Best Bets for Preemies & Low Birthweight Newborns
UPDATED July, 2017
Everyone understands that low birthweight babies often come with challenges. However, most expecting parents don’t consider the possibility that the carseat they bought or put on their baby registry might not fit baby well if she or he arrives early or is smaller than average at birth.
Of course, you often have no idea ahead of time that you’re going to have a preemie or smaller-than-average term baby. But if you’re expecting multiples, have a history of preterm labor or just a history of delivering small babies then you really want to be prepared with a carseat that is likely to fit the baby/babies well – regardless of whether they’re 4 lbs. or 9 lbs. at discharge.
There are 3 important factors when choosing a carseat that is likely to fit a smaller baby well. First is the minimum weight rating. Many carseats are rated from 5 lbs. up. But many babies are discharged from the hospital weighing less than 5 lbs. and the hospital staff might not let you leave with your under-5-pounds-baby in a carseat that has a 5 lbs. minimum weight rating. Ideally, you want a carseat with a minimum weight rating of 4 lbs.
However, the minimum weight rating is only one factor in what you’re looking for in a carseat. You’re also going to need lower-than-average bottom harness slots (ideally 6″ or lower), OR a carseat that comes with an insert cushion that goes under baby’s bottom which raises them up so that their shoulder level is even with, or slightly above, the bottom harness slots. To clarify, in a rear-facing carseat, you want the harness straps to be situated “at” or slightly below the child’s shoulder level. In order to evaluate this properly, you may want to remove the harness strap covers if your seat came with them. In my review photos, I almost always ditch the harness strap covers because, in my opinion, they just tend to get in the way more than anything else when you have a small baby.
Speaking of getting in the way, I want to take this opportunity to educate you on the plethora of aftermarket carseat stuff that lines the shelves of every baby store. With the exception of a blanket to put over baby in cooler weather, you only want to use the things that came in the box with your carseat. Or, items made by your carseat manufacturer that are specifically approved for use with your carseat. Aftermarket products may look helpful or useful but they can be a real detriment to proper usage so they are not recommended. Products like the Bundle Me are great for the stroller but should never be used with your carseat. Ditto for aftermarket harness strap covers and aftermarket infant support cushions. However, there are some safe, recommended alternatives to such products so if you’re looking for suggestions or advice (on this or any other carseat-related topic), please visit our Car-Seat.org forum and we’ll be happy to help educate you.
Since you probably don’t have a good lifelike preemie doll at home to test your carseat with – you can rely on us to steer you in the right direction when it comes to carseats and smaller babies. All of the seats on this recommended list have been tested by us using the preemie doll made by Huggable Images and we’re confident that these seats will provide a snug and proper harness fit for the vast majority of babies who measure at least 4 lbs and 17″ (the size and weight of this particular doll).
List of Recommended Carseats for Preemies & Multiples
UPDATED July, 2017
Priced under $100:
Cosco Light ‘n Comfy: 4-22 lbs.; up to 29″ tall; front harness adjuster; 4 sets of harness slots, 3 crotch strap/buckle positions, optional 4th adjustment position shortens the crotch strap length for small newborns; energy-absorbing EPS foam; some models come with a 2-position adjustable base.
Evenflo Embrace LX: 4-35 lbs.; up to 30″ tall; front harness adjuster; 3 sets of harness slots, 3 crotch strap/buckle positions, optional 4th adjustment position shortens the crotch strap length for small newborns; adjustable base; energy-absorbing EPS foam. See our complete Embrace 35 Review Here.
Safety 1st onBoard 35 LT: 4-35 lbs.; up to 32″ tall; front harness adjuster; 4 sets of harness slots, 3 crotch strap/buckle positions, optional 4th adjustment position shortens the crotch strap length for small newborns; adjustable base; energy-absorbing EPS foam. Currently available only at Target & Target.com. Review coming soon!
