When my eldest daughter was a newborn, date night with my husband involved driving to the Indian buffet 20 minutes from our home to lull her to sleep, putting her car seat on our regular table against the wall so we could stare at her and eating enough butter chicken to get through a night of breastfeeding. I knew that putting the car seat on an elevated surface was dangerous in theory, but in practice, one of us was guarding it like the philosopher’s stone at all times. I didn’t realize that there were other risks associated with letting her catch some Zs in the bucket seat. In fact, with the National Safety Mark stamped on the side, I thought it was one of the safest places she could be. Turns out, I was wrong.
A new study of infant sleep-related deaths in sitting devices—car seats, strollers, chairs, swings and bouncers—found that 63 percent happened in car seats. The study, which was published in Pediatrics in July 2019, looked at all 348 sitting-device deaths in the United States from 2004 to 2014. It found that in over 90 percent of deaths in car seats, they were not being used as directed, meaning that the child wasn’t strapped into an appropriately-sized car seat and travelling in a vehicle. More than half of car seat deaths occurred in the child’s home, and it wasn’t just already-vulnerable babies who were victims.
“We thought we were going to find a lot of premature infants die in car seats,” says Jeffrey Colvin, a paediatrician at Children’s Mercy in Kansas City and one of the authors of the study. “Instead, we found perfectly healthy babies who had been put into car seats not for the purpose of travelling. That’s just where the caregiver had them sleep, which makes it so much more preventable.”
What makes a car seat an unsafe place to sleep?
When babies sleep in the sitting position, their heads can fall forward, restricting their airways and causing them to stop breathing. This devastating phenomenon, known as positional asphyxiation, was found to be the cause of 48 percent of deaths in car seats in a 2015 study published in The Journal of Pediatrics, affecting children up to age two. The other 52 percent of deaths were caused by strangling on straps, often because they weren’t properly secured.
There are new guidelines about when to turn your kid's car seat forward-facingWhile it’s safe for your baby to have a cat nap as you drive from point A to B—provided it’s not too long of a journey, though no evidence-based limits have been determined—you shouldn’t continue to let them sleep when you arrive at your destination, says the Canadian Paediatric Society. When you remove the bucket seat from its base in a vehicle and place it on another surface, the baby’s position can change. “A car seat is tested at a very specific angle,” says Katherine Hutka, president of the Child Passenger Safety Association of Canada who also works at Child Safety Link, an injury prevention program at the IWK Health Centre in Halifax.
Many strollers and shopping carts now offer the option to clip in the car seat, which seems super-convenient, but means babies are spending a lot of time in the sitting position and some stroller systems place babies in more upright positions than the car seat base, adds Hutka.
When the seat is taken out of the car parents will also often loosen the straps or fully or partially unbuckle them, thinking they’re no longer needed and it will be more comfortable for the baby; however, this is extremely dangerous. “The baby can easily slide into that unsafe C shape where they go chin to chest,” Hutka says. “When you don’t buckle a baby up, they can squirm and squiggle and even get fully sideways or upside down in that car seat and get themselves trapped and compromise their airway.”
Hutka adds that sometimes caregivers will only buckle up the chest clip and leave the ones between the legs undone. As a result, a child can slide down in the seat, catch their neck on the chest strap and strangulate themselves.
Colvin says the length of time babies were in car seats was a factor in many of the deaths in the study. In about 30 percent of all sitting device deaths, the caregiver was sleeping when the death occurred, suggesting the baby was sleeping in the car seat unsupervised for an extended period of time. “It appeared that these infants had been placed in car seats overnight or for very long durations,” Colvin says. “We got the feeling that this is where they always slept.”
What can a parent do?
While very few deaths in Colvin’s study occurred when the babies were travelling in vehicles, it’s prudent to limit the time of your journeys or take breaks to check on your baby and get them out of the car seat. At IWK, Hutka advises parents of premature infants to take them out of the car seat frequently but adds that there is no recommended safe time.
If you arrive at your destination and your baby just needs a few more minutes of shut-eye, it’s permissible to let them stay put if you follow a few rules, Colvin says. “If you are directly supervising the infant and the infant remains strapped in, it’s reasonable to keep your infant in the car seat for a short duration,” he says, adding that he can’t say what a safe amount of time would be, you should never stay in a warm car and your eyes have to be on the baby at all times. “If you’re going to be doing chores around the house for an hour or two, then the safest thing to do is to gently and quietly remove the infant from the car seat and put them in a crib or bassinet. Like every parent, I know that the last thing you ever want to do is wake up a sleeping baby, but it’s just the right thing to do.”
To attempt to smoothly transfer your baby to their crib or bassinet, Sukkie Sandhu, a baby and child sleep specialist and owner of HappyBaby Sleep Solutions in Victoria, B.C., suggests carrying the bucket seat into their room, making sure the room is dark and quiet, and then gently lifting them out of the car seat and placing them in the crib. “Some babies transfer beautifully from car seat to crib if they know how to sleep in their crib,” she says. “Unfortunately, other babies are up after they’ve had a little car nap and it’s hard to get them back down.”
If your baby rouses mid-transfer, Sandhu suggests running through your naptime routine—whether it be nursing, reading a book or singing a lullaby—to see if that helps them go back to sleep. If that doesn’t work, she says you should consider the nap done and move the next nap or bedtime up earlier. While it’s not convenient, it’s the safest option.