Which Car Seat

The Medical Evidence. A MUST read for every parent!

Why a baby should travel flat in the first few months of life.

There are in fact four differing styles of car seats suitable for a newborn. All are technically classified as either "Group 0" or "Group 0+" or may comply to the latest R129 i-Size regulations.

The norm is an "infant carrier" a small shell like seat that as the name suggests can easily be carried.  Most manufacturers make infant carriers with at least a 45 degree angle but the latest medical research report suggests that even a 40 degree angle can cause breathing issues.  Most manufacturers also suggest time limits on how long baby can sit in an infant carrier in a 24 hour period as they are aware of the possible dangers.

Conventional infant carriers and car seats (excluding lie flat seats) are subject to "the two hour rule" but recent research has no proven the two hour rule should be re-written to as low as the 30 minute rule.

The second option is a car travel cot. Do not confuse these with a flimsy soft carry-cot! These products have mega strong shells and allow baby to sleep in ultimate comfort. The latest models have excellent crash tests results and in real accident scenarios they probably offer the very best of protection when the vehicle has rolled. There are no time limits in how long a baby can occupy a car travel cot and they can normally be used for overnight sleeping for the first few months.There was a time when in car carry-cots had very poor crash test results but that is not the case any more.

The third option is a multi position car seat that offers baby the best of both worlds, laying flat (no time limits) and rear facing (with time limits).

All the above products can normally be secured to a pushchair to make a "travel system" and options one and three can normally be secured to a "Base" in a car. A Base (sometimes called a Platform) is a separate unit that normally costs upwards of one hundred pounds. You don't have to use a Base, but if you do it saves you having to secure the child's car seat in using the cars seat belts.  

The final option is a static seat that often spans two stages (technically called groups). Of all the seats these normally have the steepest angle though new generation models are just starting to be built with O.D. in mind. These seats normally rear & forward face. 

SO JUST WHY ARE THERE TIME LIMITS?  

Within the bloodstream the red blood cells contain oxygen. This is a vital ingredient to life and in a baby the percentage of blood oxygen is normally around 95%-97%. It is important that the levels are maintained at around these percentages but should the level slip to below 90% a medical state called "hypoxia" occurs. Lowering of blood oxygen levels equals "Oxygen Desaturation".

It is well known that levels can vary with newborns but hypoxia is potentially very serious and there are well established links to ADHD, learning difficulties, brain damage and in the most extreme cases, SIDS.  You can find out more about blood oxygen here: -  http://en.wikipedia.org/wiki/Oxygen_saturation_(medicine)

When a newborn baby is placed in a car seat their head invariably falls forward and this can restrict the amount of air that reaches the lungs. The width of a babies airway is very narrow (similar to drinking straw) and the lungs are one of the very last organs to develop so are certainly not fully efficient. In a car seat there is one additional obstacle; being restrained in a "v shape" upright position makes breathing still harder, as some internal organs could compress the lungs still further. All these ingredients adds up to one potentially major problem. The lowering of blood oxygen levels.

Medical research has suggested that oxygen desatuation can hit pretty quickly, sometimes in just a few minutes but the norm is the longer baby is in the car seat the higher the risk.  The problem is once a baby suffers lowering blood oxygen levels a carer has just a few seconds (and at best 1 to 2 minutes) to react.   

The simple answer to minimise all these risks is (for the first few months of life) that baby travels supine (flat). This is just a natural extension of the original "Back to Sleep" campaign that changed babies sleeping position from prone (sleeping on their tummy) to supine (sleeping on their backs). This campaign has over the last twenty years reduced SIDS by over 75%.

In 2016 the British Medical Journal (BMJ) accepted a new research report into car seats and oxygen desatuation entitled " Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle".   The findings of this study was widely reported on BBC news November 11th 2016.  

The phrase "car seat challenge" relates to a test mainly used in America to check a newborns blood oxygen levels and pulse when "challenged" by a car seat. This test is rarely used in UK hospitals in part because NHS staff are not trained in relation to car seats.  In any case this research proves the original test protocols used in the USA were never correct. 

This study which also included the vibration factor (straight line at 30 mph no cornering or braking,) found that in a simulated moving vehicle the chances of a child havimg an episode of de-satuation were much higher that first thought.   The authors of the report were Renu Arya, Geogina Williams and Ann Kilonback of the Great Western Hospital Swindon, Professor Peter Fleming of Bristol University (together with Peter S Blair) and Martin Toward and Michael Griffin of Southampton University.

It should be noted that Professor Peter Fleming (one of the authors of the report) IS A WORLD EXPERT ON SIDS AND IS ACCREDITED TO HAVING SAVED 100,000 NEWBORN BABY LIVES WITH HIS PREVIOUS SIDS RESEARCH, SO THIS REPORT SHOULD NOT BE IGNORED.   Click here for further details of Professor Fleming: http://www.bristol.ac.uk/research/impact-stories/2012/cotdeath.html

 

To read the report please click here.

