We all know the purpose of a child safety seat.  The seat is to secure children in a moving car so that in the event of an accident, they won’t be hurt.  Child safety seats are engineered to protect young children at specific ages while they ride in the car.  Manufacturers make two kinds of child safety seats:  infant safety seats and convertible safety seats.  Infant safety seats are for infants up to 20 lbs.  Convertible safety seats are for children from birth to age 4 when they will need a booster seat.


When an infant safety seat is properly installed in a car, it is leveled in order to keep the infant safe.  Removing the infant safety seat from the car and putting it in a crib, swing, on the ground, etc., is using the safety seat in a way for which it was neither intended nor engineered.  There have been isolated incidents in Canada where the straps of the infant safety seats have accidentally strangled infants who had been left unattended in their infant safety seats outside of the vehicle.  Two of the deaths occurred when the infant safety seat was used as a crib and another when the seat was modified for use as a swing.  When an infant seat is placed on a surface other than the car it was intended for where it is properly installed, the center of gravity shifts, raising the seat and the infant, and making it top heavy and unstable.  The movement of the baby can result in the infant car seat tipping over and/or the harness system can exert sufficient pressure on the infant’s neck to cause asphyxiation.


A recent study attributed many cases of sudden infant death syndrome (SIDS) to the prolonged sitting or lying position of infants in an infant safety seat. When researchers reviewed more than 500 infant deaths, it was found that 17 of these deaths occurred while the infant was in a device such as a child safety seat. The most common age of SIDS in a child safety device was under one month, with 6 of 17 deaths occurring in this age group.


An Ontario, Canada coroner warned that infants should not be left to nap in their cribs while in their child safety seats after the death of a two-month-old boy was linked to positional asphyxiation. The coroner said that it is common for a baby’s head to “slump forward while in a car seat and it diminishes oxygen.” It is recommended for drivers to make frequent stops during trips to prevent an infant from sitting in a slumped forward position for any length of time.


Some infant safety seat manufacturers make strollers to fit their safety seats.  These strollers are engineered to hold the seat with the correct center of gravity to protect the baby while in the stroller.  They should also protect the baby from positional asphyxiation, but only if the baby is placed properly in the seat and the straps are adjusted properly.  As the baby grows, the seat needs to be adjusted and the belts need to be tightened properly every time the baby is put into the seat.  As always with any type of safety device, it is imperative for parents to constantly monitor their child.



The current recommendation to eliminate SIDS is for all infants to sleep on their backs.  The “Back to Sleep” campaign has been very effective in getting the word out, and the majority of all infants now sleep on their backs.  It is equally important that babies spend a part of every day on their tummies from birth.  Tummy Time is critical in helping the baby build muscle strength and achieving developmental milestones.  Babies should ideally spend at least one supervised waking hour per day on their tummies.  Tummy Time does not need to be on the floor.  Another option is to position the baby on blankets on a table to make it more comfortable for the parent to entertain the baby in the first few months of life.
When babies spend all their time on their backs, they can develop positional plagiocephaly and/or torticollis.  Plagiocephaly is a flattened head, most commonly associated with spending the majority of time sleeping on the back and sitting in a supine position. In almost all infants with plagiocephaly, there is some amount of active neck movement that leads to a preference to turn the head to one side and not to the other. The medical term for this is torticollis.

The cause and effect relationship between torticollis and plagiocephaly goes both ways. Many infants are born with torticollis — perhaps related to fetal positioning in the uterus during late pregnancy — and subsequently develop plagiocephaly after birth.  Infants with severe flattening on one side must expend much more energy than normal to turn their heads to the other side, so they do not do so, and their necks become stiff from disuse. In many infants with torticollis, their head will be turned to one side (usually to the right, for unknown reasons) while their chin is tilted toward the other.  Beginning tummy time at birth can prevent plagiocephaly and torticollis.


A child safety seat will keep your child safe in the car, so please use it and follow the manufacturer’s installation guide carefully for the best protection in case of an accident.  You can also have the seat installed by a professional.  Check the safety straps every time you put your child in the car to make sure that they are tight and in the proper position.  Change to a combination safety seat when your child outgrows the infant safety seat and, again, follow all instructions carefully.  Do not use the infant safety seat as a crib, swing, high chair or any other use for which it’s not intended. Make sure that your child gets plenty of tummy time to assure critical muscle strength development, developmental milestone development , a strong neck and a rounded head.