Reducing the risk of Car seat cot death

Doncaster and Bassetlaw Teaching Hospitals
NHS Foundation Trust
WPR43583 Aug 2023

Car seat cot death is very rare, but still carries a very real risk. Car seats are to keep babies safe when travelling and are not to be used as a primary sleeping place. This leaflet offers practical advice when using car seats.

Young babies can experience respiratory problems if placed in a sitting position or a car seat. A baby’s reflex to keep the head held up is not fully developed when still a newborn, making their heads flop down and restrict their airway.

This is why it is always best to keep a young baby on their back wherever possible.

Car seats should only be used to transport babies in cars, and not as an alternative for cots or high chairs. Other sitting baby equipment should only be used once the baby is strong enough to support its own head.

If your trip involves driving for long periods, you should stop for regular breaks. This will allow you to check on your baby, take them out of the car seat and let them stretch and move around.

When you are bringing the baby back into the house or destination, if they have fallen asleep in the car seat, the baby’s warm outdoor clothing should be taken off even if this involves waking the baby.

If the baby is due a sleep, they should be taken out of the car seat and put into a cot or Moses basket. The safest place for a baby to sleep is on a firm, flat mattress with a waterproof cover.

What about car seats in prams?

Using a pram with a car seat top is suitable to use, but not as a primary sleeping place.

Family Services

The safest place for a baby to sleep is in a cot or Moses basket on their back and in the same room as a parent or carer.

Advice for parents and carers on car seat safety:

• Never use a car seat in the house for your baby to sleep in.
• Stop your baby from scrunching up and over. Keep an eye on their neckline.

Make sure you have a car seat which is suitable for your baby’s weight and is correctly fitted according to the manufacturer’s instructions (many shops will help with this).

It is essential for safety that babies travel in rearward-facing baby seats. Rearward-facing seats provide greater protection for the baby’s head, neck and spine than forward-facing seats.

Car seats must conform to safety standards – United Nations standard, ECE Regulation 44.04 (or R 44.03) or to the new i-size regulation, R129. Look for the ‘E’ mark label on the seat.

Do not buy or use a second-hand child seat, as you cannot be certain of its history. It may have been involved in an accident and the damage may not be visible.

Car seats with the shortest distance from the crotch strap to the seat back are recommended, as they reduce the potential for your baby to slip forward feet first under the harness.

Car seats with multiple harness-strap slots may also be more suitable for smaller infants.

The distance from the lowest set of harness slots to the bottom of the car seat should be short enough that the harness is level with, or below the shoulders.

The harness should be snug and the retainer clip should be positioned correctly, not pressing on the abdomen or the front of the neck. The fabric strap should be snug enough that the fabric cannot be pinched together.

It is also possible to check that the harness is adjusted correctly by doing the two‑finger test: if you can fit more than two fingers between the underneath of the car seat harness and your baby’s shoulder bone, the harness tension should be tightened.

• Make sure grandparents/carers know how to fit the car seat and watch them practice.
• Try to wait about an hour after feeding time before putting your baby in the car seat – especially if they have reflux. This will allow the feed to digest and will help prevent regurgitation.
• Babies travelling in a car seat should be observed by a responsible adult at all times. If you are a lone driver, driving a significant distance, use roadside services to check on your baby.
• Babies find it difficult to regulate their temperature and quickly overheat. When babies get too hot, they are at a greater risk of Sudden Infant Death Syndrome (SIDS). We advise removing any hats or outdoor clothing such as snowsuits and coats once your baby is in the car.

The best way to check your baby isn’t getting too hot is to feel their tummy or the back of their neck. If their skin feels clammy or sweaty, they are too hot, so remove a layer of clothing as young babies cannot regulate their temperature.

Family Services

Patient Advice & Liaison Service (PALS)

The team are available to help with any concerns, complaints or questions you may have about your experience at the Trust. Their office is in the Main Foyer (Gate 4) of Doncaster Royal Infirmary. Contact can be made either in person, by telephone or email.

Telephone: 01302 642764 or 0800 028 8059
Email: dbth.pals.dbh@nhs.net

Download the PDF version of this leaflet

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