Large study sheds light on infant deaths in sitting devices
AlysonSulaski Wyckoff, Associate Editor
Every year, several hundred infants fall victim to sleep-related deaths in sitting
devices like car seats, bouncers or swings used improperly for routine sleep.
A 10-year study of 11,779 infant sleep-related deaths showed that 348 (3%) babies
died in sitting devices, in most cases while in car seats. More than 90% of the time,
the car seats were not being used as directed. The median age at death was 2 months.
About 3,700 infants die every year from sleep-related deaths, which include sudden
infant death syndrome, accidental suffocation and strangulation in bed, and other
Although sitting devices are designed for activities such as transportation, feeding
and playing, parents may inappropriately rely on them as an alternative to a crib
or bassinet. When the devices are not used as directed, infants can fall, fall from
an elevated surface on which the device was placed, or flip onto a soft surface and
suffocate. They also can be injured or killed with improper buckling of car seat straps.
The AAP recommends that babies be placed for sleep in a supine position for every
sleep by every caregiver until the child reaches 1 year of age. Loose bedding and
soft objects must be kept out of the sleep area. Sitting devices should not be used
for routine sleep.
Using fatality data from a large U.S. case reporting system, and reflecting data from
45 states, researchers compared risk factors for sleep-related infant deaths in both
sitting and non-sitting devices to better understand the factors surrounding fatalities
in sitting devices.
The following were classified as sitting devices: car seats, strollers, bouncers,
swings and other infant seats (infant slings/carriers not in this category). Non-sitting
devices included cribs and bassinets. Researchers considered primary caregiver at
time of death, setting, bedsharing, objects in the environment and additional risk
The majority of deaths in sitting devices occurred at home and under the supervision
of a parent. However, when compared to other (non-sitting device) deaths, babies who
died in sitting devices “had higher odds of having a child care provider or babysitter
as the primary supervisor at the time of death,” the study noted.
Over three-fourths of those who died in any sitting device also had at least one risk
factor, and more than half had two or more risk factors.
“The main take-home message is not the combination of risk factors so much as it is
(the problem of) using car seats as replacements for cribs or bassinets,” said study
co-author Jeffrey D. Colvin, M.D., J.D., FAAP.
More than 4 million Rock ‘n Play Sleepers from Fisher-Price recently were recalled
after the deaths of at least 32 infants were reported by Consumer Reports. Four days
after the AAP called on the U.S. Consumer Product Safety Commission (CPSC) to immediately
recall the sleepers — receiving extensive media coverage — the CPSC relented.
Some of the infants who died in the Rock ‘n Play Sleepers rolled over while unrestrained;
others were unable to breathe because of their position.
Babies should not be placed on an incline to sleep. With the head elevated, an infant
is in a position that could lead to asphyxia. The straps on such products also can
strangle infants. In addition, the AAP does not recommend any products for sleep that
require restraining a baby, especially if the product also rocks.
The Pediatrics study and recent events are reminders of the need to educate parents and families
about safe sleep environments, experts say.
“While car seats are always the best place for babies when they are being transported
in a vehicle, that doesn’t mean they are the safest place when they’re sleeping outside
of the car,” Dr. Colvin said. Parents should bring along a portable crib or bassinet
for sleeping when they arrive at their destination.
“It’s not only that doctors — pediatricians — need to educate their families, the
parents of their patients. They also need to have parents educate anyone who is taking
care of their infant, whether it’s a grandparent, babysitter or child care provider,
that car seats are not substitutes for cribs and bassinets,” he said. “The same is
true for bouncers, swings and strollers.”