Parents are being warned that "car seats are not substitutes for cribs and bassinets" following a large study of infant sleep-related deaths in sitting devices.
The research, published in the journal Pediatrics, found that the majority of deaths in sitting devices, which also included strollers and bouncers, occurred while babies were in car seats. And many happened when the child was in the care of someone other than their parent.
The study used fatality data spanning a ten-year period from 2004-2014 and included almost 12,000 infants. The aim was to examine risk factors for sleep-related infant deaths in both sitting devices (car seats, strollers, bouncers, swings and other infant seats) and non-sitting devices (cribs and bassinets) to better understand the factors surrounding fatalities in sitting devices. Researchers also looked at who the primary caregiver was at the time of death, where it took place, as well as the presence of other objects in the environment.
Results indicated that three per cent (348) of the infant sleep-related deaths occurred in sitting devices, with 63 per cent of these happening in car safety seats. In 90 per cent of cases, seats were not used as directed. More than half of deaths in child seats occurred in the infant's home and the median age was just two months old.
Bouncers, swings or devices were responsible for 35 per cent of deaths while 2 per cent occurred in strollers.
Compared to other deaths, those occurring in sitting devices were more likely to happen under the supervision of a child care provider than a parent.
Car seats are the safest way for a baby to travel, but be sure to move a sleeping baby to bed once you reach your destination. A new Pediatrics study shows 3% of sleep-related infant deaths occurred in a sitting device that was not being used properly.https://t.co/qdQNWd3II5— Amer Acad Pediatrics (@AmerAcadPeds) May 20, 2019
"There are higher odds of sleep-related infant deaths in sitting devices when a child care provider or baby-sitter is the primary supervisor," the authors conclude adding that "using child safety seats for sleep in non- travelling contexts may pose a risk to the infant."
According to co-author Dr Jeffrey Colvin, while car seats are always the best place for babies when they are being transported in a vehicle, "that doesn't mean they are the safest place when they're sleeping outside of the car". "Parents should bring along a portable crib or bassinet for sleeping when they arrive at their destination," he says.
The results also highlight that it's not just parents who need to be educated about the risks. Dr Colvin notes that anyone taking care of their infant, whether it's a grandparent, babysitter or child care provider, also need to be informed that "car seats are not substitutes for cribs and bassinets".
"The same is true for bouncers, swings and strollers," he said.
Discussing the findings, associate editor of Pediatrics Alyson Sulaski Wyckoff who was not involved in the study, writes, "Although sitting devices are designed for activities such as transportation, feeding and playing, parents may inappropriately rely on them as an alternative to a crib or bassinet. When the devices are not used as directed, infants can fall from an elevated surface on which the device was placed, or flip onto a soft surface and suffocate. They also can be injured or killed with improper buckling of car seat straps."
And the AAP's recommendations are clear.
"Babies should be placed for sleep in a supine position for every sleep by every caregiver until the child reaches 1 year of age," they say. "Loose bedding and soft objects must be kept out of the sleep area. Sitting devices should not be used for routine sleep."
The recommendations are in line with Australian advice from Red Nose.
"Once the car journey is over it is very important that you remove baby from the car seat or capsule, even if this means waking baby, because it is not safe for baby to spend long periods in car seats, capsules or infant seats," the organisation says."Falls from car seats used outside of the car as infant carriers are common, often involve children unbuckled in their car seats and represent a significant source of head injury for baby.
"Never leave baby in carriers on shopping carts, counters, or other high locations."