Tips for Preemies
Posted in: Rear-Facing Seats
Printable Preemie Tip Sheet
More than 1 in 10 parents take home a baby weighing less than 10 lbs. Every year, more than 10,000 US babies go home weighing less than 4 lbs! Just like infant-sized clothes are too big for these tiny babies, infant-sized car seats are often also too big. Many infant car seats have a starting minimum weight of 5 lbs; only some are safe for 4 pound babies.
It’s important to note that ANYTHING in the box with your car seat has gone through rigorous crash testing and by law must meet certain standards. Other products sold separately, like head/body positioners, strap covers, fleece sleeping bags, etc, are not regulated and do not have to meet any standards or pass any crash tests. These ‘aftermarket products’ should NOT be used since they will make your baby less safe and void the car seat’s warranty. NOTHING, unless it came with the car seat, should be placed under your baby or under the straps. Once your baby is wearing a few thin layers of clothing and is buckled snugly, you can use blankets on top to keep the baby warm and rolled blankets on the sides for extra support.
What makes a seat fit a preemie?
A few things:
- 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.
- Close crotch buckle position
- 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.
- Narrow spacing between hip straps, on a 5-point harness seat.
Isn’t it true that many infant seats have a 5 pound minimum weight?
Yes. But there are also many infant seats that start at 4 pounds (see below).
Rear-Facing Infant Seats by Minimum Starting Weight
NO WEIGHT MINIMUM
- BRITAX – B-SAFE (may not fit short preemies), B-Safe 35, B-Safe 35 Elite
- CHICCO– Key Fit 22,Key Fit 30,Key Fit 30 Magic
- CYBEX – Aton, Aton2, AtonQ, CloudQ
- EVENFLO– Embrace 35
- GRACO– Snug Ride: Classic Connect 30, Classic Connect 35 (most), Click Connect 35 / 35LX / 40
- MAXI COSI – Mico Max 30, Prezi
- NUNA– Pipa
- ORBIT – G2 Infant Car Seat, G3 Infant Car Seat
- PEG PEREGO – Primo Viaggio 4-35
- SAFETY 1st– Comfy Carry, onBoard 35,onBoard 35 Air
- UPPABABY – Mesa
- URBINI – Petal (found in Omni & Touri travel systems)
What is the “Car Seat Test?”
If your baby is born before 37 weeks or has a medical condition that may affect her breathing or her ability to maintain her oxygen level, before she leaves the hospital she will get a ‘car seat test’ as recommended by the American Academy of Pediatrics. During the test, the baby will sit properly strapped into her car seat for 90 minutes to make sure that her heart rate, breathing rate and oxygen levels stay in a normal range. The semi upright postion of the rear-facing child safety seat is a stressful position for a baby, compared to laying flat. A baby “fails” the test if his heart rate drops (bradycardia) OR his oxygen level drops (desaturation) OR he stops breathing (apnea).
The AAP recommends that babies who ‘pass’ the car seat test go home in a rear-facing car seat, NOT in a car bed, since the protection provided by a rear-facing car is better documented than that for car beds. Car beds should ONLY be used for babies who ‘fail’ the car seat test, meaning for those babies who cannot maintain a normal heart rate, breathing rate or oxygen level while in the car seat.
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:
- Going home on an apnea monitor
- Going home on oxygen
- With craniofacial deformities–like Pierre Robin sequence–that may make it harder to breathe in a semi-upright position
- For whom the pediatrician is concerned that the baby may not tolerate the semi-upright position
Tips for passing the Car Seat Test:
- 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.
- Make sure the car seat is as reclined as the manufacturer allows. All infant carriers have an angle indicator – typically a line on the side of the carrier that when the line is parallel to the pavement/floor, the carrier is as reclined as it is allowed to be in the vehicle. Use this line to make sure the carrier is reclined properly in the hospital’s car seat test.
- 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. 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 Angel Ride Infant Car Bed
- From birth (there is no weight minimum) up to 9 pounds and 21.5 inches.
- Takes up 1 seating position and is relatively easy to install.
- Allows child to ride prone, supine, or side-lying
- Cosco Dream Ride SE
- From 5-20 pounds
- Takes up 2 seating positions and is typically difficult to install securely.
- Allows child to ride prone or supine.
- Hope Car Bed
- From 4.5 – 35 pounds
- Takes up 2 seating positions (requires a bench seat)
- Allows child to ride prone, supine, or side-lying
- Comes with a variety of restraint types including a 5 point harness as well as a bunting. This is designed for children with medical needs that require a car bed for an extended period of time, as well as those who can not tolerate a harness (and can use the bunting) – such as those with an unrepaired giant omphalocele and severe osteogenesis imperfecta.
Tips for traveling with medical equipment
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.
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