Priced $100 – $150:
Graco SnugRide Click Connect 35: 4-35 lbs.; up to 32″ tall; front harness adjuster; 4 sets of harness slots, 2 crotch strap/buckle positions; adjustable base; energy-absorbing EPS foam.
Safety 1st onBoard 35: 4-35 lbs.; up to 32″ tall; front harness adjuster; 4 sets of harness slots, 3 crotch strap/buckle positions, optional 4th adjustment position shortens the crotch strap length for small newborns; adjustable base; energy-absorbing EPS foam.
Priced $150-$200 (MSRP):
Britax B-Safe 35: 4-35 lbs.; up to 32″ tall; 4 sets of harness slots; 2 buckle positions; impact-absorbing base with SafeCell technology; built-in lockoffs for seatbelt installations; premium push-on LATCH connectors; EPS foam, newborn insert. Britax B Safe 35 Review Here.
Chicco KeyFit 30: 4-30 lbs.; up to 30″ tall; 3 harness slots; single buckle position; adjustable base; built-in lockoffs for seatbelt installations; unique “center-pull” LATCH tightening adjustment; premium push-on LATCH connectors; EPS foam; newborn insert (4-11 lbs. only). KeyFit 30 Review Here.
Evenflo SafeMax Infant
: 4-35 lbs.; 17-32″ tall; 4 harness slots; 3 buckle positions; 3 hip-width positions; adjustable base with anti-rebound bar; built-in lockoffs for seatbelt installations; EPS foam; newborn insert. SafeMax Infant Review Here.
Graco SnugRide 35 LX Click Connect: 4-35 lbs.; up to 32″ tall; no re-thread harness with 15 height positions; 2 buckle positions; optional 3rd adjustment position shortens the crotch strap length for small newborns; adjustable base; LX model has built-in lockoff for seatbelt installations; EPS foam; lower body positioning insert. See our complete SnugRide 35 LX Review Here.
Graco SnugRide SnugLock 35 DLX: 4-35 lbs.; up to 32″ tall; 4 harness slots; 2 buckle positions; premium SnugLock DLX base which also acts as a lockoff for seatbelt installations; premium push-on LATCH connectors; EPS foam; lower body positioning insert. See our complete SnugRide SnugLock DLX Review Here.
Safety 1st onBoard 35 Air & onBoard Plus: Only the “Air” and “Plus” models have the premium base with lockoff and Air-Protect Technology. All models rated from 4-35 lbs.; up to 32″ tall; 4 sets of harness lots, 3 crotch strap/buckle positions, optional 4th adjustment position shortens the crotch strap length for small newborns; adjustable base with lockoff; EPS foam. See our OnBoard 35 Air Review Here.
Priced $200-$300 (MSRP):
Britax B-Safe 35 Elite: 4-35 lbs.; up to 32″ tall; no-rethread harness with 6 height positions; 2 crotch strap/buckle positions; impact-absorbing base with SafeCell technology; lockoffs for seatbelt installations; push-on lower LATCH connectors; energy-absorbing EPP & EPS foam; newborn insert. Complete B Safe 35 Elite Review Here.
Chicco Fit2: 4-35 lbs.; up to 35″ tall; no-rethread harness with 7 height positions; 2 crotch strap/buckle positions; adjustable base with anti-rebound bar; base has separate settings for infant & toddler; lockoffs for seatbelt installations; push-on lower LATCH connectors; energy-absorbing EPS foam; newborn insert. Complete Fit2 Review Here.
Graco SnugRide SnugLock 35 Elite: 4-35 lbs.; up to 32″ tall; no-rethread harness with 15 height positions; 2 buckle positions; premium SnugLock DLX base which also acts as a lockoff for seatbelt installations; premium push-on LATCH connectors; EPS foam; lower body positioning insert. See our SnugRide SnugLock Review Here.
