Babies could be at risk if left to sleep in standard car safety seats without supervision.
December 8, 2006 (Press Release) --
Babies could be at risk if left to sleep in standard car safety seats without supervision, say researchers.
Although they save lives in car crashes, they are warning that safety seats should not be used as a substitute for carry cots where babies are allowed to sleep for long periods of time.
Doctors believe the upright sleeping position puts infants at risk of obstructing their airways, which could endanger their lives.
The 'salutary' warning is designed to alert parents who may rely on car journeys for sending their babies to sleep - and then allowing them to stay asleep in the car seat for many hours longer.
A new study looked at nine infants who suffered 'life threatening events' while strapped into a car seat where they were left asleep outside the car.
The children were described as "blue", "scrunched up" and "not breathing", says a report from New Zealand researchers in today's British Medical Journal (BMJ).
Reconstruction of the events using the baby's own car seat found their heads were bent forward with the jaw pressed down on the chest, which narrowed the airway and caused breathing problems.
Paediatrician Professor Alistair Gunn, who did the study with colleagues at the Auckland Cot Monitoring Service, said car safety seats were essential to protect children from injury or death in an accident.
But they were not meant to be used as a substitute for a cot or bed when the children were not being transported around, he said.
"They should be used for their principal purpose, not as a sleeping aid " he said.
"There are several possible reasons why the babies could be at risk in a car seat which is being used outside the car, although we can't fully explain it.
"Babies are often left by themselves when they are taken into the house in a car safety seat, which means the parents are not around to keep an eye on them.
"It may also be that babies don't sleep so deeply when they are asleep in the car, and the journeys are often of short duration so there is less time for problems to arise" he added.
In the study between July 1999 and December 2000 doctors investigated the cases of nine babies aged 3 days to 6 months - one of which was preterm - who had been left to sleep restrained in a car safety seat appropriate for their age.
All babies were given breathing monitors and the parents were given advice on appropriate positioning - including not leaving the infant for excessive periods in the car seat.
None of the infants had any further reported problems over the next 12 months.
Prof Gunn, of Auckland University, said babies were at risk of oxygen de-saturation probably because their heads were bent forward during sleep, which narrowed the upper airway.
Modifying the design of car seats to allow a gap for the back of the skull which would better support the head might help, he said.
"The infants were very young when head control is not well developed.
"They were reported to be asleep at the time of the events - the pharyngeal muscles relax during active sleep" he added.
Half the mothers in the study were smokers which may have had an effect, with nicotine exposure reducing the amount of oxygen reaching body tissues.
Dr Michael Hayes, of the Child Accident Prevention Trust who wrote an editorial in the BMJ, said "When used properly, child passenger restraints reduce injury by 90-95 per cent for rear facing systems and 60 per cent for forward facing systems compared with not using a restraint."
He welcomed new UK legislation that all children in cars should use appropriate child restraints and that adult seat belts are intended for adults, not children.
He said "This study looked at car safety seats being used outside the car - inside the car these safety features save lives.
"It's unlikely any health problems will arise from sleeping babies being taken into the house in a safety seat for a short period of time, but this study suggests in a salutary way they should not be used for hours as a substitute for a carry cot or proper cot" he added.
Some car seats are designed to be fixed to frames which provide a travel system, but the car seat manufacturers said parents were already advised against letting babies spend a long time in them.
A spokesman for Maxi-Cosi said "We advise parents not to leave babies in them for long periods because they need to lie flat for some of the time.
"Our car seats have built-n adjusters that can make the car seat flatter for younger babies, and allow older babies to sit more upright" she added.
A spokesman for the Foundation for the Study of Infant Deaths said "Previous studies have shown that infants, especially if born prematurely, experience falls in their blood oxygen levels when placed in seats of this kind, compared with the levels when they were placed on their backs in a cot or crib. "It is not yet clear, however, whether other factors, in addition to prematurity or poor muscle tone, increase the risk for individual babies of airway obstruction in car safety seats.
"The findings of the new study confirm that the safest place for a baby to sleep is in a properly designed cot or crib, on their back, and preferably in the same room as a parent or other carer. "Car seats are not ideal places for safe infant sleep in the home.
