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Car Seats are for Cars

Written by Catherine McKenzie   
Tuesday, 01 September 2009 00:00
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Children who are consistently carried in car seats instead of held close to mom suffer adverse physical and psychological effects

“You know, you’re the only mother here who doesn’t carry her baby in a car seat,” commented the receptionist at my midwife’s office.

My daughter was several weeks old at the time and I’d left her seat in the car, mainly because I didn’t feel like lugging it all the way up the stairs to the clinic. I looked around the waiting room and realized that we were the odd ones out.

It seemed true wherever we went. At the library, the shopping mall and the drop-in center for parents, the babies were all in infant seats—parked next to waiting-room chairs, snapped into matching strollers, clipped onto shopping carts or carried by handles and trailing a woolly blanket.

No longer just a safety device for automobiles, portable infant car seats are now an important part of “travel systems”—sets that include an in-car base, a stroller and a car seat that snaps into both. They’ve been called the SUVs of the stroller world, and a quick glance in any baby store will show you how popular they’ve become.

Infant seats, whether sold as part of a travel system or alone, now sometimes include a cold-weather boot, a head hugger and an adjustable base that stays in the car. Most can be used only until the child reaches 20 pounds, which may be as early as three or four months. They often cost as much as longer-lasting, convertible car seats, which can be used in both rear- and front– facing positions and can accommodate children weighing from 5 to 40 pounds. That doesn’t discourage most families, however, who consider the infant seat an essential item for a baby’s early months.

Many parents don’t think twice about using an infant seat as an all-purpose baby carrier. But is there any harm in relying so heavily on a single piece of baby gear?

Do the portability and convenience come at a price? As it turns out, there are good reasons why you should consider leaving the car seat in the car.


The Rise of Flat Head Syndrome

Medical professionals have begun to notice an alarming rise in the incidence of a skull deformity in infants called “flat head syndrome.” Plagiocephaly, the medical term for this flattening of the skull, can occur as a result of consistent pressure on a particular spot. It is a cosmetic condition, but one that can be permanent if left untreated. The increase in plagiocephaly is frequently blamed on the fact that babies are now placed on their backs to sleep, a position that has been shown to prevent sudden infant death syndrome (SIDS).

If a baby’s head is always in the same position, the pressure can deform the skull. However, back-sleeping is not the only factor. Extended periods of time spent in a baby seat can also contribute to this condition, as can long periods in strollers, swings, and other devices that put babies in a back-lying position.

Thomas R. Littlefield, M.S., is affiliated with an Arizona clinic that treats plagiocephaly. In an article in the Journal of Prosthetics and Orthotics, he notes that 28 percent of infants who attend the clinic spend 1.5 to 4 hours daily in car seats or swings, and nearly 15 percent are in them for more than four hours per day. Another 5 percent of infants are allowed to sleep in these devices. Littlefield observes that cranial distortion resulting from overuse of car seats and swings is more severe and complex than in children who develop plagiocephaly from back-lying on a mattress. Consequently, he recommends reducing the time spent in car seats and swings, if possible.

Concern over plagiocephaly also led the American Academy of Pediatrics to suggest in 2003 that infants “should spend minimal time in car seats (when not a passenger in a vehicle) or other seating that maintains supine positioning.”

When infants must be in a back-lying position, moving their heads occasionally can help reduce pressure and avoid developing a flat spot. The simplest and most effective prevention, however, is to decrease the cumulative time an infant spends on her back.


Poor Positioning for Infants

Plagiocephaly is not the only problem associated with heavy use of car seats. According to Dr. Jeanne Ohm, executive coordinator of the International Chiropractic Pediatric Association (icpa4kids.com), many infants in strollers or car seats constantly tilt their heads to one side or the other. “That’s a good indication that their upper cervical spine is out of alignment,” says Ohm.

Short periods spent in a car seat are fine, but “keeping them in that position where it’s easiest for their head just to fall to the side—that leads to further spinal stress later on in life.” Ohm prefers to see parents carry infants in their arms and use different types of carriers. “Using a variety of carriers supports correct postural development for the child.”