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7 essential car seat safety tips for NICU babies

When my son arrived at 31 weeks + 6 days, I felt completely unprepared. We had not finished researching or purchasing baby equipment. We had canceled our baby showers due to my hospitalization. We had no car seat and no idea how to install one.


In the two and a half years since our discharge, I have gotten lots of experience traveling with my NICU graduate and completed a training program to become a certified Child Passenger Safety Technician (CPST).

Here are all the tips I wish I knew back then:

1. Confirm that your car seat is approved for low birth weight*

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Many NICUs do not have a minimum discharge weight, so you may find yourself coming home with a very small baby—sometimes in the 4-5 pound range. Therefore, it is important to research any potential car seat and confirm that it is safe for babies in this lower weight range.

For example, the Graco SnugRide 35 (a popular infant seat) is approved for use with babies as low as 4 pounds. In contrast, the Chicco Nextfit (a popular convertible seat) is approved for rear-facing babies starting at 5 pounds. Both infant seats (rear-facing only) and convertible seats (used rear-facing) are safe for newborns.

*Many NICU graduates are able to safely use traditional car seats. However, some babies with certain medical conditions may require a car bed or other arrangements for safe travel. Those travel decisions should be made in collaboration with your child’s medical team.

2. Read your manuals

In the NICU you may find yourself with some downtime (either during or between visits). In that case, your car seat and vehicle manuals make great reading material! Okay, so the manuals may not look like page-turners, but they provide life-saving information and should be read thoroughly before installing or using a car seat.

Every vehicle and car seat is a little different, so check your manuals for the details on the following:

  • Car seat manual: Age, weight, and height requirements for safe usage; car seat components; proper installation and vehicle seating positions; correct harness usage/placement; and safe cleaning/maintenance of the seat.
  • Vehicle manual: Airbag locations; proper vehicle seating positions for car seats; locations of lower and tether anchors (LATCH); and proper seat installation.

3. Resist the urge to bundle (under the straps)

When you have a NICU grad (e.g., a premature baby) that gets cold easily, your first instinct is to bundle them up—at home and definitely on the road where they may be exposed to cold weather. But I’m telling you to resist the urge.

For maximum protection in a crash, you want the car seat harness to be fitted as close to your child as possible. When they wear a snowsuit or other thick outerwear, you end up fitting the harness to the clothes—and those clothes can compress during a crash and leave the harness too loose. A loose harness can lead to extra crash forces on the child and in the worst case scenario—ejection from the seat.

There are many safe alternatives to keep your child warm in the car like lighter fleece clothing under the straps and blankets and shower cap style covers that fit over the seat and do not interfere with the harness.

4. Secure medical equipment

If your baby is ready for discharge but still needs a little extra help, you may find yourself heading home with medical equipment such as oxygen tanks and apnea monitors. This equipment can be heavy and therefore has the potential to be a projectile during a crash and injure your child.

Before leaving the hospital, take some time to evaluate your vehicle and see how best to stow medical equipment (or other potential projectiles). You should identify all storage compartments, cargo spaces and strategies for securing items. Using bungee cords can be a great solution.

5. Save money and skip the aftermarket products

There are a lot of products marketed to parents to make their child’s car seat more comfortable—like cozy harness covers and infant inserts. These are non-regulated aftermarket products and are not recommended for use with your seats.

First, these were not crash tested with your seat, so we have no idea how they will perform during a crash. Second, many of these products interfere with the safe functioning of your seat, and some can actually put your baby into an unsafe breathing position.

But don’t worry, there are safe alternatives. For example, if you are concerned about your baby’s position in the seat, skip the aftermarket products and use rolled up receiving blankets to get them in a better position.

6. Keep the chest clip on the chest

The chest clip (or retainer clip) is designed to keep the car seat straps parallel over the torso during a crash. To work properly and keep the child safe, the clip should be placed at armpit level. A helpful visual can be found here.

After you tighten the straps and correctly place the chest clip, do the “pinch test." You should not be able to pinch any excess strap webbing at the shoulder or hips once the harness is buckled.

7. Have your install checked by a certified tech

Even if you’ve read your manuals and practiced installing your seat, you may still be unsure about the safety of your installation (or that seat may still move back and forth more than 1 inch no matter what you try).

I always encourage parents to make an appointment to have their car seat checked by a certified Child Passenger Safety Technician (CPST). CPSTs are not car seat installers. They are educators. They will teach you how to safely install and use your car seat. They will show you how to properly harness a baby and answer any other questions you may have.

Be sure to mention any special needs your child has (low weight, medical equipment, etc.), and they can offer additional resources.

If you aren’t sure how to find the closest CPST, here are a few ideas:

Congratulations on your discharge from the NICU! I hope these tips help keep your NICU graduate safe and healthy on your many adventures together.

Originally published by Leah A. Roman on GrahamsFoundation.org.

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