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Home / How Long Can a Baby Sleep in a Car Seat

How Long Can a Baby Sleep in a Car Seat

Recent product recalls, and a new study, reaffirm the old advice: Infants should sleep flat on their backs in a crib.

Credit... Luis Mazón

This story was originally published on May 24, 2019 in NYT Parenting.

A new study published May 20 in the journal Pediatrics highlights the risks of allowing babies to sleep for extended periods in rocking devices or car seats. If the thought of giving up your infant swing or vibrating chair is daunting, I get it. My first child is now 11. Although day-to-day memories of his first few months are fading, one that remains fresh is his screaming. As an infant, he was often difficult to soothe. My wife or I would put him in his car seat: Cue the screams. Rocking chair? Screams. Crib? Tummy time? Stroller? Guess. The one thing that worked was his infant swing. We would strap him in, turn on the motor that swung the cushioned seat back and forth, and count on about 30 minutes of blissful silence while he snoozed.

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Safe sleep advocates, and pediatricians like me, have long been concerned about the array of rocking or bouncing devices on the market that promise to calm crying infants. But if you had told me, as the new father of a fussy 3-month-old, that I needed to give up the swing, I'm not sure what I would have done.

Yet, the real dangers associated with these devices cannot be ignored. Early last month, Fisher-Price recalled its popular Rock 'n Play sleeper after multiple infant deaths in the device were reported. Just two weeks later, Kids II recalled its similar rocking sleepers after five infants died.

It is a heartbreaking situation. One of the earliest reports to the Consumer Product Safety Commission, from January 2018, reads as follows:

My 6-month-old son was put down for a nap in the Fisher Price Rock n Play. During the time of his nap, he rolled over in the Rock N Play and silently died. The Rock N Play is sold as a sleeper and is marketed for "great overnight sleep" . . . My son was a beautiful, healthy baby and only died because of the Rock N Play and the false sense of security they provide with their false and UNSAFE claims of the Rock N Play being used for safe sleep. The only place for safe sleep for an infant is a flat surface. This death trap needs to be recalled and labeled as a SUPERVISED PLAY PRODUCT so no other family has to lose their child like I have.

The authors of the Pediatrics study, led by Dr. Jeffrey Colvin, reviewed a registry of more than 10,000 infant deaths that occurred during sleep. Approximately 3 percent of these deaths took place in what the authors called "sitting devices": car seats, swings, bouncers and strollers. The majority of the infants who died in "sitting devices" were between 1 and 4 months old, and the majority of the deaths were due to suffocation. Of the deaths that occurred in "sitting devices," over 60 percent occurred in car seats, 35 percent in swings and under 5 percent in strollers. While incorrect harness use was the biggest risk factor, other risk factors resembled those for SIDS: infants born prematurely or at a low birth weight (less than 5.5 pounds) and secondhand smoke exposure. Deaths in "sitting devices" were also found to be more likely when a caregiver was sleeping or distracted, and when someone other than a parent was watching the baby.

Yet, for some parents, the baby in motion is the only baby who sleeps: either back and forth in a swing or a parent's arms, or back and forth in a car or stroller on an aimless cruise around town (God forbid you hit any traffic). That is why devices which promise (and sometimes deliver) a calm and sleepy baby with less parental exertion are so alluring. It's not a coincidence that most of the deaths occurred in the first few months of life, when babies are still waking up frequently and many parents are going back to work. What is an exhausted parent to do?

The safest sleep environment for an infant is the most boring setting you can imagine: a flat, empty crib, devoid of blankets, bumpers, cushions or even stuffed animals. In a perfect world, you put your baby down on his back drowsy but awake, and he sleeps, still and sound, for long stretches at night, as well as extended daytime naps.

Sometimes sleep on the move is inevitable, and most babies will need to fall sleep in a car seat or stroller from time to time; the authors of the Pediatrics study took pains to reiterate the fact that car seats remain the safest way for babies to travel, and to note that almost all of the car seat-related deaths occurred outside a motor vehicle. It's also important to remember that deaths in these devices were relatively rare. Yet there are a few rules of thumb to keep in mind.

First, babies in car seats, strollers and bouncers should be observed. Obviously, this is impractical if you are, say, driving a car, but you should never leave your child alone in a car seat. For devices like swings and rockers, you must be nearby and keeping an eye on your baby.

