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First Candle is often asked by parents if it is okay to let their baby sleep in his or her car seat instead of a crib or other safe sleep space. We always answer with an emphatic “No!” It is important for parents to understand that car seats are not intended for sleeping babies and should only be used to protect their baby when riding in a car. If the baby falls asleep while in the car, parents or caregivers should move the baby to a crib or other safe sleep space as soon as they reach their destination.

The main concern is that the more “upright” position in car seats can compress the chest and lead to lower levels of oxygen. In this study, the infants in car seats spent more time with oxygen levels below 95 percent than did infants sleeping on their backs in a crib with a firm mattress. The longer the infant was in the car seat, the worse the respiratory problems.

In addition, injuries and even deaths have been reported when a car seat containing a sleeping baby has accidentally tipped over when placed on the floor, in a crib or other unsafe place. SIDS deaths have occurred in car seats as well.

Car Seat Guidelines:

• Always secure your infant in a car seat when traveling. Make sure the size of the car seat is appropriate for the size of the baby.
• Use a car seat only for traveling, not for sleeping or in lieu of a bouncy seat or other similar product designed for use when the baby is awake.
• If the baby falls asleep when riding in the car, move him or her to a crib or other safe sleep space as soon as you reach your destination.
• For younger babies, limit the length of time spent in the car as much as possible.
• Always place babies to sleep their backs on a firm, flat mattress covered with a tight fitting sheet. The safest place is in a crib or play yard that meets current safety standards.

Study Abstract: A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds

Lilijana Kornhauser Cerar, MDa, Christina V. Scirica, MD, MPHb, Irena  tucin Gantar, MDa, Damjan Osredkar, MDc, David Neubauer, MDc and T. Bernard Kinane, MDc

a Division of Neonatology and Department of Obstetrics and Gynecology 
c Division of Neurology and Department of Pediatrics, University Medical Centre, Ljubljana, Slovenia 
b Division of Pediatric Pulmonary and Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Massachusetts

OBJECTIVE: The purpose of this work was to compare the incidence of apnea, hypopnea, bradycardia, or oxygen desaturation in healthy term newborns placed in hospital cribs, infant car safety beds, or infant car safety seats.

METHODS: A consecutive series of 200 newborns was recruited on the second day of life. Each subject was studied while placed in the hospital crib (30 minutes), car bed (60 minutes), and car seat (60 minutes). Physiologic data, including oxygen saturation, frequency, and type of apnea, hypopnea, and bradycardia were obtained and analyzed in a blinded manner.

RESULTS: The mean oxygen saturation level was significantly different among all of the positions (97.9% for the hospital crib, 96.3% for the car bed, and 95.7% for the car seat; P < .001). The mean minimal oxygen saturation level was lower while in both safety devices (83.7% for the car bed and 83.6% for the car seat) compared with in the hospital crib (87.4%) (P < .001). The mean total time spent with an oxygen saturation level of <95% was significantly higher (P = .003) in both safety devices (car seat: 23.9%; car bed: 17.2%) when compared with the hospital crib (6.5%). A second study of 50 subjects in which each infant was placed in each position for 120 minutes yielded similar results.

CONCLUSIONS: In healthy term newborns, significant desaturations were observed in both car beds and car seats as compared with hospital cribs. This study was limited by lack of documentation of sleep stage. Therefore, these safety devices should only be used for protection during travel and not as replacements for cribs.