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.
Yes. But there are also many infant seats that start at 4 pounds (see below).
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.
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:
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.
Some children must travel with devices such as apnea monitors, oxygen tanks and ventilators.