Newborns face breathing difficulties if left in car seats for too long

Newborn infants may be at risk of breathing difficulties if left in car safety seats for long periods, particularly when travelling, according to new research.

Most UK hospitals require premature infants to complete a ‘car seat challenge’ before discharge, in which infants are observed for breathing difficulties or changes in heart rate while in a car seat. However, the test does not take into account the more upright position in a car, or the vibration of the seat when the car is moving.

The study, funded by the Lullaby Trust, is the first to assess the effect of motion on infants and to replicate the angle of the rear seat of a small family car.

Professor Peter Fleming from the University of Bristol’s School of Social and Community Medicine, said: "This was a unique pilot study – the first to look at the physiological effect of vibration on infants in a car safety seat. The standard static car seat challenge currently used in hospitals does not reflect the angle infants are placed at, or the motion of the journey.

"Placing an infant at the more upright 40° position, along with the vibration experienced in a car, leads to significantly increased heart and respiratory rates, and decreased oxygen saturation. Simulating motion reveals a striking increase in potentially clinically significant oxygen desaturations. Surprisingly, we found these differences were similar in term and preterm infants."

Safety

Researchers from the University of Bristol developed a motion simulator to replicate vertical vibration, similar to that at the base of a car safety seat in a rear-facing position in the back of a small family car.

The simulator was designed, manufactured and tested by the Human Factors Research Unit at the University of Southampton’s Institute of Sound and Vibration Research. The simulator reproduced the vertical vibrations from travelling at 30mph on a straight urban road, without braking, acceleration or going over bumps.

The test allowed the team to look at how the vibrations affected babies’ heart and lung functions. They discovered that both full-term and preterm babies showed significant signs of potentially negative cardiorespiratory effects.

Francine Bates, chief executive of the Lullaby Trust, said the findings provided cause for concern and has advised parents to keep a watchful eye on babies travelling in a car seat. "We recommend that parents also avoid driving long distances without a break," she said. "However, avoiding the risk of injury due to a road traffic accident is paramount and fitted car seats should always be used to transport babies and toddlers.

"It is clear that further research is needed to explore what more we can do to ensure babies are safe and comfortable when travelling in a car seat and we will be convening an urgent summit of leading child car seat manufacturers to take this forward in the autumn."

Suitability

Dr Renu Arya, consultant paediatrician at Great Western Hospitals NHS Foundation Trust, who led the research project, added: "Parents should not stop using car safety seats to transport their infants. Infants must be protected in moving vehicles and UK law requires car seats to be used whenever infants travel in cars. However, our findings support the AAP (American Academy of Paediatrics’) guideline that infant car seats should not be used as a routine infant sleep environment."

According to Professor Michael Griffin, from the Institute of Sound and Vibration Research at the University of Southampton, more research in this area is needed. He said: “We may well be able to use the motion simulator to investigate the potential benefits and limitations of various designs of infant car seats. What we find could help inform a revision of current recommendations for testing infants’ suitability for travel in an infant car seat, and also have implications for the design of car seats for newborn infants."

The study was funded by the Lullaby Trust, and was carried out at the Great Western Hospitals NHS Foundation Trust, with support from the University of Southampton and the University of Bristol.

Booster seats

New stricter rules introduced by the Government will also come into force in March 2017 limiting the use of backless booster seats for children.

The backless booster seats will only be authorised for children taller than 125cm and weighing more than 22kg – the equivalent of a six or seven-year-old.

Until now, the law has allowed children from 15kg (about three-years-old) to sit on a booster seat without a back.

According to a report conducted by Good Egg Safety in May this year, 34 per cent of eight to 11-year-old children in the UK are not using a booster seat on car journeys when one is required.

Kat Furlong Good Egg safety manager and training expert said: "A high-back booster is far more preferable to a booster cushion to provide children with adequate head, neck and torso protection from side impacts, which booster cushions do not offer. We implore parents to buy these instead and ensure they are the right seat for their child and car."

When the approval rules change, any new backless booster seats entering the market, and seeking approval to be legally sold in the UK, will only be approved for use with older children, and will need labels clearly stating what age and weight they can be used from.

Which? child car seat expert Lisa Galliers said: "The new rules will only apply to any new products entering the market, and seeking approval, after the date the change comes into force, which we're told should be by March next year."

Legislation on who is required to use a child car seat is set by the Government, but the technical specifications for child car seats are set internationally by the United Nations Economic Commission for Europe.

For more information, visit: www.gov.uk/child-car-seats-the-rules/using-a-child-car-seat-or-booster-seat