Premature and low birth weight infants

If your baby was born prematurely or is very small, the following information will help you transport your child safely.

• Select a car seat that will fit your tiny baby. Seats that have less than 5 1/2 inches from the crotch strap to the seat back will help keep your baby from slouching forward. Seats that have less than 10 inches from the lowest harness strap position to the seat bottom will keep the harness from crossing over your baby's ears.

• Do not use a car seat with a shield or tray. In a crash or sudden stop, these could injure your infant's neck or head.

• Make sure the harness of the car seat fits over your infant's shoulders and holds your baby in the seat.

• Place rolled receiving blankets on both sides of your baby to center her in the car seat. Place a rolled diaper or washcloth between your child's diaper area and the crotch strap to keep your baby from slipping down.

• Some premature infants have breathing problems when they sit semi-upright in a car seat. Make sure your baby is observed and monitored in a car seat by hospital staff before going home. Your child may need to use a car bed if she experiences any of the following while in a car seat:
  • a decrease in oxygen levels
  • slow heart rate
  • apnea

Infants and toddlers with tracheostomies

Most children with a tracheostomy will fit in a standard car seat. Avoid using child restraints with a tray or shield. In a crash, these could come in contact with the tracheostomy, and injure your child or block his airway.

Infants and toddlers in hip spica casts

Hip spica casts and other orthopedic devices, such as splints, can make it impossible for a child to sit in a standard car seat. The Spelcast convertible car seat has been designed for children in casts. It is used rear-facing for infants up to 20 pounds and forward-facing for toddlers up to 40 pounds and 40 inches. An optional tether is available for use forward-facing.

Older children in hip spica casts

The modified E-Z-On Vest is designed for children 2 years and older who weigh up to 100 pounds. It allows a child to lie down in the back seat of the vehicle. It requires two seat belts for installation.

Never use a reclined vehicle seat to transport a child. In a crash, the child can slip out of position and not be protected by the seat belt.

Children who can sit up in their casts

Children who can sit up in their casts may be able to use a standard car seat. Make sure the cast does not get in the way of the buckle or hit the sides of the restraint. A Spelcast car seat can be useful for children in broomstick casts whose legs are spread widely apart.

If an older child is in a cast and can sit up, she may be able to use a booster seat or a seat belt. Make sure she is using the booster seat or seat belt properly and has enough leg room. The lap belt should be worn low and snug across the hips. The shoulder belt should be across the chest, never behind the back or under the arm. Put padding or blankets on the floor so that the child's legs will be better supported.

Children and wheelchairs