1. 15 minute lesson Gina Peek, Ph.D. Laura Hubbs-Tait, Ph.D.
Protecting infants and toddlers from positional asphyxia: Car seats and sling carriers
15 minute lesson
Gina Peek, Ph.D.
Laura Hubbs-Tait, Ph.D.

2. What is positional asphyxia?
Positional asphyxia occurs when babies cannot breathe.
The baby’s airway can be blocked when:
The mouth and nose are blocked
The passage of air from mouth and nose to lungs is blocked because the head is slumped over or the chin is pressing into the chest.
Infants and toddlers can die quickly when they cannot breathe
Even when infants and toddlers survive, asphyxia can cause cognitive or behavioral problems
Improper positioning in car seats or sling carriers can lead to positional asphyxia

3. Who is at risk and why? Newborns and young infants
They cannot move enough on their own to reposition their head and neck
Premature and low birthweight infants - greatest risk
Too small for seat
Breathing problems
Cannot sit upright enough

4. Car seats: Who is at risk?
In certain situations, older infants and toddlers may be at risk
When car seats are placed on beds and other furniture, the seat can roll over and trap the child.
A sleeping child left unattended in a car seat can slump and rest their chin on their chest, restricting or stopping breathing.
An awake child left unattended in a car seat can move and block their nose and mouth, preventing breathing.

5. Reduce car seat risk Follow manufacturer’s instructions
Use straps to position baby; do not add pillows or blankets
Use car seats for riding in a car or other vehicle and not for other purposes
Whenever possible, have an adult ride in the back seat with baby to check head and neck position and breathing
Make sure baby’s chin is up at all times
Have everyone using the car seat practice installing and using the seat
Get your seat inspected; call your state or county health department for assistance
Reference: see for more information

6. Sling carriers Ring slings
Are adjusted to fit the baby by tightening or loosening the sling fabric through rings.
Pouch slings
May be adjusted to fit the baby with buckles.
Wrap slings
Are adjusted without any fasteners.

7. Sling carriers: Who is at risk?
Sling may position baby with chin bent to chest, cutting off airway and leading to death
Newborns and young infants are at risk because they cannot move enough on their own to reposition their head and neck
2017 Consumer Product Safety Commission Standards

8. Reduce sling risk: Remember TICKS
Sling should hold baby tight against your body, upright, facing you, and positioned high on your body and with head supported
Tight
Baby’s face, nose and mouth should be uncovered by sling and your body and you should be able to see baby’s face at all times simply by looking down
In view at all times
Baby’s head should be so close that you can tip down your own head and kiss the top of baby’s head
Close enough to kiss
Check baby frequently to make sure her/his head is up – not on the chest. On the chest means that his/her breathing is blocked; if in doubt, gently tilt baby’s chin up
Keep chin off chest
Support baby’s back in a natural position so that tummy and chest are facing you; if you need to bend over, bend from the knees while supporting baby’s back
Supported back
Reduce sling risk: Remember TICKS
(Australian Competition and Consumer Commission, 2014)

9. Car seats and sling carriers are not safe sleep environments
Take away message
Car seats protect infants and children from serious injury and death in vehicle collisions
Slings allow parents of infants to be close and physically connected with them while on the go
Car seats and sling carriers are not safe sleep environments

10. Thank you!
References
Australian Competition & Consumer Commission. (2014). What you need to know about baby slings. Retrieved from Alert_Baby slings_FA.pdf
Batra, E. K., Midgett, J. D., & Moon, R. Y. (2015). Hazards associated with sitting and carrying devices for children two years and younger. The Journal of Pediatrics, 167(1),
Hoffman, B. D., Gallardo, A. R., & Carlson, K. F. (2016). Unsafe from the start: serious misuse of car safety seats at newborn discharge. The Journal of Pediatrics, 171,
Liaw, P., Moon, R. Y., Han, A., & Colvin, J. D. (2019). Infant deaths in sitting devices. Pediatrics 2019;144; DOI: /peds