Getting your baby to sleep in a bassinet or crib can be easier said than done, and parents often find their little ones naturally fall asleep in the car because of the angle and comfort. But car seats aren’t meant to hold babies for extended amounts of time, and there’s a reason why.
In April 2015, Derek and Ali Dodd’s 11-week-old son Shepard was put to sleep in a car seat at daycare. When the daycare staff checked on him two hours later, he was cold and blue. His airway had become blocked in the time he slept, and the position of his head prevented him from getting enough oxygen.
This may seem like an extreme and worst-case scenario when it comes to leaving a baby in a car seat to sleep, but the Dodds are not alone. These stories pop up more often than you might think – Mary and Zach Fales had a similar experience with their 3-month-old son Cooper, and each year there are hundreds of close calls or deaths because of extended sleep time in car seats.
From 2003 to 2007, there were more than 43,000 car seat-related injuries reported in emergency rooms, and many of these were considered preventable. For parents looking at alternative devices to get their baby to sleep, the dangers of using a car seat should be clear – as well as the reasons why.
Why it’s not a Good Idea
“Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for young infants,” says the American Academy of Pediatrics (AAP).
Though it may seem like the position and angle of your baby’s car seat is suitable for extended sleep, this doesn’t make it a safe alternative to a flat surface. Why? The position of your baby’s head may shift during sleep and cut off oxygen by blocking her airway.
“When your baby is seated, her heavy head can fall forward causing difficulty breathing…and even suffocation,” writes Dr. Harvey Karp, author of The Happiest Baby Guide to Great Sleep: Simple Solutions for Kids from Birth to 5 Years and other books. “That’s why car seats – outside of moving cars – are not safe for naps or overnight sleep for the first 6 months of life.”
The Mayo Clinic cites a 2009 study that says sitting in a car seat can “compress a newborn’s chest and lead to lower levels of oxygen,” and even a mild lack of oxygen can be enough to suffocate a baby.
A study in The Journal of Pediatrics on 47 baby deaths in sitting and carrying devices – car seats, swings, strollers, slings – found that two-thirds of the deaths reported occurred in car seats, and most of those deaths happened outside of the car.
The study suggests, then, that it’s lack of supervision and proper use that leads to car seat deaths. More than half of the deaths were due to “strangulation from straps” and the rest from “positional asphyxia,” when a baby can’t breathe because of their positioning.
Either of these situations can be preventable if a baby is supervised and in a vehicle. The problem is when parents leave a baby unattended in a car seat and aren’t present if the baby starts to become strangled by straps or asphyxiated by their head position.
Nearly half of all the deaths analyzed in the study occurred because the parent was looking to have the child fall asleep, where only 5 instances occurred while the baby was in a device to travel. The study points out that it’s this unintended use of car seat that leads to the greatest dangers.
“Inferring from our and others’ data, an infant in a properly positioned car seat, in a car, with the straps properly attached is at little risk of suffocation or strangulation,” write the authors of the study.
Safe Sleep Guidelines
The American Academy of Pediatrics (AAP) recommends using car seats “only for travel” instead of sleeping and other needs, like feeding. To create the best sleeping environment for your baby the AAP recommends:
- Putting your baby to sleep on his or her back
- Only using a firm surface like crib or bassinet mattress
- Using tight-fitting sheets and avoiding blankets and pillows
- Avoiding soft, plushy surfaces like couches and cushy beds
The AAP and other organizations estimate that 3,500 to 4,000 babies die each year from SIDS or accidental deaths that occur during sleep. This makes it the number one cause of death for babies between one month and one year of age.
Anything you can do to provide a safe sleep environment for your baby, then, is highly encouraged. Parents may think that babies with medical concerns, such as reflux, may have an easier time sleeping in a car seat because of the upright angle, but this isn’t necessarily true.
“Some parents worry that babies will choke when on their backs, but the baby’s airway anatomy and the gag reflex will keep that from happening,” says Rachel Y. Moon, MD, FAAP. “Even babies with gastroesophageal reflux (GERD) should sleep on their backs.”
If your baby has medical or physical considerations, talk to your pediatrician about what you can do to provide a successful sleep environment for your baby. To learn more about safe sleep, check out the Safe to Sleep® program and their Safe Sleep Environment Tool.
How to Avoid Using Car Seats for Sleep
To those without kids, it may seem like a cliché: parents driving around the neighborhood at night trying to get their baby to fall asleep. But the reality is many babies have an easy time falling asleep in the car because of the white noise and vibrations of a moving vehicle.
If your baby is a car-sleeper, there are things you can do to prevent accidents and avoid using the car seat as a staple of your baby’s sleep routine. The AAP recommends transferring sleeping babies from their car seat to a safe sleep surface as soon as possible, and making sure that your baby is properly buckled and strapped whenever they’re in their car seat.
If you’re taking long trips, be sure to check on your baby from time to time, and take frequent breaks to prevent your baby from sitting in their car seat for too long.
If your little one has gotten in the habit of falling asleep in their car seat instead of crib, focus on creating a routine and schedule, and then try to transition from car naps to ones at home.
“You can help your baby transition to consistent crib naps by taking him for a stroller or car nap at the same time every day,” writes Jennifer Goldberg at Today’s Parent. “After a week, try putting him down in his crib at this time instead. Because his body is expecting sleep, he’ll nod off more easily, without needing motion.”
Deciding What’s Best for Your Baby
Although there’s evidence against allowing babies to sleep in car seats at night, there are plenty of stories in online forums from parents who do just that. Many of them have had success getting their babies to sleep this way, and use it as a transition to the crib or bassinet down the road.
If you’re considering letting your baby sleep in his or her car seat, we recommend talking to your pediatrician about potential risks and benefits before doing so. For many parents, reducing the risk of SIDS and accidental deaths is enough to avoid using the car seat as an extended sleep device, but for sleep-deprived parents, having a conversation with your pediatrician is often the best way to learn more about your options.