Use infant-only car safety seats with three-point harness systems or convertible car safety seats with five-point harness systems provide optimum comfort, fit, and positioning for the premature or small infant. A small infant should not be placed in a car safety seat with a shield, abdominal pad, or arm rest that could directly contact an infant's face and neck during an impact. Similarly, car safety seats designed for use only by children who weigh more than 20 lbs. should not be used for small infants.
Car safety seats with a distance of less than 5 1/2 in. from the crotch strap to the seat back should be selected to reduce the potential of slumping forward. The car safety seats should have a distance of less than 10 in. from the lower harness strap to the seat bottom to reduce the potential of harness straps crossing the infant's ears.
The infant should be properly positioned in the car safety seat, with buttocks and back flat against the back of the car safety seat. Blanket rolls may be placed on both sides of the infant to provide lateral support for the head and neck. A small rolled diaper or blanket between the crotch strap and the infant may be added to reduce slouching. Commercially made inserts are also available (Children's Medical Ventures 1-800-377-3449). Be sure any commercially made insert does not have padding behind the baby's back or under his/her bottom.
In rear-facing car seats, shoulder straps must be in the lowest slots until the infant's shoulders are above the slots; the harness must be snug; and the car safety seat's retainer clip should be positioned at the midpoint of the infant's chest, not on the abdomen or in the neck area.
If the vehicle seat slopes so that the infant's head flops forward, the car safety seat should be reclined halfway back, at a 45° tilt. Until engineering modifications can be implemented to prevent this problem, a firm roll of cloth or newspaper can be wedged under the car safety seat below the infant's feet to achieve this angle.
A rear-facing car safety seat must not be placed in the front passenger seat of any vehicle equipped with a passenger-side front air bag because of risk of death or serious injury from the impact of the air bag.
An infant should never be left unattended in a car safety seat.
Families should minimize travel for infants at risk for respiratory compromise.
Many nurseries monitor preemie infants in car seats before discharge. Infants with documented apnea, bradycardia or drops in oxygenation in a semiupright position should travel in a car safety bed, lying flat. Parents of these infants should avoid using other upright equipment such as infant swings, infants seats and infant carriers.
Infants sent home on apnea monitors should have portable monitors during travel. Power should last twice the expected travel time.
Portable medical equipment such as monitors and oxygen tanks should be secured or wedged on the floor or under the seat.
