Ashwin Lewis
Car seats are essential to keep children safe when travelling in vehicles. However, they are not designed for prolonged sleep. While it is safe for a baby to sleep in a car seat for short stretches, it is not recommended as a substitute for a crib or bassinet. The American Academy of Pediatrics recommends that babies sleep on their backs on a flat, empty surface without any blankets, pillows, stuffed animals or bumpers to reduce the risk of sudden infant death syndrome (SIDS). Sleeping while sitting upright can cause a baby to slump down, potentially blocking their airways and causing suffocation. Therefore, it is important to never leave a baby unattended in a car seat and to ensure that the harness straps are securely fastened.
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What You'll Learn
Car seats are not a safe sleep environment
While it is inevitable that your baby will fall asleep in their car seat at some point, car seats are not a safe sleep environment and should not be used as a substitute for a crib or bassinet. The American Academy of Pediatrics (AAP) recommends that babies sleep on their backs on a firm, flat surface without any loose items in the crib with them. Car seats, swings, and bouncers do not provide this type of environment and can put babies at risk of positional asphyxia, which occurs when the positioning of the child's head and neck block their airway. Sleeping in an inclined seat, like a car seat, can cause a chin-to-chest posture, potentially causing suffocation.
The danger of letting infants sleep on an incline has become more apparent in recent years, with a 2022 law banning infant reclined sleepers due to their link to dozens of deaths. While a few minutes of on-the-go sleep in a car seat is generally considered safe, it is important to avoid letting your baby sleep in the car for long stretches or using the car seat as a dedicated sleep device. If your baby falls asleep in the car, it is recommended to pull over every two hours to allow them to stretch, feed, and have a diaper change. Additionally, car seats should not be used outside of the car or placed on high or soft surfaces, as this can increase the risk of the seat tipping over or obstructing the baby's airway.
Infant car seats are designed with a recline feature to protect the baby's head and spine in the event of a collision. However, this incline is not safe for prolonged sleep. Car seats should only be used when you are with your baby and observing them, not for extended or overnight sleep. Babies do not have the neck or torso strength to keep their heads up and prevent slouching, which can lead to a blocked airway. Furthermore, loosening the harness straps or unfastening the buckles can increase the risk of entanglement or the baby slumping down and cutting off airflow.
While it may be tempting to let your baby sleep in their car seat, especially when transitioning from the car to a stroller or home, it is important to prioritize safe sleep practices. Always remove your baby from the car seat when you reach your destination and place them in a safe sleep environment, such as a firm, flat crib or bassinet. By following these guidelines, you can help ensure your baby's safety and reduce the risk of sleep-related injuries or death.
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The risks of sleeping on an incline
While it is common for babies to fall asleep in their car seats, the American Academy of Pediatrics (AAP) recommends that babies sleep in a flat, empty sleep space like a crib or play yard. The AAP further recommends that you only place the baby on their back, and avoid placing any loose items in the crib with the baby. Car seats, swings, and bouncers do not provide this type of environment and put babies at risk of positional asphyxia, which occurs when the positioning of the child's head and neck block the airway.
Sleeping in an inclined seat, like a car seat or swing, can cause a chin-to-chest posture, which can obstruct the airway and cause suffocation. If a baby is left unattended in a car seat, they can also move slightly and tip the balance of the car seat so that it falls to the floor or topples over onto a soft surface that blocks the baby from breathing. An unbalanced seat can also allow the baby’s head to fall forward and obstruct their airway.
In addition, inclined sleepers have been linked to an increased risk of suffocation and sudden infant death syndrome (SIDS). The AAP recommends avoiding the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths, including at-home cardiorespiratory monitors, as there is no evidence that these devices reduce the risk of death and they may provide a false sense of security.
Inclined sleepers are now banned under federal law due to the risk of injury and death. The Safe Sleep for Babies Act, passed in 2022, banned infant reclined sleepers, such as the Fisher-Price Rock ’n Play Sleeper, which had been linked to dozens of infant deaths.