Maxi-Cosi Mico Max 30: 4-30 lbs.; 19-32″ tall; 4 sets of harness slots; 2 buckle positions; optional 3rd adjustment position shortens the crotch strap length for small newborns; adjustable base with anti-rebound bar; push-on lower LATCH connectors; energy absorbing EPP foam & AirProtect cushions for enhances side-impact protection; low birthweight wedge insert required for babies 4-5 lbs. Mico Max 30 Review Here.
Nuna PIPA: 4-32 lbs.; up to 32″ tall; 3 sets of harness slots; 2 buckle position; optional 3rd adjustment position shortens the crotch strap length for small newborns; adjustable base with load leg; rigid lower LATCH anchor connectors; built-in lockoff for seatbelt installations; EPS foam & memory foam; newborn insert and separate low birthweight pillow insert. See our complete Nuna Pipa Review Here.
Peg Perego Primo Viaggio 4-35: 4-35 lbs.; up to 32″ tall; no-rethread harness with 6 height positions; single buckle position; adjustable base with lockoff for seatbelt installations; anti-rebound bar; push-on lower LATCH connectors; EPS foam; 2 stage newborn insert. See our complete Peg Perego Viaggio 4-35 Review Here.
UPPAbaby MESA: 4-35 lbs.; up to 32″ tall; no re-thread harness with 5 height positions; 2 buckle positions; adjustable base with tension indicator and auto-retracting lower LATCH connectors; built-in lockoff for seatbelt installations; EPS foam; integrated canopy made with SPF 50 material; low birthweight insert for babies 4-8 lbs. See our complete UPPAbaby Mesa Review Here.
Thank you! Very well done! What about the new Combi infant seats and the Combi Cocorro?
Thanks for the great post, Kecia! Since preemies have been around since the dawn of man, I’m surprised it’s so difficult to find carseats that can accommodate them safely. Those low bottom harness slots and easy adjusting harness straps are important when dealing with tiny babies who with little tone.
Thanks Kecia – I’m off to link this to our Multiples club web page 🙂
what about the new safety 1st Comfy Carry Elite? when it was checked out by other people on the board, it had really nice low bottom slots and was thought to fit preemies well.
Kat, Kecia should be getting the Comfy Carry Elite Plus any day and we hope to have a report soon! It might make an excellent program seat, too.
For the record, this list consists of seats that we can generally recommend without reservation. While there may be other seats that technically fit the criteria for fitting preemies, these are seats that we feel comfortable recommending based on overall ease of use, ease of installation, etc. Currently the Coccoro still has a 5 lb minimum wt rating but we will evaulate the new model once it’s released.
In addition to the Comfy Carry, Evenflo is supposed to be coming out w/ a 4# version of the Embrace (also will go to 35# and have a straight handle), so that might be a decent program seat, too.
I agree that the above mentioned seats are definitely nicer when it comes to ease-of-use, quality, etc. for preemies.
My nephew has the Chaperone, but he was a big baby (8# 3.5oz at birth), so he never needed the extra foam infant insert; in fact, he needed the straps moved up a level. I was pleasantly surprised at how well my preemie sized doll (just a wal-mart doll, not a huggable images doll) fit, especially w/ the foam insert. The insert also changes the interior angle of the seat. I could see how it was helping keep the baby at a better angle that would do a good job of keeping a small baby’s airway open. I believe the Chicco insert is supposed to change the interior angle as well, but I don’t remember it having such a discernible effect on the baby’s head.
What about a seat like the Graco Snugride 30 which is also rated to 4lbs? The Chicco and Britax are both great seats, but they can be on the spendy side. The OnBoard35 is another great seat, but it doesn’t fit on the frame of a double snap and go, which many parents of multiples use in the beginning. In fact only the Chicco on this list seems to fit onto the Snap and Go. Is there a reason the Graco was excluded?
The chicco doesn’t fit on the snap and go correctly…it just sits on their but does not actually snap in like it is suppose to. That is the reason that we went with the Graco snugride 30 seats as well. They are rated to 4 pounds and actually snap into the stroller. Easy to install. I would have liked to see them included or reviewed for this article.