"If a baby is being transported in a car, he or she should be carried in a properly designed and fitted car seat, facing backwards, and be observable by a competent adult."
source: http://www.dailymail.co.uk/
Although they save lives in car crashes, they are warning that safety seats should not be used as a substitute for carry cots where babies are allowed to sleep for long periods of time.
Doctors believe the upright sleeping position puts infants at risk of obstructing their airways, which could endanger their lives.
The 'salutary' warning is designed to alert parents who may rely on car journeys for sending their babies to sleep - and then allowing them to stay asleep in the car seat for many hours longer.
A new study looked at nine infants who suffered 'life threatening events' while strapped into a car seat where they were left asleep outside the car.
The children were described as "blue", "scrunched up" and "not breathing", says a report from New Zealand researchers in today's British Medical Journal (BMJ).
Reconstruction of the events using the baby's own car seat found their heads were bent forward with the jaw pressed down on the chest, which narrowed the airway and caused breathing problems.
Paediatrician Professor Alistair Gunn, who did the study with colleagues at the Auckland Cot Monitoring Service, said car safety seats were essential to protect children from injury or death in an accident.
But they were not meant to be used as a substitute for a cot or bed when the children were not being transported around, he said.
"They should be used for their principal purpose, not as a sleeping aid " he said.
"There are several possible reasons why the babies could be at risk in a car seat which is being used outside the car, although we can't fully explain it.
"Babies are often left by themselves when they are taken into the house in a car safety seat, which means the parents are not around to keep an eye on them.
"It may also be that babies don't sleep so deeply when they are asleep in the car, and the journeys are often of short duration so there is less time for problems to arise" he added.
In the study between July 1999 and December 2000 doctors investigated the cases of nine babies aged 3 days to 6 months - one of which was preterm - who had been left to sleep restrained in a car safety seat appropriate for their age.
All babies were given breathing monitors and the parents were given advice on appropriate positioning - including not leaving the infant for excessive periods in the car seat.
None of the infants had any further reported problems over the next 12 months.
Prof Gunn, of Auckland University, said babies were at risk of oxygen de-saturation probably because their heads were bent forward during sleep, which narrowed the upper airway.
Modifying the design of car seats to allow a gap for the back of the skull which would better support the head might help, he said.
"The infants were very young when head control is not well developed.
"They were reported to be asleep at the time of the events - the pharyngeal muscles relax during active sleep" he added.
Half the mothers in the study were smokers which may have had an effect, with nicotine exposure reducing the amount of oxygen reaching body tissues.
Dr Michael Hayes, of the Child Accident Prevention Trust who wrote an editorial in the BMJ, said "When used properly, child passenger restraints reduce injury by 90-95 per cent for rear facing systems and 60 per cent for forward facing systems compared with not using a restraint."
He welcomed new UK legislation that all children in cars should use appropriate child restraints and that adult seat belts are intended for adults, not children.
He said "This study looked at car safety seats being used outside the car - inside the car these safety features save lives.
"It's unlikely any health problems will arise from sleeping babies being taken into the house in a safety seat for a short period of time, but this study suggests in a salutary way they should not be used for hours as a substitute for a carry cot or proper cot" he added.
Some car seats are designed to be fixed to frames which provide a travel system, but the car seat manufacturers said parents were already advised against letting babies spend a long time in them.
A spokesman for Maxi-Cosi said "We advise parents not to leave babies in them for long periods because they need to lie flat for some of the time.
"Our car seats have built-n adjusters that can make the car seat flatter for younger babies, and allow older babies to sit more upright" she added.
A spokesman for the Foundation for the Study of Infant Deaths said "Previous studies have shown that infants, especially if born prematurely, experience falls in their blood oxygen levels when placed in seats of this kind, compared with the levels when they were placed on their backs in a cot or crib. "It is not yet clear, however, whether other factors, in addition to prematurity or poor muscle tone, increase the risk for individual babies of airway obstruction in car safety seats.
"The findings of the new study confirm that the safest place for a baby to sleep is in a properly designed cot or crib, on their back, and preferably in the same room as a parent or other carer. "Car seats are not ideal places for safe infant sleep in the home.
"If a baby is being transported in a car, he or she should be carried in a properly designed and fitted car seat, facing backwards, and be observable by a competent adult."
source: http://www.dailymail.co.uk/
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