Preterm or Low Birth Weight Child Restraint Usage Guidelines

According to the U.S. National Highway Traffic Safety Administration, a properly installed child restraint reduces the risk of death by over 70% for infants involved in crashes. Federal Motor Vehicle Safety Standard (FMVSS) 213 establishes design and dynamic performance requirements for child restraint systems. However, the standard has no minimum weight limit and does not address the special medical needs of preterm or low birth weight infants. To ensure that preterm and low birth weight infants are transported safely, the guidelines published by the American Academy of Pediatrics (AAP) in Pediatrics 2009;123:1424–1429 must be followed.

All children should ride rear-facing in the vehicle as long as possible. Preterm and low birth weight infants are at additional risk of breathing difficulties and heart problems when placed in a child restraint. Evenflo requires that the evaluation recommended by the AAP be conducted for all infants born earlier than 37 weeks and all newborn infants who weigh less than 5 lb at birth before their first car trip to check for breathing difficulties or heart rate problems when traveling in a rear-facing child restraint. The AAP recommends that appropriate hospital staff observe your infant in the child restraint for a period of 90 to 120 minutes or the duration of travel, whichever is longer. This period of observation must be performed with the infant properly positioned as described in these instructions and with the child restraint placed at an angle that is approved for use in the vehicle. The hospital staff will check for any breathing difficulties or heart rate problems. Your child’s pediatrician will let you know if there are any special considerations for travel. The number of trips and the duration of time the infant is seated in the child restraint should be minimized. A caregiver should ride in the back seat to monitor the infant during travel.

You can learn more about the AAP’s recommendations for observation of newborns and the guidelines for safe transportation of preterm and low birth weight infants, as well as other resources for parents and medical professionals, at