High Misuse Rate of Car Seats Puts Infants at Risk

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Infant in car seat, via Shutterstock Infant in car seat, via Shutterstock

The day has finally come: new parents can take their bundle of joy home from the hospital or birthing center. To be sure that baby is safe on the trip home, they have paid $100 or more (sometimes much more) for a car safety seat (CSS).

But according to a new report in the Journal of Pediatrics, many of these parents either don't install the seat and/or don't position the baby in the seat correctly. This means that in the event of an accident, the seat may well increase the chance that the baby will be injured sometimes severely.

Because earlier research found a high level (over 70 percent!) of CSS misuse, investigators from Doernbecher Children s Hospital, and Oregon Health and Science University, Portland, OR, examined the prevalence of CSS misuse by parents who were taking their newborns home from the hospital. There were 291 randomly-selected families that participated in the study. Child passenger safety technicians (CPSTs) assessed the performance of the families with respect to both installing the CSS and positioning the baby in the seat.

The researchers, led by Dr. Benjamin D. Hoffman, found that an astounding 95 percent of families misused their CSS in some way. Of these, 86 percent made errors in CSS positioning and 77 percent in installation. Frequent misuse with respect to positioning the baby in the CSS included errors in using the seat's harness and chest clip, an incorrect recline angle, and incorrect use of the seat belt or lower anchors.

Some of these errors could be fatal for the infant. For example, having the baby in too upright a position could result in the baby's head leaning forward (newborns have little control of head position) and blocking the airway.

Characteristics of the mothers (only mothers were the object of the study) that were linked to an increased risk of CSS misuse included: being a woman of color, a non-English speaker, on Medicaid, or with a lower educational level. In addition, the researchers found that although mothers who worked with a CPST before their babies were born made fewer errors, 77 percent of them still performed some portion of CSS use incorrectly.

In light of such results, the authors noted:

"Even though most families who had worked with a CPST before the birth of their baby had installed their CSS correctly at hospital discharge, 35 percent still made serious installation errors [of the 77 percent who made some error]. This suggests that prenatal collaboration with a CPST alone is insufficient to ensure correct CSS installation, and that postpartum assistance might decrease misuse rates."