While it is generally not recommended for babies to sleep in car seats, if your baby falls asleep in the car, there is no need to panic as long as the trip is short and someone is observing the baby. However, it is important to avoid using the car seat as a dedicated sleep device or for prolonged sleep, as this can pose serious risks to the baby's safety.
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Safe sleep alternatives
It is understandable that parents may be tempted to let their babies sleep in their car seats, especially when they are travelling or when they are trying to get their babies to sleep. However, this is not recommended for extended periods of time. Car seats, swings, and bouncers are not designed for sleeping and can put babies at risk of positional asphyxia. Positional asphyxia occurs when the positioning of the child's head and neck block the airway. Sleeping in an inclined seat, like a car seat or swing, can cause a chin-to-chest posture, which can obstruct the baby's breathing.
Safe Sleep Environment
The American Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing until your baby's first birthday or for at least 6 months, as the risk of Sudden Infant Death Syndrome (SIDS) is highest during this period. Room-sharing involves placing your baby's crib, portable crib, play yard, or bassinet in your bedroom instead of a separate nursery. This allows you to keep your baby nearby, making it easier to feed, comfort, and monitor them at night. While room-sharing is safe, bed-sharing increases the risk of SIDS and other sleep-related deaths, so it is important to avoid sharing a bed with your baby.
Firm and Flat Sleep Surface
The AAP recommends that babies sleep on a firm, flat surface, such as a crib or bassinet. These surfaces provide a safe sleep environment and reduce the risk of SIDS. Make sure that all sleep surfaces and products you use are approved by the U.S. Consumer Product Safety Commission (CPSC) and meet federal safety standards. Always place your baby on their back to sleep, without any loose items, blankets, pillows, stuffed animals, or bumpers in the crib or bassinet.
Consistent Sleep Schedule
Most 9-month-olds should sleep for 12-16 hours per day, including a stretch of 9-12 hours at night. They may still take two naps per day, ranging from 30 minutes to 2 hours each. Establishing a consistent sleep schedule can help your baby get the rest they need. Aim for 2.5-3.5 hours of awake time between sleep periods, and be consistent with bedtime routines and nap schedules.
Soothing Bedtime Routine
A soothing bedtime routine can help relax your baby and signal that it's time for sleep. This can include a warm bath, followed by stories or singing. These activities can become part of your baby's bedtime routine as they grow older. If your baby is struggling with separation anxiety, there are gentle and effective guidance resources available to help you both get a good night's rest.
Safe Sleep Products
Use sleep products that are specifically designed for babies, such as sleep sacks. Sleep sacks are a safe way to keep your baby warm and can also serve as a cue that sleep time is approaching. Offer a pacifier to your baby at sleep time, but don't force it. If your baby is breastfeeding, wait until it is firmly established before introducing a pacifier. Avoid products that claim to reduce the risk of SIDS, such as sleep positioners or monitors.
Remember, it is important to always follow safe sleep practices and prioritize your baby's safety and well-being.
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Car seat safety tips
Car seats are essential for keeping children safe when travelling in vehicles. However, they are not designed to be used as a substitute for a crib or bassinet. Here are some tips to ensure your baby's safety when using a car seat:
Angle of the Car Seat
The angle of rear-facing car seats has been extensively tested and is necessary to protect your baby's head and spine in the event of a collision. Most rear-facing car seats should be installed at a 30-45 degree angle, and almost all of them have a recline indicator to help you find the correct angle. Infant car seats naturally recline closer to the 45-degree mark, and the greatest allowable recline should be used until your baby gains head and neck control. As your baby grows and develops full head, neck, and torso control, they can safely sit more upright.
