Babies that are born prior to 37 weeks gestation are considered pre-term, and those that weigh less than 5.5 lbs. at birth are considered to be low birth weight infants. As survival rates of these tiny passengers improve, and more of them are being discharged from hospitals earlier, many are now being transported in the family car.
Choosing an appropriate child restraint for transporting these infants and making sure they’re safe during travel requires special consideration. These babies are particularly prone to conditions such as apnea (suspension of breathing), bradycardia (slow heart rate), oxygen desaturation (low oxygen levels in the blood) and hypotonia (low muscle tone). A recent report in the May issue of Pediatrics provides additional advice and guidance for safely traveling with them.
When considering a seat appropriate for your tiny newborn, consider the following:
• Most rear-facing car safety seats are designed by the manufacturer to be used by infants weighing more than 4 or 5 lbs., with some that specify “from birth,” regardless of weight. Care should be taken to choose a restraint that can accommodate a baby’s lower weight, but also has sufficient adjustability in the harness and crotch straps to fit smaller infants securely. Look for car seats that have a shorter distance between the crotch strap and seat back, and that have harness slots low enough that the straps can be placed at or below the shoulders of the infant when seated. If needed, a small rolled towel can be added between the crotch strap and the infant, as well as between the infant and the sides of the seat to reduce the risk of the infant sliding forward under or out of the harness (see image at top right). Safe Ride News Publications released a report titled Car Seats with Best Fit for Preemies and Small Newborns, which summarizes the better options for fitting a low birth weight or premature infant into a traditional car seat, as well as options for obtaining a car bed from various manufacturers.
• Traditionally, rear-facing infant carriers should be reclined to about a 45-degree angle to help prevent an infant’s head from falling forward and potentially causing breathing difficulties. Infants whose necks cannot yet support their heads in this semi-reclined position may need to be transported in a fully-reclined car bed (see AngelRide Infant Car Bed, pictured bottom right).
Things we learned about keeping them safe in and out of the car:
• Though it is common for hospitals to observe the child’s breathing and muscle tone prior to discharge from the hospital, it is recommended that these observation periods be as long as 90 to 120 minutes to simulate travel times that will potentially be of that length, and that those observations be conducted in the child’s own seat and in a position that will be used in the car.
• The duration of time infants should be seated in a car safety seat should be minimized. Use car seats only for travel.
• Babies who are prone to respiratory or other medical issues in the car seat may also be susceptible to those same conditions when in their swings, ‘bouncy’ seats, and carriers. Use of these items should be limited until after the child has been shown to be stable when semi-reclined.
• If the child is required to travel with additional equipment such as monitors or supplemental oxygen, care should be taken to wedge or secure those devices in the vehicle to eliminate them becoming a “projectile” in a crash or during hard braking.
Learn more about all car seats in our buying guide.
--Michelle Tsai, automotive safety engineer