Car seat safety for premature babies

It is universally agreed that babies should only travel when strapped safely in a car seat. However, for premature babies ready to go home from hospital, car seats carry certain risks that are often overlooked. Unlike most full-term babies, premature babies are at an increased risk for breathing problems while sitting in a car seat. The American Academy of Pediatrics recommends that every infant born at less than 37 weeks should undergo the infant car seat challenge (ICSC), an observational test now implemented in many hospitals across the globe, though not widely yet in South Africa. While no standardised guidelines for this test are set, the general recommendation is that the baby should be placed in the car seat and observed for 90 minutes while still in the NICU. If the baby shows irregular breathing or stops breathing for longer than 20 seconds, as well as some other criteria, the baby has failed the ICSC and should not be sent home in a car seat. If this is the case, the AAP recommends using a crash-tested car bed for travel - these are unfortunately not available in South Africa, though they can be ordered from overseas websites. Alternatively, car seat inserts and head support pillows for premature babies can be bought locally.

Factors that place babies at risk in a car seat, especially when premature, include:
• Position of the car seat – the more upright the seat, the higher the risk
• Poor muscle tone
• Posture – flexion of the head increases the risk
• Time – the longer the baby is kept in the seat, the higher the risk
• Sleeping while traveling
• Genetic disorders affecting muscle tone and breathing
• Gender – boys seem to be at higher risk

Tips to parents to ensure safer travelling:
• Where possible, limit the time which the baby will spend in the seat to no more than one hour at a time. If longer travelling is necessary, stop every hour and take the baby out of the seat.
• An adult should always sit next to the baby and observe him for signs of apnoea and desaturation.
• Clothing and blankets to keep baby warm should be placed over baby after the buckle has been secured to ensure that the straps are not too loose and that the baby is protected in case of an accident.
• Position the car seat as flat as possible.

Premature babies should also not be placed in other seating devices until they have good head control in the sitting position.




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