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Neonatal nurse develops car seat cot death guidelines

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An initiative by a neonatal nurse to help improve safety for babies in care seats has been recognised by a national charity.

Michelle Clark, neonatal unit sister at Doncaster Royal Infirmary, produced information to raise parents’ awareness of the risk of car seat cot death, due to a dearth of materials in this area. 

Ms Clark spent two years researching the subject, studying findings from various sources, including New Zealand and the Foundation for Sudden Infant Death. 

She has now developed guidance for parents to help minimise the risk of car seat cot death and her work has been recognised by the national special care baby charity Bliss, which is publishing it on its website and in its information booklet for parents.

Hilary Bond, director of nursing and quality Doncaster and Bassetlaw Hospitals NHS Foundation Trust, said: “This is an excellent achievement and we are proud to have such a dedicated health professional working in the trust.”

She added: “Michelle’s work is being published nationally, demonstrating the importance attached to her work.  It is important to inform parents, other family members, and the general public when new knowledge is available.”


Key findings from Ms Clark’s work include:

  • Young babies may experience respiratory (breathing) problems if placed in a sitting position or car seat. A newborn baby’s reflex to keep its head held up is not fully developed, meaning the head flops down and restricts the airway. 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 other sitting baby equipment should only be used once the baby is strong enough to support their own head.
  • Car seats are designed to keep babies safe while travelling, not as a main sleeping place. The research recommends that frequent breaks are taken on long journeys to get the baby out of the seat, even if this involves waking the baby up. The same applies when bringing the baby into the home 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 crib; the safest place for a baby to sleep is on a firm, flat mattress - a car seat does not meet this requirement.  Worryingly, it has been found that some babies were spending hour after hour in car seats, ie during the journey, transferring the car seat in a travel system pram, and once home allowing the baby to continue sleeping in the car seat rather than waking the baby up and placing in them in a cot or crib. 
  • All the advice suggests that babies should not spend longer than possible in a car seat, especially whilst sleeping.


Best practice to reduce risk of car seat cot death:

  • the safest place for a baby to sleep is in a cot or crib on their back and in the same room as a parent or carer
  • you should 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 the car seat you buy is age appropriate and correctly fitted
  • make sure grandparents and carers know how to fit the car seat and watch them practice
  • where possible, babies travelling in a car seat should be observable by a responsible adult
  • if you are a lone driver driving a significant distance use services to check on your baby
  • babies find it difficult to regulate their temperature and quickly overheat. When in the car, remove any headgear the baby is wearing as they lose excess heat through their head
  • be wary of thick snowsuits. It may be cold outside, but cars can heat up quickly. Natural materials will help the baby’s body with heat rather than nylon, polyester, and other man-made fabrics.


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