Safe Sleep Environment
According to the American Academy of Pediatrics (AAP), babies should sleep on their backs on a firm, flat surface without any loose items in the crib or bassinet. This includes blankets, pillows, stuffed animals, and bumpers. Car seats, swings, and bouncers place babies in an inclined position, which can cause a chin-to-chest posture and obstruct their airway, leading to positional asphyxia. Therefore, car seats should not be used as a substitute for a safe sleep environment, and babies should only sleep in car seats for short stretches while travelling.
Car Seat Maintenance
If you are using a second-hand car seat, ensure it is still safe to use by checking the expiration date, whether it has been recalled, and examining it for any cracks or missing parts. Car seats that have been involved in a crash should not be reused. Additionally, never loosen the harness straps or unfasten the buckles, as this increases the risk of your baby slumping down and obstructing their airflow or becoming entangled in the straps.
Breaks During Travel
On long trips, it is important to take breaks every two hours to allow your baby to stretch, feed, and have a diaper change. This helps to prevent respiratory problems that can occur from being in the car seat for too long. During these breaks, do not offer food or drinks in the car seat as they can pose choking hazards.
Transferring the Baby
When transferring a sleeping baby from the car to your home, it is safe to briefly place the car seat on the ground. However, do not place it on a high or soft surface, as this can cause the car seat to tip over or the baby's head to obstruct their airway. If your baby wakes up during the transfer, try running through your naptime routine to help them go back to sleep. If that doesn't work, consider the nap done and move on to the next nap or bedtime.
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How to transfer a sleeping baby
While it is okay for your 9-month-old to take a short nap in their car seat, it is not recommended for them to sleep for long stretches or use the seat as a dedicated sleep device. Car seats are designed for safe travel, not for prolonged sleep. Sleeping in an inclined seat can cause a chin-to-chest posture, which can obstruct your baby's airway and lead to positional asphyxia. Therefore, it is important to transfer your baby to a crib or bassinet as soon as they fall asleep. Here are some tips to help you successfully transfer your sleeping baby from the car seat to their bed:
- Before you start driving, undo any Velcro shoes your baby may be wearing, as undoing them later might wake your baby up. You can also unzip any jackets or remove hats while your baby is still in the car seat.
- If you know in advance that your baby is likely to fall asleep in the car, change their diaper and feed them before departure. This will ensure that your baby is comfortable during their nap and reduce the need for immediate attention upon arriving at your destination.
- When you reach your destination, carry the car seat into your baby's room, ensuring the room is dark and quiet. Gently lift your baby out of the car seat and place them in their crib or bassinet. Try to maintain a limp hold, as this usually indicates that your baby is still sleeping.
- If your baby wakes up during the transfer, try running through your naptime routine, such as nursing, reading a book, or singing a lullaby, to help them go back to sleep.
- If your baby does not go back to sleep, consider the nap done and move their next nap or bedtime earlier. While it may not be convenient, it is the safest option for your baby's well-being.
Remember, always diligently monitor your baby when they are sleeping in a car seat, and ensure that the car seat is installed correctly and positioned at the right incline angle.
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Frequently asked questions
It is generally advised that babies should sleep on a firm, flat surface, such as a crib or bassinet. Car seats are not recommended for extended or overnight sleep, but a quick nap from point A to B is probably okay.
Sleeping in an inclined seat can cause a chin-to-chest posture, which may obstruct your baby's airway and lead to positional asphyxia. In addition, a baby's head can fall forward and block their ability to breathe, especially if the car seat is placed on a high surface.
It is recommended to stop every 2 hours to let your baby stretch, feed, and have a diaper change. The Canadian Paediatric Society advises against letting your baby continue to sleep in the car seat when you arrive at your destination.
No, babies should always be supervised when sleeping in a car seat. In many cases of infant death in sitting devices, the caregiver was sleeping when the incident occurred, suggesting the baby was left unsupervised for an extended period.
If your baby falls asleep during a short car ride, it is generally safe to let them finish their nap in the car seat as long as you or another rider is observing them. Once you reach your destination, transfer your baby to a safe sleep environment, such as a firm, flat crib or bassinet.
