Patient education: Car seat safety for premature babies (The Basics)

What does it mean when a baby is born premature? — 

A baby born before 37 weeks of pregnancy (3 or more weeks before the due date) is called "premature" or "preterm." Pregnancy normally lasts about 40 weeks, counting from the first day of your last period. Premature babies are sometimes called "preemies" for short.

Premature babies often need extra medical care after birth. They might stay in the neonatal intensive care unit, or "NICU." This is a part of the hospital for babies who need special care. The medical staff will decide when it is safe for you to take your baby home.

When can my baby ride in a car seat? — 

This depends on the baby's size and health. Before you can take your baby home from the hospital, the staff will make sure that they can safely ride in a car seat. This is important because premature babies can have heart and breathing problems after birth. This risk is higher when they are sitting partly upright, like in a car seat.

Your baby will have a "car seat test" while you are still in the hospital. This is sometimes called "car seat tolerance screening." For the test:

●The baby will be placed in their car seat for at least 90 to 120 minutes. The test might take longer if you will need to travel a longer distance home from the hospital.

●The medical staff will watch the baby's heart rate, breathing, and oxygen level while they are in the seat.

If the baby has any problems during the test, the staff will talk to you about what to do next. Your baby might need more monitoring before they can go home. In some cases, it might be an option to use a "car bed." This is a special type of car seat that lets the baby lie flat.

What kind of car seat does my baby need? — 

Babies should ride in a rear-facing car seat in the back of the car. Many people choose an infant "bucket" seat that clicks into a base that stays in the car. The other option is a "convertible" car seat. These can be installed rear-facing, then switched to forward-facing when the child is older.

●When choosing a car seat, check the weight and height range. Some seats have special inserts to help keep a smaller baby in the right position.

●In the US, make sure that the car seat has a label saying that it meets or exceeds "US Federal Motor Vehicle Safety Standard 213."

●Make sure that the seat will fit in your car and can be installed properly.

●Register your car seat with the company that made it. You can do this by filling out the registration card that comes with the seat or by going online. This way, the company can contact you if there are any issues with the seat.

●Never use a car seat that has expired, is missing parts, or has been in an accident.

●Check the manufacture date and model number on your car seat. These can help in making sure that the seat does not have any safety recalls.

How do I correctly install a car seat? — 

This depends on the car seat and your car. In general:

●Read the instructions that come with the car seat.

●Check your car's manual. This tells you where and how to install a car seat. Car seats always go in the back seat.

●Many seats can be installed with "lower anchors and tethers." This is called the "LATCH" system. You can also use the seat belt to install the seat.

●Follow the seat's instructions for securing it with the LATCH system or seat belt. Check your car manual to know where the anchors are.

●Push down on the seat while you tighten the straps or belt. Once installed, the seat should not be able to move more than 1 inch (2.5 cm) side to side or front to back.

●Make sure that the seat is reclined at the correct angle. It should have an indicator showing this.

●After installing the seat, consider getting it checked by a safety technician. Many police and fire stations can do this.

How do I make sure that my baby is safe in the car seat? — 

It's important for all babies to ride in a car seat. This is the best way to stay safe in the car. For a premature baby:

●Place your baby in the seat with their buttocks and back flat against the back (figure 1). The shoulder straps should be in the lowest slots, and not twisted. The clip should be at chest level. If your baby slouches in the seat, you can place a tightly rolled receiving blanket on each side of them to help support their head and neck. Do not place padding under or behind your baby. Only use car seat "inserts" that were made by the manufacturer for use with that specific seat.

●For a premature baby, the seat should have a distance of:

•Less than 5 1/2 inches (14 cm) from the crotch strap to the seat back

•Less than 10 inches (25.4 cm) from the lower harness to the seat bottom

●If you are using an infant seat with a handle for carrying, check the instructions to make sure that the handle is in the right position.

●Do not dress your baby in bulky clothing or a coat while they are in the seat. This can make it hard to buckle them in safely. If it is cold, tuck a blanket over the harness once it is buckled snugly. Make sure that the blanket does not cover your baby's head or face.

●Always put the car seat in the back seat. Whenever possible, have an adult sit next to the baby in the car. Never leave a baby alone in a car seat.

●Only put your baby in the car seat when you need to travel, for example, to doctor appointments. Do not put your baby to sleep in the seat.

●If your baby needs special equipment for monitoring, the doctor will talk to you about how and when to use it during travel. Any equipment should be wedged securely on the floor or under the seat. This way, it will not fall or hit anyone in the car.

More on this topic

Patient education: Car seat safety (The Basics)
Patient education: When a baby is born premature (The Basics)
Patient education: Safe sleep for babies (The Basics)