Child Passenger Safety


Low birth weight infants are those born weighing less than five pounds and can include full-term and premature infants. Premature infants are those who are born before 37 weeks.
With premature or low birth weight infants, special considerations are necessary to ensure their safe transportation. Car safety seats are needed to not only protect small infants in an event of a sudden stop or crash, but also position them to protect their respiratory system.
Due to their size, low birth weight and premature infants need to travel in child safety seats that fit their smaller bodies. Here are some important safety factors to keep in mind:

  • The harness system of the child safety seat will need to have smaller dimensions. Because the harness should be at or below the baby’s shoulders, special attention must be given to the distance from the lowest set of harness slots to the bottom of the child safety seat. Choose a car safety seat with a distance of less than 10 inches from the lower harness strap to the seat bottom. This reduces the potential for harness straps to fit improperly & prevents slouching, decreasing the possibility of airway obstruction.
  • The distance from the crotch strap to the back of the seat should be short enough so that the baby's bottom is held back against the child safety seat and does not slide forward. Use a car safety seat with a distance of less than 5 ½ inches from the crotch strap to the seat back or that has an adjustable crotch strap. This reduces the potential for baby to slump forward. If the distance is larger than 5 ½ inches, place a small rolled cloth diaper or blanket between the crotch strap and the infant to reduce slouching. Never place blankets or padding below or behind an infant.
  • Child safety seats that have shields or trays should be avoided. In a crash or sudden stop, the baby's head could hit the shield or tray.
  • Make sure the baby’s back is flat against the back of the seat. Rolled towels or receiving blankets may be placed rolled blankets on both sides of the baby to provide lateral support for their head and neck. Again, never place blankets or padding below or behind an infant.
  • To ensure proper fitting of a seat that fits a premature infant, it is important to ensure the seat is safety tested for the child’s weight. Most infant and convertible seats are only safety tested for children over 5 pounds (you can easily check by looking on the sticker on the side of the safety seat). In addition, some infants experience breathing problems when they are sitting semi-reclined in a child safety seat. Those babies who experience respiratory difficulties or are below 5 pounds may have to travel flat in a car bed that meets federal safety standards.
  • In the carbed, remember these safety guidelines:
    • Place the bed so that the infant’s head is toward the center of the vehicle
    • Install the bed using the safety belt to anchor the bed. Due to their length, some carbeds may take two seating positions

Follow the same safety guidelines for premature infants as you do for all infants:

  • Make sure the harness is snug (if you can fit more than finger under the harness, it is too loose).
  • Ensure the retainer clip is positioned at the midpoint of the infant's chest (armpit level).
  • If in an infant or convertible seat, make sure the seat is at a 45 degree angle.
  • Never place any car safety seat in the front seat or in front of an airbag.
  • All infants must rear-facing until they are one year AND 20 pounds.
  • Never leave a child unattended in a car safety seat.
  • Make sure the seat is in tight, moving less than 1 inch at belt path when installed.

Compiled by the Violence & Injury Prevention Program. Source: American Academy of Pediatrics