Sitting devices endanger sleeping infants

Infants who sleep in sitting or carrying devices such as car seats, swings, slings, or bouncers run a risk of suffocation, warns a new study.

Researchers reviewed 47 deaths of children aged younger than 2 years, newborns as well as toddlers, that occurred in sitting or carrying devices and were reported to the US Consumer Product Safety Commission between April 2004 and December 2008. Analyzing data from death certificates, coroners’ and medical examiners’ reports, and interviews with family members and witnesses, investigators determined that all but 1 of the deaths were attributable to asphyxia by position or strangulation.

Thirty-one infants died in car seats, 5 in slings, 4 in swings, 4 in bouncers, and 3 in strollers. Of the children who died in car seats, 52% died of strangulation on the straps and the rest of positional asphyxia. Children as old as 2 years died in car seats, whereas babies up to 8 months died in other types of devices.

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The researchers found wide variations in the time between when a caregiver last saw the child and the child was found dead, from as little as 4 minutes to as long as 11 hours. Mean times were 26 minutes for slings, 32 minutes for strollers, 140 minutes for car seats, 150 minutes for bouncers, and 300 minutes for swings.

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Proper restraint and supervision are key to the safety of infants and children aged younger than 2 years in car seats, the researchers conclude. They advise parents not to use car seats as sleeping places outside the vehicle (89% of car seat deaths with a known location occurred outside a car) or place them on a soft or unstable surface, and never to leave a child in a seat with unbuckled or partially buckled straps. A child in a correctly positioned car seat inside a car with properly fastened straps is in little danger of asphyxiation.

Baby slings pose a particular hazard, the researchers point out, because of the ease with which an infant’s airway can be compromised without constant supervision. The baby’s face should be “visible and kissable” above the edge of the sling at all times, not covered by fabric, and not compressed into his or her chest.

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The researchers further advise caregivers to make sure that infants in sitting devices can’t turn their heads into soft bedding or slump forward in the seat. They caution that the restraints on strollers, bouncers, and swings may not prevent children from getting into positions that could compromise the airway and warn against putting 2 infants in a swing designed for 1.