Second, rockers, bouncers and other such devices must be used as their manufacturers recommend. Use any seatbelts or restraints that are included (some of the Rock 'n Play-linked deaths occurred when unrestrained infants rolled sideways and suffocated). Make sure your child is not too big or too small for the device. Avoid any device that has an active recall, especially if your baby may fall asleep in it. Make sure you send in the warranty card when you purchase a device so you can receive safety notifications. If you are using a secondhand device, you can check to see if there is an active recall in the United States on the Consumer Product Safety Commission website. And remember that you should avoid using a secondhand car seat. The materials used in car seats may weaken over time, and if they have been in an accident, they may not function correctly.

Here's the most important part: Once your child falls asleep in a swing or a car seat (outside of the car), you should transfer him to a crib or bassinet. As Dr. Colvin noted, "Just like you would never let your infant travel in a car unless they were in a car seat, you should never let your infant sleep when outside of the car unless they are in a crib or bassinet."

In my pediatric sleep clinic, overuse of swings and car seats to help babies fall asleep tends to result in frequent nighttime awakenings. Why is this? Everyone has natural awakenings during the night. If your baby gets used to falling asleep in a swing and you transfer her to her crib once she is sound asleep, she is likely to need that swing to fall back asleep whenever she has one of her natural nighttime awakenings. This condition is called inappropriate sleep onset association. In practical terms, this means that, to get your baby to return to sleep, you will need to provide the same circumstances she needed to fall asleep at bedtime. (The treatment for this is sleep training.)

Another concern is that overuse of these devices can lead to flattening of the skull in some infants. Although this is generally benign, a helmet or other device may be necessary to resolve the issue — and most parents would prefer to avoid it in the first place. The American Academy of Pediatrics has some information on this here.

Poor infant sleep is often very stressful for parents and is associated with postpartum depression. Compounding parental exhaustion is the fact that parents in the United States have significantly less parental leave than parents in other industrialized nations, often returning to work before their babies are sleeping through the night. I suspect this is why adherence to the "Back to Sleep" recommendation for safe sleep plateaued in 2001. Although sudden infant death syndrome rates continue to decline, a concurrent increase in the rate of suffocation and strangulation deaths has led to a plateau in the rate of infant sleep-associated deaths since the late 1990s. These may be associated with the kind of unsafe sleep practices that are used by exhausted parents, often accidentally (such as falling asleep with the baby on a couch). Although it is difficult to study, there is some evidence that increasing parental leave is associated with fewer infant deaths.

I spoke with Dr. Harvey Karp (author of "The Happiest Baby on the Block," which I relied on when my first son was crying all the time) about the challenges facing new parents. He noted that the safe sleep guidelines can only go so far when no provision is made for the sleep of exhausted parents.

Dr. Karp developed the SNOO, a bassinet that uses motion, sound and swaddling to calm crying babies. Unlike the Rock 'n Play or similar devices, the SNOO meets the same safety requirements as a bassinet or crib and, in a recent study, was shown to be almost as effective as parental attention in soothing crying infants. The cost of the SNOO puts it out of reach of most young families, but it is heartening to see more innovation in this space. We need to find novel and safe ways to help exhausted parents to both sleep and keep their babies asleep. More generous family leave policies are necessary too, Dr. Colvin noted. "As a community, we need to develop programs that support families with infants and fill in the gaps, especially when it comes to directly assisting those families and providing respite for parents," Dr. Colvin said.

If you are struggling, I strongly recommend discussing your concerns with your child's pediatrician, both to rule out any medical cause for your baby's irritability (such as acid reflux or a milk protein allergy), and to come up with strategies to help you manage your exhaustion. These may include asking a grandparent or friend to provide some respite care or, if your child is over 4 months old, sleep training.

The prospect of transferring an infant — peacefully asleep, at long last — from car seat to crib can feel agonizing in the moment. But it is crucial to avoid unsafe sleep practices, because they can have catastrophic consequences. Try to remember that, in time, your child will sleep better, and so will you. Ask for help, be safe and hang in there.

Craig Canapari, M.D., is an assistant professor of pediatrics at Yale University, director of the Pediatric Sleep Center at Yale-New Haven Hospital and the author of It's Never Too Late to Sleep Train. He blogs about childhood sleep issues on his website.

How Long Can a Baby Sleep in a Car Seat

Source: https://www.nytimes.com/2020/04/17/parenting/baby-sleep-dangerous.html