Bringing home a preemie comes with a lot of questions, including when it comes to travel. Car seats play an important role in helping support your baby’s developing body, and not every seat is designed with preemies in mind. Let’s explore what makes preemies unique, what to look for in a preemie car seat, and how to feel more confident on the road. What is a Preemie? A preemie, or premature baby, is any baby born before 37 weeks of pregnancy. There are a few categories of prematurity: Late preterm: 34 to 36 weeks Moderately preterm: 32 to 34 weeks Very preterm: under 32 weeks Extremely preterm: under 25 weeks While every baby develops at their own pace, preemies often need a little extra support in those early weeks. Many weigh less than 5 pounds at birth, which can affect how they fit in standard baby gear like infant car seats. Common Challenges Faced by Preemies Preemies are strong and resilient, but their smaller size and ongoing development can create a few challenges when it comes to positioning in a car seat. Some preemies may have lower muscle tone, especially in the neck and trunk, which can make it harder to maintain an upright position. Their airway and respiratory systems are still developing, and some may experience pauses in breathing or changes in heart rate. A semi-reclined position can also affect how easily they breathe. The right car seat can make a meaningful difference here. A seat with an appropriate fit, proper support, and correct installation helps keep your baby positioned comfortably while supporting their natural posture. If you have questions about whether your car seat is a good fit for your newborn, or if they’re positioned correctly, it’s a good idea to consult with the appropriate hospital staff or a certified car seat technician before taking that first ride. Why Car Seats Are Especially Important for Preemies All newborns are still developing head and neck control, but this is especially true for preemies. Their smaller size and lower muscle tone can make positioning even more important during travel. If a car seat is not reclined at the correct angle, a baby’s head can tip forward toward their chest. This position can partially block the airway and make breathing more difficult. Preemies may also get tired more quickly in a seated position, which can affect how they hold their head over time. Fit is just as important as positioning. Some preemies may be too small for certain car seats, especially if the minimum weight limit or harness height is too high. A harness that does not sit correctly at or below the shoulders may not provide the support your baby needs. When everything is set up correctly, a well-fitted infant car seat helps support your baby’s head, neck, and body while keeping them properly positioned for every ride. Not All Infant Car Seats Are Preemie-Friendly It might seem like any infant car seat will do the job, but not all models are designed with very small babies in mind. Some car seats have a minimum weight requirement of 5 pounds or more, which may not work for smaller preemies. Harness slots can also sit too high, making it difficult to achieve the correct strap position for a snug and supportive fit. In some cases, bulky headrests or padding that are not designed for smaller babies can push the head forward instead of allowing it to rest naturally. Some models include removable infant inserts that can help improve fit for smaller babies. These inserts are specifically designed to support the hips and torso while helping maintain proper positioning. However, it’s important to use only the inserts that come with your car seat and follow the instructions in the product manual because aftermarket products are not designed for or tested with your specific car seat. Understanding the Car Seat Tolerance Test for Preemies Before many preemies leave the hospital, they complete something called a car seat tolerance test. You might also hear it referred to as the Infant Car Seat Challenge or Car Seat Tolerance Screening. This test usually takes place in the NICU before your baby is discharged. Your baby is placed in their own car seat and monitored for a set period of time, often between 90 and 120 minutes. During the test, medical professionals keep a close eye on: Breathing patterns Heart rate Oxygen levels The goal is to see how your baby handles sitting in a semi-reclined position for an extended period, similar to what they would experience during a car ride. This test helps identify babies who may have difficulty maintaining steady breathing or heart rate while seated. It also helps confirm that your baby can tolerate the car seat you plan to use at home. If any concerns come up, your care team can offer guidance, suggest adjustments, or recommend next steps before discharge. How to Choose the Best Preemie Car Seat Choosing an infant car seat for a preemie often comes down to one thing: fit. A seat that works well for a full-term newborn may not offer the same level of support for a smaller baby, so it helps to look a little closer at the details. Look for a low minimum weight: Some infant car seats are designed to accommodate babies as small as 3-4 pounds. This lower weight minimum can make a big difference for preemies who need a more precise fit. Pay