 

The contents of the report made the UK newspapers including The Sun, Daily Mail and Plymouth Hearld to name just three. Here are some links:

https://www.thesun.co.uk/living/1905566/babies-shouldnt-be-taken-for-anything-but-the-shortest-car-trips-due-to-suffocation-risk/

http://www.dailymail.co.uk/news/article-3820586/Health-fears-letting-babies-sleep-car-seats-Newborns-slump-forward-blocking-airways.html 

 http://www.plymouthherald.co.uk/serious-dangers-of-having-your-baby-in-a-car-seat-for-more-than-an-hour/story-29776019-detail/story.html

 

Suprisingly, one baby in every 133 born in the UK has a heart condition. That's about 5000 babies every year. Obviously some are more serious than others but sometimes the babies with heart conditions (and/or potentially O.D.issues) are not immediately picked up and this was certainly the case in regard to Lochlan.

One test that could have saved Lochlan's life was a "Pulse-Ox" test. This simple, painless and non invasive test costs about £2.00 and at the time of writing is offered in about one third of the UK's hospitals. Sadly Lochlan never had a Pulse-Ox test. In due course all UK hospitals will roll it out but, in our opinion, there are still "holes" in the test they are going to offer.

Firstly, it takes some days for a babies lungs to start to operate correctly so the ideal time of the test is probably just before baby is discharged from hospital and then at about one week.

Secondly the test is normally completed whilst baby is laying flat. We would like the test to be done when baby's breathing is being "challenged" that is when the newborn is in their car seat. 

A CNN report produced some years ago shows Lochlan was not the only baby who may have survived if Pulse -Ox was introduced earlier. The contents of this video is sad but it is very informative so please watch:    https://www.youtube.com/watch?v=Ogk87W4AVBU 

 

Here are some other useful links (hopefully still onlne when you read this) to suggest car seats are a potential risk to some newborns and the usefulness of Pulse-Ox. It is sad to see some of these reports are very old but nothing changed:-

 http://adc.bmj.com/content/99/Suppl_1/A55.1  

 http://www.cps.ca/documents/position/babies-car-seat-safety-before-discharge

http://www.dbh.nhs.uk/Car_seat_awareness.aspx

http://www.webmd.com/parenting/baby/news/20110819/blood-oxygen-test-finds-heart-defects-in-newborns

http://news.bbc.co.uk/1/hi/health/6216892.stm

And here are some more research report quotes and where possible links:-

Because lowering of oxygen saturation values was seen uniformly in all newborn infants, car seats should only be used for travel and travel should be minimised during the first months of life.  http://pediatrics.aappublications.org/cgi/content/abstract/108/3/647

Low blood oxygen levels in newborns may contribute to ADHD development. http://www.medicalnewstoday.com/medicalnews.php?newsid=15419

Adverse impacts of chronic or intermittent hypoxia on development, behaviour and academic achievement have been reported in many studies. Because adverse effects have been noted at even mild levels of oxygen desaturation, future research should include precisely defied data on exposure to all levels of desaturation.  http://pediatrics.aappublications.org/cgi/content/abstract/114/3/805

Prolonged use of infant seating devices with infants who are too young to sit unsupported may have several potential adverse consequences.  http://archpedi.ama-assn.org/cgi/content/abstract/151/3/233

Oxygen Desaturation in Term Infants in Car Safety Seats (commentary report, a great overview) http://pediatrics.aappublications.org/cgi/content/extract/110/2/401

"Because not all infants at risk of oxygen desaturation can be identified at birth, an alternative approach would be to recommend that infants should be routinely transported in a supine (flat on back) position car seat in the early months of life".   (Quote from an American medical research report:  Bass / Mehta August 1995).

In the UK the locations of SIDS victims are not published but from time to time there maybe (at the descretion of the Coroner) a public inquest. Sometimes details of inquests are published in local press but often SIDS deaths do not get reported so we never get to know all of the facts. Here are a few links:

http://www.leicestermercury.co.uk/Anguish-mum-baby-girl-dead/story-19481637-detail/story.html

http://www.derbytelegraph.co.uk/Warning-baby-preferred-sleep-car-seat-dead/story-16781041-detail/story.html

http://www.chroniclelive.co.uk/news/north-east-news/warnings-after-two-north-baby-1403825

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FOR HEALTH PROFESSIONALS AND THOSE WITH ACCESS TO MEDLINE WANTING FULL VERSIONS WE ALSO SUGGEST THESE MEDICAL RESEARCH REPORT TITLES (apologies for any duplications to the above):-

  1. Rear facing restraints for small child passengers - a medical alert" University of Michigan Transport Res Inst Rev 1995 25 12-17 (Author K Webber).
  2. Effects of child car seats on the cardioespiratory function of newborns. University of Kobe (Japan) (Author Hiroake Nagase).  http://onlinelibrary.wiley.com/doi/10.1046/j.1442-200X.2002.01507.x/abstract
  3. Airway of babies in car seats (New Zealand) (Author S L Tonkin).
  4. Some healthy babies suffer Apnea or Bradycardia when placed in a car seat. (Author M J Bull).
  5. Respiratory instability of term and near term healthy newborns in car seats University of Michigan (Author J R Merchant).
  6. Oxygen desaturation in term infants in car safety seats (Authors J L Bass and M J Bull)  
  7. Oxygen desaturation of selected term infants in car seats (Authors J L Bass and K A Mehta)
  8. The physiological effects of positioning premature infants in car seats (Author P S Smith)
  9. Risk of Hypoventilation in premature infants in car seats (Author L D Willet) 

 

 

 

 

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