Skip to main content

Sudden unexpected infant deaths associated with car seats

Abstract

The purpose of this study was to investigate the frequency, circumstances, demographics, and causes of death of infants dying while seated in car safety seats. A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period was undertaken to identify any infant deaths (aged <1 year), in whom death occurred while seated in a car safety seat. Fourteen car seat-associated deaths were identified from a total of 1,465 coronial infant autopsies (0.96 %). Four involved infants were being appropriately transported in the car seat, all of whom had a medical underlying cause of death (one infection and three congenital heart disease). The majority (10 cases; 70 %) occurred while car seats were being inappropriately used, outside of the car, including as an alternative to a cot or high-chair. Five of these infants died of explained causes, but four deaths remained unexplained after autopsy, and in one no cause of death was available. There were no cases of previously healthy infants dying unexpectedly in a car seat when it was being used appropriately, and in this series there were no cases of traumatic death associated with car seats, either during road traffic accidents, or from falling or being suspended from a car seat. Infant deaths in car seats are rare. These data support the recommendation that car seats be used only for transport and not as alternatives for cots or high-chairs. More research is required to investigate the effect of travel in car seats on infants with underlying conditions. There appears to be no increased risk of unexpected deaths of healthy infants transported appropriately in car seats.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Motor vehicles (wearing of seat belts) (amendment) regulations. 2006 (SI 2006/1892).

  2. Snowdon AW, Hussein AA, Ahmed SE. Children at risk: predictors of car safety seat misuse in Ontario. Accid Anal Prev. 2008;40:1418–23.

    PubMed  Article  Google Scholar 

  3. MaxiCosi. Frequently asked questions: “how long can i use a MaxiCosi without a break”. 2013. http://www.maxi-cosi.com/service/faq.aspx. Accessed November 2013.

  4. Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med. 1997;151:233–5.

    CAS  PubMed  Article  Google Scholar 

  5. Mitchell EA. SIDS: past, present and future. Acta Paediatr. 2009;98:1712–9.

    PubMed  Article  Google Scholar 

  6. Merchant JR, Worwa C, Porter S, Coleman JM, deRegnier RA. Respiratory instability of term and near-term healthy newborn infants in car safety seats. Pediatrics. 2001;108:647–52.

    CAS  PubMed  Article  Google Scholar 

  7. Bass JL, Bull M. Oxygen desaturation in term infants in car safety seats. Pediatrics. 2002;110:401–2.

    PubMed  Article  Google Scholar 

  8. Nagase H, Yonetani M, Uetani Y, Nakamura H. Effects of child seats on the cardiorespiratory function of newborns. Pediatr Int. 2002;44:60–3.

    PubMed  Article  Google Scholar 

  9. Tonkin SL, McIntosh CG, Nixon GM, Rowley S, Gunn AJ. Can we reduce episodes of haemoglobin desaturation in full-term babies restrained in car seats? Acta Paediatr. 2008;97:105–11.

    PubMed  Article  Google Scholar 

  10. Tonkin SL, Vogel SA, Bennet L, Gunn AJ. Apparently life threatening events in infant car safety seats. BMJ. 2006;333:1205–6.

    PubMed Central  PubMed  Article  Google Scholar 

  11. Moore L, Byard RW. Pathological findings in hanging and wedging deaths in infants and young children. Am J Forensic Med Pathol. 1993;14:296–302.

    CAS  PubMed  Article  Google Scholar 

  12. Byard RW, Beal S, Bourne AJ. Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood. Arch Dis Child. 1994;71:497–500.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  13. Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003–2007. Pediatrics. 2010;126:352–7.

    PubMed  Article  Google Scholar 

  14. Côté A, Bairam A, Deschenes M, Hatzakis G. Sudden infant deaths in sitting devices. Arch Dis Child. 2008;93:384–9.

    PubMed  Article  Google Scholar 

  15. Weber MA, Ashworth MT, Risdon RA, Hartley JC, Malone M, Sebire NJ. The role of post-mortem investigations in determining the cause of sudden unexpected death in infancy. Arch Dis Child. 2008;93:1048–53.

    CAS  PubMed  Article  Google Scholar 

  16. Pollack-Nelson C. Fall and suffocation injuries associated with in-home use of car seats and baby carriers. Pediatr Emerg Care. 2000;16:77–9.

    CAS  PubMed  Article  Google Scholar 

  17. Wickham T, Abrahamson E. Head injuries in infants: the risks of bouncy chairs and car seats. Arch Dis Child. 2002;86:168–9.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. Mayo Clinic. Car seat safety: avoid 10 common mistakes. http://www.mayoclinic.org/car-seat-safety/ART-20043939. Accessed November 2013.

  19. Bliss. Going home: the next big step. http://www.bliss.org.uk/wp-content/uploads/2012/02/Going_Home_-_The_Next_Big_Step.pdf. Accessed November 2013.

  20. Davis NL, Zenchenko Y, Lever A, Rhein L. Car seat safety for preterm neonates: implementation and testing parameters of the infant car seat challenge. Acad Pediatr. 2013;13:272–7.

    PubMed  Article  Google Scholar 

  21. Elliott MR, Kallan MJ, Durbin DR, Winston FK. Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006;160:617–21.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

A.R.B. is supported by a grant from the Lullaby Trust. N.J.S. is part supported by GOSHCC and the NIHR GOSH BRC. This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew R. Bamber.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bamber, A.R., Pryce, J., Ashworth, M.T. et al. Sudden unexpected infant deaths associated with car seats. Forensic Sci Med Pathol 10, 187–192 (2014). https://doi.org/10.1007/s12024-013-9524-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-013-9524-5

Keywords

  • Car safety seats
  • Sudden unexpected death in infancy
  • Sudden infant death syndrome