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Apparently life threatening events in infant car safety seats

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39021.657083.47 (Published 07 December 2006) Cite this as: BMJ 2006;333:1205

Rapid Response:

Making Infant Car Safety Seats Safe --- a Low Tech Option

Editor,
Tonkin et al. describe the cases of nine infants having apparently life
threatening episodes while restrained in car safety seats [1]. The cause
of these events seems
to be related to the design of the car safety seats: The seats do not
provide space for the infant's large occiput, leading to forward flexion
of the neck and airway obstruction.
A car seat insert increasing the gap for the occiput has been designed by
the same group three years ago [2] but is not commercially available in
the United Kingdom.

A far easier `low-tech' solution is to put a folded towel behind the
baby's shoulders.
This simple method is commonly used in paediatric anaesthesia and in
prehospi-
tal emergency care to keep the airway open and to avoid neck flexion in
infants immobilised on a spine board [3].
This is not stating the obvious: A group from Tel Aviv went to great
length to
prevent lateral head movement in infant car seats and unsurprisingly found
no
difference in the frequency of hypoxia [4].
A folded towel or similar padding will not change the restraining function
of the
seat in an accident, certainly not more than a winter jacket without hood.

Towels are readily available to all parents, all we need to do is to
show them how to do it. A demonstration of a few minutes could save a baby
from airway obstruction and can be integrated easily in the `car seat
test' [5]. Midwives, health visitors, and general practitioners may be in
the best position to teach parents how to use an infant car safety seat
safely.

References

[1] Tonkin SL, Vogel SA, Bennett L, Gunn AJ. Apparently life
threatening events in infant car safety seats. Br Med J. 2006 9th
December;333(7580):1205 -- 1206. First author given as Tonkin in bmj.com,
Tondon in printed clinical research edition.

[2] Tonkin SL, McIntosh CG, Hadden W, Dakin C, Rowley S, Gunn AJ.
Simple
Car Seat Insert to Prevent Upper Airway Narrowing in Preterm Infants: A
Pilot Study. Pediatrics. 2003;112(4):907 -- 913.

[3] Gausche-Hill M, Brownstein D, Diekmann RA, editors. Pediatric
Education
for Prehospital Professionals: PEPP Resource Manual. Sudbury: Jones &
Bartlett; 2001.

[4] Dollberg S, Yacov G, Mimouni F, Ashbel G. Effect of Head Support
on
Oxygen Saturation in Preterm Infants Restrained in a Car Seat. Amer J
Perinatol. 2002;19:115 -- 118.

[5] American Academy of Pediatrics, Committee on Injury and Poison
Prevention. Safe transportation of newborns at hospital discharge.
Pediatrics.
1999;104:986 -- 987.

Competing interests:
None declared

Competing interests: No competing interests

16 December 2006
Tim Vemmer, MD FRCA DMCC
Specialist Registrar
Dept. of Anaesthesia, St George's Hospital, Blackshaw Road, London SW17 0QT