Preemies and car seats

As long as it has a seatbelt, just about any seat in the car is safe for you. The same can’t be said for your preemie, though. Because they’re so small, low birthweight babies require different kinds of car seats than full-term babies. A lot of car seats that are okay for infants aren’t okay for preemies. 

Before your baby can leave the hospital, NICU staff will probably perform a ‘car seat test’ to make sure your baby’s car seat is properly fitted – it’s that important! The right car seat keeps your baby comfortable and safe on all drives, no matter how long or short.

What to look for in a car seat

There are three things that you want to keep in mind when finding a car seat for your preemie.
  • The minimum weight rating: A lot of newborn babies weigh around 5 pounds or more, and many car seats are designed with this number in mind. It might be that your baby weighs under 5 pounds, though, so you want to buy a car seat that has a lower minimum weight rating – preferably 4 pounds.
  • Harness straps placement and points: Harness straps are the straps that secure a baby into a car seat. A preemie’s harness straps need to be lower than average, because preemies have lower shoulders than full-term babies. Some car seats come with insert cushions that compensate for this, but if your seat doesn’t, it’s best not to use anything that doesn’t come with the car seat to try to do the same thing. Your baby’s car seat should also be a five-point harness system, which means that it should attach to the car seat at five different points.
  • Distance between crotch strap and seat back: For a preemie, the shorter the distance between these two parts of the car seat, the better. The March of Dimes recommends finding a car seat where the distance between the crotch strap and seat back is 5 ½ inches. If you need to, you can roll a diaper or blanket in the crotch-to-seat area, but ideally you want to keep your baby as secure in the seat as possible without anything added in, since added inserts can shift.

What not to look for in a car seat 

There are a few things that you don’t need to worry about when looking for a car seat.
  • Shields, abdominal pads, or armrests: These aren’t necessary – a proper car seat should take care of all of these things by itself.
  • Extra head supports: These could actually be dangerous. The American Academy of Pediatrics recommends only using rolled up blankets for extra support.

Putting baby in the car seat 

To safely put your baby in the car seat, you’ll first want to make sure your baby is in a rear-facing car seat. The American Academy of Pediatrics recommends that babies be in rear-facing seats until they’re 2 years old. Make sure the seat is reclined at the recommended angle for the seat, usually about 45 degrees. Gently position your baby so that their bottom and back are firmly against the back of the seat. Adjust the harness straps so that they’re at or below your child’s shoulders, clip the straps into the center retainer clip, and then make sure they’re snug. Double-check the retainer clip – it should be halfway between the baby’s neck and stomach.

Final thoughts

Driving is an essential part of most people’s lives, and keeping your baby safe in the car should be just as important as buying them diapers or getting them vaccinated. Picking the right car seat for a preemie can be a bit of a challenge, but it’s worth it in the long run (or in this case, the long drive). Until they’re old enough for a booster seat or a seat belt alone, babies – and preemies in particular – need a little extra attention to keep them safe in the car.

  • “Car Seat Safety: Premature Babies and Babies with Medical Conditions.” Children’s Hospital of Philadelphia. Children’s Hospital of Philadelphia, 2016. Web.
  • “Car safety seats: Tips for parents of preemies.” March of Dimes. March of Dimes, August 2014. Web.
  • “Child Passenger Safety: Get the Facts.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, February 8 2015. Web.

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