To leave the NICU you need a car seat, specifically a car seat that will not affect your baby’s oxygen level while keeping them safe from injury. The problem is car seats, like just about everything else, are designed for term babies, most of whom weight 6 1/2 lbs or more at birth.
Many preemies weigh less than 5 lbs when they are ready to go home, so you need to look at the car seat specifications. I know it is easy to get caught like a deer in the headlights with the accessories, colors, etc. etc. I was so excited to be buying a “real” baby product for my boys that only the “finest Italian” brand would do. Turns out, I bought the wrong car seats. My boys didn’t hit 5 lbs for almost a month after discharge and the car seat I picked was only rated down to 5 lbs. In addition to being a safety concern, too large a car seat is an airway hazard. When a baby does not fit well in her car seat, she can slump over, kinking off her airway. Preemie airways are weaker and in addition, many premature babies have weaker muscles, so they are more likely to slump and kink their airway, dropping their oxygen levels. That is the whole reason for the car seat test!
So the 2 key specifications you need to consider for a preemie are the lower weight limit and lowest harness height. The weight is self explanatory, but the harness needs to be at armpit level; for most preemies that means less than 8 inches from the seat. Even with the smallest settings, some babies will still slump over so I have included a nice diagram in my book that shows you how to use receiving blankets to pad your baby so her neck stays straight and she remains centered in the seat.
Another car seat tip is to never use unapproved inserts (i.e. not made by that manufacturer for that specific model)- these can dislodge and cause problems with the airway or even become a projectile if they become loose during an accident.
Car seats also have an upper weight specification; however, for many preemies this will not be an issue for a very long time. Many car seats are only rated to 20 lbs, but some are rated higher (like the Chico KeyFit 30, up to 30 lbs, and the Combi Shuttle 33, up to 33 lbs). But let’s put than in perspective. Depending on your baby’s birth weight, those numbers may be so far away that they are not worth thinking about right now. For example, Oliver, birth weight 1 lb 11 oz, didn’t hit 20 lbs until he was 2 years old and didn’t get to 33 lbs until he was five years old!
I also recommend looking at Consumer Reports for safety. If you don’t want to buy access on-line, go to your local library. That’s what we did! It actually made a nice little field trip from the NICU.
The table below is adapted from the American Academy of Pediatrics 2010 car seat data. I have deleted the upper weights, less of a concern for preemie parents, and included lower weights as well as tracked down the lowest harness height. Some manufacturers give a minimum child height instead, so when applicable, that is listed too. For a couple of car seats I could not find the lowest harness height, so those spaces are left blank
The Chicco KeyFit had a good recommendation from Consumer Reports and has a minimum weight of 4 lbs as well a lowest harness height of 6.5 inches. Not an endorsement, just the facts. What is most important is that your baby fits in her car seat. Many babies fail their car seat challenge test based on fit, and sometimes you will need to return your seat and pick a different model, so what ever you do get one that you can return if need be.
Table 1: Car Seats by Harness Height and Minimum Infant Weight as of July 2010
|Brand||Name||Infant Weight||Lowest harness height||Minimum Child Height|
|Baby Trend||LATCH-Loc||5 lbs||5.5”|
|Britax||Chaperone||4 lbs||6” (with newborn insert)|
|Chicco||KeyFit and KeyFit 30||4 lbs (with newborn insert)||6.5” (with newborn insert)|
|Shuttle 33||No minimum||9”|
|Eddie Bauer||Deluxe||5 lbs||8”|
|Sure Fit and Sure Fit 30||5 lbs||7”|
|Evenflo||Discovery 5||5 lbs||7.0”||19”|
|First Choice 5||5 lbs||7.5”|
|The First Years||Via Infant Car Seat||4 lbs||10”|
|Graco||Snug Ride, Snug Ride 32, Snug Ride 35||5 lbs||8”|
|Maxi-Cosi||Mico Infant Car Seat||5 lbs||19”|
|Mia Moda||Viva Supreme Infant car Seat||4 lbs|
|Orbit||Infant Car Seat||No minimum|
|Peg Perego||Primo Viaggo, Switch, Si||5 lbs||7.5”|
|Safety First||Designer||5 lbs||19”|
|OnBoard, OnBoard 30||4 lbs||5”|
|Tuetonia USA||T-tario||5 lbs|