Car Travel Precautions for Newborns (Preterm, Term, and Low Birth Weight)
All newborns should travel rear-facing in an appropriately fitted car safety seat positioned in the back seat, but preterm and low birth weight infants require pre-discharge car seat testing to screen for life-threatening cardiorespiratory events that occur in up to 12% of these vulnerable infants. 1, 2
Critical Distinction: Preterm/LBW vs. Term Infants
For Preterm Infants (<37 weeks) and Low Birth Weight Infants
Mandatory pre-discharge car seat challenge testing is required for all infants born at less than 37 weeks gestation, regardless of where they were hospitalized. 3, 1, 2
- Observe the infant in their actual car seat for cardiorespiratory stability before hospital discharge, monitoring for apnea, bradycardia, and oxygen desaturation. 3, 1, 2
- Twelve percent of preterm infants (35-36 weeks) experience apneic or bradycardic events during car seat testing, even when they appear healthy and were in a normal newborn nursery. 1
- Oxygen saturation drops significantly in all newborns in car seats (from 97% supine to 94% after 60 minutes), but 12% of preterm infants had dangerous desaturations below 90% for more than 20 minutes. 1
If the infant fails the car seat challenge (develops apnea, bradycardia, or oxygen desaturation), discharge in a car bed that allows the infant to lie flat (supine or prone) instead of a semi-upright car seat. 4, 2
For All Newborns (Term and Preterm)
Position the car seat rear-facing at approximately a 45-degree angle to prevent the infant's head from flopping forward and obstructing the airway. 5
- Never place a rear-facing car seat in the front passenger seat of any vehicle with a passenger-side airbag, as this can cause fatal injuries. 5
- The back seat is the safest location for all children under 13 years of age. 5
Proper Car Seat Selection and Fit
Avoiding Dangerous Equipment for Small Infants
Premature or small infants must not be placed in car seats with shields, abdominal pads, or arm rests that could contact the infant's face or neck during a crash. 5
- Twenty-four percent of preterm infants do not fit securely in standard car seats even with blanket rolls for positioning. 1
- For infants who cannot be positioned safely in a standard semi-upright car seat, use a crash-tested car bed instead. 4, 2
Harness Positioning
In rear-facing seats, shoulder harnesses must be placed in slots at or below the infant's shoulders, with the harness snug and the retainer clip positioned at armpit level—never on the abdomen or neck. 5
Installation Requirements
Install the car seat tightly using either the vehicle seat belt or LATCH system, ensuring the seat does not move more than one inch side-to-side or front-to-back. 5
- Read both the vehicle owner's manual and car seat instructions carefully, as compatibility issues between specific vehicles and car seats can compromise safety. 5
Special Precautions During Travel
Minimize car travel during the first months of life, as oxygen saturation values decline uniformly in all newborns when positioned in car seats, even in healthy term infants. 1
- Use car seats only for travel, never as sleeping devices or infant carriers outside the vehicle. 1
- Never leave a child unattended in a car seat, whether in or out of the vehicle. 5
For preterm infants discharged in a car bed, arrange follow-up car seat testing to determine when it is safe to transition to a standard car seat. 4
Common Pitfalls to Avoid
Do not assume that healthy-appearing preterm infants (35-36 weeks) are safe in car seats without testing—these minimally preterm infants still experience significant cardiorespiratory instability at rates of 12% for apnea/bradycardia. 1
Do not use after-market add-on devices for adjusting car seat fit, as performance standards have not been developed for these products. 5
Avoid positioning the car seat too upright, as this increases the risk of airway obstruction from head slouching, particularly in preterm infants with poor head control. 5, 6