Tips for Preemies

Many people are surprised to learn that not all infant seats fit preemies well. Some infant seats don't even fit normal size newborns well! The other surprise is that some convertible seats and even preemies very well.

What makes a seat fit a preemie?

1. Low shoulder strap slot. The closer the shoulder strap slots are to the baby's shoulders, the better. It is best to have the straps start BELOW the baby's shoulders when the baby is rear-facing. With preemies and even newborns, it is usually not possible to have the straps start below the shoulders, but getting a seat where the strap slot is as close as possible is important.

2. Close crotch buckle position

3. Small, short, and narrow chest clip. On some seats, the clip is so big that it pushes under the baby's chin. On other seats the clip is so wide that it pushes the straps so far apart that they fall off the baby's shoulders.

4. Narrow spacing between hip straps, on a 5-point harness seat.

Isn't it true that most seats start with a 5 pound minimum weight?

Yes. But there are some seats that can be used for babies under 5 pounds, as follows (the number in parentheses is the height of the lowest shoulder strap):

Britax Companion (7.25"). Starts at 4 lbs. Head pad must be used for side impact protection. Newborn foam insert available for babies under 7 lbs (order it from Britax).

Chicco KeyFit and KeyFit30 (6.5"). Starts at 4 lbs. Use of newborn insert from 4 to 11 lbs is highly recommended. Insert creates slightly more reclined position to help baby's head from falling forward.

Combi Connection (7.5" with infant insert). No minimum weight. Use of infant insert is highly recommended.

Compass I-400 (4.75"). Starts at 4 lbs.

Dorel On-Board 22. Starts at 4 lbs.

Graco Assura (7.5"). No minimum weight. Available only in industrial packs at this time

What is the "Car Seat Test?"

This is a test to see if the baby is safe to ride in a rear-facing child safety seat. The semi upright position of the rear-facing child safety seat is a stressful position for a baby, compared to laying flat. During the test, the baby is strapped into a rear-facing safety seat while the hospital monitors watch the baby's heart rate, breathing and oxygen level. A baby "fails" the test if his heart rate drops (bradycardia) OR his oxygen level drops (desaturation) OR he stops breathing (apnea). A baby who "fails" the test will need to ride in a car bed.

Who should get a Car Seat Test?

The American Academy of Pediatrics recommends that all babies born before 37 weeks get a car seat test. Other babies who should get a car seat test before going home are those:

1. Going home on an apnea monitor

2. Going home on oxygen

3. With craniofacial deformities--like Pierre Robin sequence--that may make it harder to breathe in a semi-upright position.

4. For whom the pediatrician is concerned that the baby may not tolerate the semi-upright position.

Tips for passing the Car Seat Test:

1. Buckle the baby into the safety seat exactly as you would if they were to ride in the car. Make sure of the following:

• the straps are snug
• the baby is not swaddled, and nothing that did not come with the safety seat, including blankets, infant positioners, pillows, etc, is in the safety seat.
• once the baby is buckled in snugly, you can put receiving blankets alongside their head and/or body to provide extra support if you'd like.

2. Make sure the car seat is reclined to 45 degrees.

3. Wait at least 30 minutes after a feed to do the test.

Who needs a car bed?

Car beds are for use only by babies who have a medical need to lay flat. According to the American Academy of Pediatrics, a baby (even a 4 pound preemie) who can tolerate sitting in a semi-upright position should ride in a rear-facing safety seat, not a car bed. A car bed is a safe option for babies for whom there is no other option. However, a rear-facing safety seat offers better protection than a car bed for a baby who can tolerate sitting semi-upright. Rear-facing safety seats have an excellent track record in all real world crashes of providing the best protection in any type of crash. In a rear-facing safety seat, the shell of the safety seat does a tremendous amount to absorb the crash forces and distribute them on the strongest parts of the baby's body--the baby's entire back. A car bed's shell is not able to do as much, especially in a side impact. Babies who fail the car seat test and leave the hospital in a car bed should have a plan in place for when they will be retested in a rear-facing safety seat.

What Car Beds are available?

Angel Guard Products Angel Ride Infant Car Bed. This goes from birth to 9 pounds and 21.5 inches. Babies with taller torsos may need a longer harness, available from the manufacturer.

Dorel Cosco Dream Ride SE. Goes from 5 to 20 pounds.

Traveling with medical equipment? Here are some tips:

Some children must travel with devices such as apnea monitors, oxygen tanks and ventilators. Secure these devices in the vehicle so that they do not become flying objects in a crash or sudden stop. At this time, there is no single product available to secure medical devices. Try wedging the equipment on the vehicle floor with pillows or securing it with seat belts not being used by a passenger.

Make sure that any devices that use batteries have enough power for your entire trip.

Are you a physician or nurse working in a well baby nursery or neonatal intensive care unit?

This 2 page handout is a fantastic guide for helping ensure new babies leave the hospital safely.