I know this is about carseats but I have to add that we ended up with the Chicco Keyfit 30 seats for our twins after lots of stroller research. Highly recommend the Keyfit 30 seats and the Cortina Together stroller.
SeattleRain,
We have a review prepared for the Graco SnugRide 30, but haven’t yet published it due to some questions regarding fit for preemies. The 4 pound doll we use for reviews is nearly two inches too short to fit in the SnugRide 30. It does fit acceptably in terms of crotch and hip straps on the inner adjustments, though. We have discussed this with Graco, and their research indicates that the doll is not typical of most 4 pound infants. The Britax B-Safe Kecia mentioned also fits the doll well, but our review is still in progress. We will also be reviewing the Safety 1st Comfy Carry Elite Plus soon. What we do know is that the doll does fit the other seats we have reviewed and recommended, so for now, those are the ones we can suggest for low birthweight babies without reservation.
I know this post is years old, but I thought it was worth adding our experience. We purchased the SnugRide30 for our 5.5 lb, 17.5 inch preemie, and she fit in it acceptably, although we did use rolled up blankets around her sides and head, as recommended by the hospital. I know our baby was quite a bit bigger than the 4lb minimum, but this seat worked really well for us.
What about the Mia Moda Cerdo? I know that’s rated from 4 lbs., what are the straps like on that?
Also, Combi will provide documentation in writing upon request that the Shuttle 33 may be used with shoulders below the bottom slots as long as the straps can be properly tightened.
KQ – We don’t have any experience with the new version of the Mia Moda infant seat so we can’t comment on it at this time. However, we have reviewed the Shuttle 33 and while it may be a decent fit for some low birth weight babies, it’s not a seat that we feel comfortable recommending without reservation. https://carseatblog.com/7153/combi-shuttle-33-review-is-this-the-one-for-you/
This list has been updated as of July, 2012. I’d like to add a note that our recommendations are based primarily on the fit to the Huggable Images preemie doll. We realize that this doll is not an ideal “average” size and maybe not even a “typical” size and shape of a 4lb. low birthweight infant. In particular, the shoulders do not hold up well like those on a real baby of this size. We use this doll because it is is commercially available and used by many programs and technicians. That means it is an easy way to compare infant models directly. That also means that models not included on this list may still fit an actual 4-5 pound low birthweight infant. Every baby is a different size and shape, so a real baby might or might not fit well in a product not appearing on our list! On the other hand, while you can be sure that models on our list will fit most babies down to 4 pounds, it’s possible the tiniest babies at this weight may still not fit in some of them. Please read the manual or contact a local special needs trained technician if you have any question before taking baby home!
I see this list was updated this year, is there a reason the Cybex Aton was not included? I’m curious because I own one and had a preemie sized child who fit in it perfectly. When we came home from the hospital, my daughter was 18 inches long, 5 lbs 8oz. The only adjustment I had to make to get a snug harness fit was remove the shoulder pad things. She stil fit snug the next day when we went to the pediatrician and she only weighed 5 lbs 3 oz which would have warranted the 2 hour testing prior to leaving the hospital had she weighed that the day before.
I realize all babies are shaped differently, I just think this seat might deserve a second look. I LOVE this seat, especially the fact that you can have most fronts seats almost all the way back when it is installed behind that seat!