attention to harness height: For rear-facing use, harness straps should sit at or just below your baby’s shoulders. Car seats with lower harness slot positions or adjustable headrest systems can help you achieve a better fit as your baby grows. Check for clear recline indicators: Getting the correct seat angle matters for your baby’s positioning. Many car seats include built-in level indicators or bubble guides that help you install the seat at the proper angle. Use infant inserts designed for small babies: Some car seats include inserts that provide extra support for a smaller torso and hips. These can help improve fit without pushing your baby’s head forward. Always use the inserts that come with your car seat and follow the instructions in the manual. Look for a supportive seat design: A flatter backrest can help your baby’s head rest more naturally against the seat, which supports better positioning during travel. Chicco infant car seats, like the KeyFit 30, have been ranked as a top choice for preemie babies by industry experts such as Safe in the Seat. If you’re unsure what car seat type is right for your baby, or you need help installing it, a Certified Passenger Safety Technician can guide you. You can also find car seat installation instructions in the product manual. Positioning Preemies in Car Seats In addition to choosing the right preemie car seat, you must learn how to properly position your baby in it. Small adjustments can make a big difference in how your baby sits and how well the harness supports them. The goal is to keep your baby’s body aligned with their head, neck, and body resting naturally. Here are a few key positioning tips to keep in mind:. Place harness straps at or below the shoulders: This helps keep your baby secure and properly supported in a rear-facing position. Make sure the harness is snug: You should not be able to pinch any slack at the collarbone. Position the chest clip at armpit level: This keeps the harness in the correct place across your baby’s body. Keep your baby’s head resting naturally: Their head should lie back against the car seat, not fall forward. Ensure your baby’s back is flat against the seat: A flush position helps support the spine and overall alignment. Follow the recline angle instructions: Use the seat’s built-in indicators to guide installation and positioning. Skip bulky clothing: Thick layers can interfere with how the harness fits against your baby’s body. Avoid extra padding or add-ons: Items that did not come with your car seat, including rolled towels or cushions, should never be used, as they can affect positioning and fit. Tips for Traveling With Preemie Medical Equipment Some preemies may come home with medical equipment, such as oxygen tanks or monitoring devices. Traveling with these items can feel like a lot to manage at first, but a little preparation can help everything go more smoothly. Secure equipment during travel: Oxygen tanks and other items should be secured with a vehicle seat belt or placed on the vehicle floor to keep them in place. Add padding around equipment when possible: This can help prevent shifting or damage during the ride. Route tubing carefully: Make sure tubing does not interfere with the harness or your baby’s positioning. Keep monitors stable and within view: Secure monitoring equipment so it does not move while driving. Avoid placing equipment behind your baby’s head: This can affect positioning and comfort in the car seat. Talk with your care team before longer trips: Your medical team can provide personalized guidance based on your baby’s needs and equipment. Find the Right Infant Car Seat From Chicco Bringing your preemie home is a big moment, and having the right car seat can help you feel more prepared for the journey ahead. Chicco offers a range of infant car seats designed with features that help create a better fit for smaller babies. Explore the full collection of infant car seats from Chicco to find the right fit for your family and your routine. FAQs Are preemies allowed to ride in standard infant car seats? Yes, many preemies can ride in standard infant car seats, as long as the car seat fits their size and weight. It is important to check the minimum weight requirement and ensure the harness can be adjusted to sit at or below your baby’s shoulders. Why do NICU babies have to pass a car seat test? The car seat tolerance test helps confirm that your baby can handle sitting in a semi-reclined position for a period of time. During the test, medical professionals monitor breathing, heart rate, and oxygen levels to make sure everything is stable before your baby heads home. What challenges do premature babies face in car seats? Preemies are still developing muscle tone and head control, which can affect how they sit in a car seat. Their smaller size can also make it harder to achieve the right harness fit. Positioning plays an important role in supporting their posture and helping them stay secure during travel. Are there preemie inserts for car seats? Some infant car seats include inserts designed to support smaller babies. These can help improve fit by supporting the hips and torso. It is important to only use inserts that come with your car seat and follow the instructions provided in the product manual.