June 21, 2023/Children's Health

Preemies and Car Seats: What You Need To Know

Babies born preterm may need special precautions to ride safely in a car

car seat in the foreground with parents holding newborn in the background

When your baby is born preterm (“preemie”), you already have a lot to think about. What health risks should we be concerned about? How long will they need to be in the hospital? Will they even fit in their diapers?

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And, in matters of practicality, how are we going to get the baby home? Can preemies ride in standard car seats?

Car seats are an important — and legally required in the U.S. — safety consideration for all babies and children. Most infant car seats are designed to be safe even for infants born with low birth weight. Even still, ensuring your baby is ready for the ride can be a challenge.

Babies born before 37 weeks of gestation are vulnerable little beings. And they may need special precautions to make sure they can safely ride in a car seat. Before your baby is discharged from the hospital, their healthcare team can help make sure they’re ready for that first ride home.

“Babies born preterm can have trouble breathing when sitting or reclined, like in a car seat,” says pediatrician William Mudd, DO. “Nurses and other hospital staff should be well-equipped to help make sure you can feel confident your baby will be safe in the car.”

What do you need to know about preemies and car seats? Dr. Mudd explains what to expect.

Preemies in car seats

Many babies, even preemies, can use standard rear-facing car seats. Infant-carrier-style car seats usually are intended for babies who weigh as little as 4 to 5 pounds. Those weight minimums vary, however, so check your manufacturer’s instructions to be sure. Other options, like a car bed, may be recommended for some babies born preterm. More on that in a bit.

Additionally, you’ll want to make sure your baby’s car seat straps are adjusted to fit them well. And, as with any baby, properly installing the car seat is a must.

Dr. Mudd walks us through the considerations.

Car seat challenge test

Infant car seats are designed for babies to rest at a 45-degree angle in the car. But babies born preterm may be at higher risk for having respiratory or airway problems when they’re propped up.

To be sure your preemie can safely ride in their car seat without any breathing troubles, the American Academy of Pediatrics recommends babies born prior to 37 weeks be given a “car seat challenge test” (also called a “car seat tolerance screen” or CSTS) before they’re discharged. Car seat challenges are also commonly given to babies who have medical conditions like Down syndrome or Pierre Robin sequence.

“The car seat challenge is a controlled setting that allows your baby’s hospital caregivers to monitor how they respond to sitting in a car seat,” Dr. Mudd explains. “Successfully completing the challenge can give parents and caregivers the peace of mind that your baby won’t have any medical complications as a result of being in the car seat.”

During a car seat challenge, hospital staff will place your baby in their car seat and monitor them. You’ll need to bring the car seat you intend to take them home in for the test.

Your baby will be strapped into the car seat and hooked up to monitoring equipment.

“During the car seat safety challenge test, healthcare providers will check your baby’s blood oxygen level, breathing and heart rate,” Dr. Mudd continues. “They do that by wrapping a pulse oximeter around the baby’s foot or wrist and placing electrodes on their chest.”

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During the test, your baby will be monitored in their car seat for at least 90 minutes. The test may be performed longer if your drive home from the hospital is farther. Monitoring equipment will send information to your healthcare provider. After the test, your provider will look over the information and discuss the results with you.

If your baby shows signs of breathing trouble during the test, it will likely be repeated later. Your provider may also discuss alternatives to a traditional car seat, like a car bed, to bring your baby home.

A car bed allows your baby to lie flat while still being safely secured in the car. Like a car seat, a car bed can be secured to your car with a seatbelt or LATCH system. And it uses a five-point harness to keep your baby comfortable and safe. Car beds typically are designed for babies between 4 and 15 pounds. But that may vary depending on the make and model. Check the manufacturer’s guidelines to be sure.

Preemie car seat installation tips

When your preemie is ready to be discharged, you’ll probably get a lot (a whole lot) of instructions about how to best care for them and yourself at home. Those will vary depending on their specific medical needs.

You may also be given directions on how to keep your baby safe in the car, including any unique instructions depending on your baby’s health.

But in general, Dr. Mudd says to consider these tips to keep your preemie safe in the car:

  1. All baby car seats should be installed rear-facing until your child outgrows the size requirements for that car seat.
  2. Infant-only car seats are typically the best choice for premature babies. Those are the carrier-style seats that snap into a base in the car.
  3. The distance between the crotch strap and the back of the car seat should be less than 5.5 inches. This reduces the potential for your baby to slump forward.
  4. The distance from the lower harness straps to the bottom of the car seat should be less than 10 inches. This reduces the potential for the harness straps to cross your baby’s ears.
  5. Shoulder straps should be at or below your baby’s shoulders. Not above them. For preemie newborns, that likely means putting the straps at their lowest setting.
  6. Never use add-on inserts, like pillows or strap cushions that didn’t come with your car seat. If your car seat came with a newborn or preemie insert, bring the insert to your hospital room and ask for advice about whether and how to use it.
  7. Don’t wrap your baby in a swaddle or blanket before buckling them in. Instead, buckle your baby in, and then put a blanket or coat over your baby if needed.
  8. If your baby needs close observation, travel with another adult who can sit in the back seat next to your baby.
  9. If your baby is sent home on an apnea monitor or oxygen, store the equipment on the floor of the car, not on the seat next to your baby. If you have to stop suddenly, the equipment could injure your baby.

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Having a baby born preterm can come with a lot of questions. And unique considerations. Talk with your healthcare team, and don’t be afraid to ask about how to keep your baby safe — in and out of the car.

Safe travels!

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