or crash.
  • A car safety seat with the shortest distance between the crotch strap and the seat back is best. Ideally, pick one with a crotch-to-seat back distance of 5 1/2 inches. That way, your baby won't slip forward feetfirst under the harness. You can also place a rolled diaper or blanket between the crotch strap and your infant. This will help keep your infant from slipping.
  • Car safety seats with multiple harness-strap slots are also good. They offer more choices than other seats and are better for small but growing infants. It's best to pick a car safety seat with harness straps that can be placed at or below your infant’s shoulders.

Placing your infant in the car seat

Now that you have bought the car safety seat, here's what you need to know about placing your infant safely in.

  • Place your infant so she is facing the rear. Your infant should be rear-facing until she reaches the highest weight and height allowed for the car safety seat by its manufacturer.
  • Place your infant so that his buttocks and back are flat against the seat back. The harness should be snug, with the car seat's retainer clip halfway between your baby's neck and stomach. The clip should not be on his belly or in front of his neck.
  • Use only the head-support system that comes with your car safety seat. Avoid any head supports that are sold separately. If your infant is very small and needs more support for her head and body, then place blanket rolls on both sides of your infant. 

More important information

  • Recline a rear-facing car safety seat at about 45 degrees or as directed by the instructions that came with the seat. If your infant's head still falls forward, place a tightly rolled blanket or pool "noodle" under the car safety seat. That way your child's car seat is at the recommended 45º angle.
  • Never place a rear-facing car safety seat in the front passenger seat of any vehicle. If you have to stop suddenly or are in a crash, the passenger-side front air bags can hit the car safety seat and cause serious harm to your baby.
  • Remember, the back seat is the safest place for all children to travel while in a car.
  • Whenever possible, have an adult seated in the rear seat near the infant in the car safety seat. If a second caregiver is not available, know that you may need to safely stop your car to assist your infant, especially if a monitor alarm has sounded.
  • Never leave your infant unattended in a car safety seat, either inside or out of a car.
  • Avoid leaving your infant in car safety seats for long periods to lessen the chance of breathing trouble. It's best to use the car safety seat only for travel in your car.

Preterm and low-birthweight infants in car safety seats have a higher chance of slowed breathing or heart rate. Because of that, your NICU staff may suggest they watch your preterm infant in his car safety seat for 90 to 120 minutes. They may watch your infant even longer if your travel home after discharge is more than 2 hours.

NICU staff may also provide instructions about how best to place your infant in the car safety seat. This will help reduce your infant's risk of breathing and heart trouble while in her car safety seat.

Your infant's safety is always important to you. And now you have some help on keeping your preemie safe when traveling in your car.

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Last reviewed: August, 2014