Prior to discharge from the NICU, our little 4 pound daughter was required to pass a carseat test. Her oxygen saturation was measured for a full hour in the seat. In the Britax B-Safe (our first choice), her oxygenation levels had dropped to the high 80s (%) within five minutes, and in the Chicco KeyFit 30 (our second choice) she lasted about 15 minutes before she was again in the 80s. Graco Snugride 35 (a model we had not even considered until my husband’s third trip to the store) saved the day! In addition to being a parent, I am also a Pediatrician, and I truly was surprised at the difference in positioning. The padded insert allowed her neck to be extended, and the crotch strap fit without rolling up a receiving blanket between her legs. I would highly recommend the Graco Snugride 35 carseat to all parents with a premature or small infant. I will admit we like the look of the Britax and Chicco much, much better; in fact, we own multiple Britax carseats for our other children. My advice as both a parent of a premature infant and a General Pediatrician: Get over the fabric (and the name, if that is a problem for you). Of course you need to leave the hospital, but once you are home, again try out infant carseat you researched for hours online. If your infant’s neck is bent down toward her chest in the carseat, her oxygen saturation levels may be lower than you expect, and you should return the seat for another model.
Has the Maxi-Cosi Prezi been evaluated for preemies? I was interested in this car seat for my preemie coming home in a few weeks.
@ Ryan Kellie – yes, if you check out Heather’s Prezi review you’ll see that it fits the preemie doll very well. We will be adding the Prezi to our preemie/multiples list in our next update. HTH & Congrats on your impending arrival! https://carseatblog.com/20169/maxi-cosi-prezi-infant-seat-review-so-euro-so-stylin/
So ive been recently looking at plush/soft dolls for my cpr class next saturday and the one in the carseat is perfect where can I find one of these to purchase for the class if not sellable I will pay extra because this is perfect
Thanks for a great post! My preemie will prob be less than 17 inches when she comes home and just under 5 lb. would any of these car seats work for her? ESP considering the harness height?
@Farah – congrats on your new early arrival! The preemie doll that we use in these review measures 17″ long and weighs 4 lbs so I think it’s reasonable to expect the seats on this list will fit a 17″ baby. None of the seats on this list state a minimum height limit – only a minimum weight limit of 4 lbs and a requirement that the child’s shoulders meet the bottom harness slot height. Plus real babies have real shoulders and real necks – something that our doll lacks so I think the chances are even better that you’ll find a good harness fit with any of these seats. HTH! Good luck!
Have you reviewed any convertible carseats for preemie use? The specific ones we are considering are Maxi Cosi Pria 70 with tiny fit, Chicco NextFit, Graco® My Ride™ 65 Convertible Car Seat, Britax Advocate 70-G3 Convertible Car Seat Seat, and Graco® Smart Seat All-in-One Car Seat. Thank you for your help!
@Marina – Yes, we have considered it but there isn’t a big demand for this type of info from parents of preemies so we haven’t composed a formal list yet. Your best bets for a preemie at this point are the Combi Coccoro and Maxi-Cosi Pria 70 with TinyFit. Those are rated from 3 and 4 lbs respectively. The Chicco NextFit could be a good option too but only for babies who weigh at least 5 lbs going home. I really wouldn’t consider any other convertibles for a preemie. HTH!
As a mom of twins & one of which was just under 5lbs when we brought them home we loved our Baby Trend Flex-loc infant seats. Our babies fit in them really well & the triangle in the handle were life savers when carrying them!! Also had the double snap & go stroller, another life saver! So when we balanced safety, ease of install/buckling, and transporting outside of the car – baby trend wins hands down. If you haven’t tried to carry two seats at once, try it before you buy. Almost all of the moms in my local multiples group use these as well.
Is there a reason you do not recommend the Cybex Aton 2 or Q for multiples?
I love all the new options for tiny babies, but I’m really surprised that the Combi Coccoro still hasn’t been added to this list. Any reason why? 🙂
Robyn- The Aton Q is better than its predecessors and above average for preemies, but we are still evaluating it in regard to some concerns with the harness pads and chest clip before we consider it for this list. We did like it enough overall to include on our main Recommended Carseats list and our full review should be published soon!
soygurl- update: our Coccoro samples were the 5 pound version with the large chest clip and did not fit our preemie doll as well as we would like. We simply do not have a Coccoro with the 3-pound minimum weight limit to test at this time. The 3-33 lb. version is certainly among the best convertibles for preemies, but we can not say how it compares to others on our list.
