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December 2006

Leaving Sleeping Babies in Car Seats Can Be Dangerous

New study says car seats can restrict breathing, especially when used indoors

Whether it’s the hum of the engine or gentle motion, something about driving in the car makes babies sleepy. And while it’s tempting to leave a lulled little one in her car seat once arriving at the destination, a new study reaffirms that babies should not be left sleeping in car seats — especially indoors—once travel has ended.

Leaving babies asleep in upright car seats can impair their breathing and become life threatening, according to a study in the December 9th issue of the British Journal of Medicine. New Zealand researchers examined 43 infants referred to the Auckland Cot Monitoring Service for apparent life-threatening events. In each case, caregivers thought the babies had stopped breathing. Nine of these infants had been left sleeping in car seats. Notably, "All but one of the infants had been left in the car seat indoors, restrained and asleep in a relatively upright position."

The researchers determined that the babies' positions in their car seats — slightly upright rather than tilted towards the back — caused babies' heads to flex forward, pressing their jaws against their chests, and causing the airways to narrow.  Researchers say the upright seat position, infants' weak neck muscles, being asleep, and mothers’ smoking, (one-half of the study subjects’ mothers smoked during pregnancy), contributed to the impaired breathing.

Proper Use of Car Seats

Car safety seats are vital in protecting infants in car accidents and should always be used in vehicles. However, problems arise when sleeping infants are left in their car seats, removed from the car and then placed on flat surfaces such as tables and floors resulting in an upright position and thus, creating greater potential for infants’ heads to fall forward.

"We encourage parents to be aware of their infants' sleep safety in the car, at home, and in child care," says Christine O'Meara, the N.C. Back to Sleep Campaign Coordinator at the North Carolina Healthy Start Foundation. "Make sure the car seat is correctly installed in the car to maintain a 45-degree angle, the child is buckled, and then, upon reaching the destination, remove the infant from his car seat and place him on his back to sleep in a crib, bassinet or playpen."

5 Ways to Keep Infants Safe in Car Seats

  1. Ensure that the car seat is properly and securely installed
  2. Buckle the child appropriately
  3. Do not leave children unattended in car seats
  4. Remember, car seats are designed for transportation safety not as sleep environments, so remove infants from the car seat upon arrival at the
  5. Keep the child’s head or face uncovered while they in a car seat to prevent suffocation or overheating

Opens in new window "Apparently life threatening events in infant car safety seats" Shirley L Tonkin, Sally A Vogel, Laura Bennet, and Alistair Jan Gunn, British Medical Journal 2006 333: 1205-1206.  

Opens in new window National Highway Traffic Safety Administration, Traffic Safety Facts 2005 Data

Opens in new window National Highway Traffic Safety Administration, Child Safety Seat Inspection Locator

American Academy of Pediatrics, Car Safety Seats: A Guide for Parents 2006
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Last updated: January 2007


At a glance

Child Car Restraints 2005 National Statistics


  • Reduced fatal injuries for infants in cars: 71%
  • Reduced fatal injuries for infants in light trucks: 58%

Children less than 5 saved by child restraint use: 420

Of the 420 saved, number in car seats: 382 (91%)

North Carolina infant restraint use: 98%

Infants = less than 1 year of age

Source: National Highway Traffic Safety Administration

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