I will be replacing my Primo Viaggio SIP 30/30 with the new 4-35 and am so happy to see they’ve improved the fit for smaller babies and it now makes the list. Anyone know the difference in lowest harness height between the two models? (just out of curiosity 😉 )
@Shoshana – Darren is currently in the process of reviewing the Peg Viaggio 4-35 and we’ll have all the details in the full review. Based on how it fits the preemie doll I’m going to say the bottom harness slots are about 6″ but don’t hold me to that because it’s just an estimate. HTH!
Great list. Thanks so much. I’m wondering, can this be updated to reflect the date it was updated? It says 2011 on it still. Does anyone have a more printable version? I was going to print this for work then saw it was 10 pages.
Hi – we can’t update the original publication date but the list of recommended seats does state that it was updated in March, 2015. I would copy and paste the list of recommended seats into a Word document and print it out from that. HTH!
I’d suggest adding the Urbini Petal to the list of seats! Great fit for tiny babies.
Have you been able to test the Eddie Bauer Surefit or Surefit II? I am scheduled to have my little one at 34 weeks and am interested in this seat, but would be interested in hearing what you have to say about it.
Great info, thanks! What are your thoughts on the Cosco Scenera NEXT for preemies? I realise the 5lbs minimum means you probably can’t recommend it unequivocally, but its lowest harness slots (5″) are lower than most of these recommended seats. Thanks!
I rent and deliver baby gear and got a call this week from a mom with a preemie just over 4lbs who needed a 4lb rated car seat to get home from the hospital. I had a Graco Snugride Classic Connect with a starting weight of 4 lbs–she was so happy. Now I’ve been looking around for a car seat rated at 3 lbs and up, as another person renting gear through Babierge got a call for a car seat for a 3.5 lb baby. The only 3lb rated car seat I can find is the Coccoro Convertible car seat. Are there any others rated for 3lbs? And can a convertible car seat really be the best option for a preemie under 4lbs?
Hi Trish, unfortunately there are no good options for a baby weighing under 4 lbs. Carseat manufacturers have been very unwilling to venture into that territory. There are car beds that can be used for some preemies but they should NOT be used for babies who are able to pass angle tolerance testing (aka the carseat challenge) administered by the hospital before discharge. Car beds are difficult to install properly, should stay in the car after they are properly installed (they aren’t carriers) and they don’t provide the same level of crash protection that rear-facing only infant seats provide. However car beds are a necessary evil for some babies who just can’t pass the carseat test in the hospital, even after repeated attempts. The Combi Coccoro really isn’t a good option either. Despite being rated from 3 lbs. it does not actually fit preemies well (especially not babies that small). Also, since it’s a convertible, it stays in the car so you lose the convenience of having an infant seat/carrier. For babies who are just an ounce or two shy of 4 lbs., the best option is a seat from this list that is rated from 4 lbs. If the hospital won’t discharge the baby in a carseat rated from 4 lbs., then they need to be prepared to keep the baby a few days longer until that minimum weight is reached.
I am getting mixed information on the width of the Graco Snugride 35 LX carseat. Some websites say it is 15.5 inches and can easy be used for 3 carseats across a backseat. Others are saying it’s 17-18 inches across and takes up a lot of space. I have a 5 year old in a Diono (we got it for it’s safety and also bc it’s only 17 inches across). I need to put a rear-facing infant seat in the middle (originally we were considering a Chicco Keyfit bc it’s only 17 inches or a Combi Coccoro bc it’s only 15 inches). And then I have a teenager that needs to sit in the 3rd seat w/o being pinned against the car door. We can’t buy a new vehicle until we move back to the United States (May 2018) bc we are military stationed overseas. So, the vehicle we have no needs to work. So, is the Graco a narrow carseat or wider? Info online is so confusing and not very clear!!!
Hi Michelle. The SnugRides are in the 17-18″ range and the width comes from the handle. Same with the KeyFit. What vehicle do you have?