Positional Asphyxia | Death Asleep in a Car Seat

Positional Asphyxia: Death Asleep in a Car Seat

Could a Baby Die Asleep in a Car Seat on the Floor?

Positional Asphyxia: Death Asleep in a Car Seat
Positional Asphyxia: Death Asleep in a Car Seat

Tragedy struck a North Dakota family when one of their twins died at daycare in his sleep.  The daycare workers usually took the babies out of their car seats.  At drop off, Linnea was taken out of her car seat.  But her twin brother, Anders Jungling fell asleep.  Just a few hours later, his mom, Rachel, got the phone call.  He died quietly in his sleep … in his car seat.  Rachel didn’t understand why he was still in his car seat.  The daycare workers didn’t know that a baby could die in a car seat placed on the floor. So, they let him sleep.

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Why Does Any Mother or Caretaker Leave a Baby Asleep in the Car Seat? 


The reasons are many … 

“I’m just so tired.” 

“He finally fell asleep.”

“He has such bad colic & has been crying all day. He needs the sleep.”

“I’ll leave him there for just 30 minutes.”

“If I take him out, it’ll take forever to get him back to sleep.”

“I’ve always heard to let sleeping babies lie.”

And many, many more.



How Many of Us Have Left Our Baby Asleep in a Car Seat? 


I’ve been guilty of that.  I remember constantly checking, every 2-5 minutes if my sleeping son was okay in the car seat.  Then, it finally dawned on me that the little bit of sleep he would get in his car seat was causing me extreme stress and additional mental unrest.  Why was I doing that to myself?  He had horrible colic.  He was only getting a maximum of 3 hours daily.  In the end, I couldn’t reconcile his much-needed sleep with my ever-increasing madness.  I’m sure my sleep deprivation made me think unclearly.  Mentally, I just couldn’t take the risk anymore.  And so, I took him out of his car seat.  And he cried.  A lot.  I hated it.  Praying he would just fall back asleep each time, but he didn’t.  So, many a night, I would drive with him until he slept in the car.  I can understand why anyone would leave a baby in a car seat.  However, we just can’t because they could die of positional asphyxia.




What is Positional Asphyxia?

Positional asphyxia happens when an infant stops breathing when they are either placed or fall asleep in an unsafe sleeping environment or an unsafe position.



How Can Positional Asphyxia Occur in a Car Seat?

A baby can sleep safely in a car seat placed in a car because the car seat is placed at an angle.  when the car seat is at an angle, a baby’s heavy head remains backward and their airways remain open.  On the floor, the baby’s head tilts forward and closes their airway.   The baby will not fight the asphyxiation.  They will die quietly in their sleep.  



What are Some Unsafe Environments for Baby’s Sleep?

Car Seat


Objects in the bed, such as blankets, pillows, stuffed animals



Beanbag Chair



What are Some Unsafe Positions for Baby’s Sleep?

Side sleeping

Sleeping facedown

Sleeping with the head covered (in a car seat)

Face against a soft surface (bed bumpers, parent’s chest)


What are the ABCs of Safe Sleep?

Alone – Babies need to sleep alone in a crib without anything that could suffocate them (bed bumpers, blankets, pillows, stuffed animals, pacifiers made with attached plushies).
Back – Babies need to sleep on their backs (no side sleeping or face down sleeping).
Crib – Babies need to sleep in a crib or a flat bassinet (not a car seat, swing, adult bed, etc).


Is This Rare?  Why Change if Nothing Bad Has Happened to Anyone I Know?


You may not hear or know someone whose baby died of positional asphyxia, but it’s not worth taking the risk.  In my pediatric career, in over 20 years, I’ve had 3 children that I’ve cared for die from positional asphyxia.  If it happens to you or someone you know, it’s life-changing.  You have to live with the pain and regret, forever wondering, if you had only changed, would life have been different?  It’s just not worth it.  


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About Nancy M. Silva, MD, FAAP

I'm a Board Certified Pediatrician. I've been in practice since 2000. I'm happily married with two children. I graduated Medical School from the State University of New York (SUNY) Downstate College of Medicine in Brooklyn, NY. My Pediatric Residency training was at University of South Florida, College of Medicine. I've been in private practice since 2000. As a medical student, I had the privilege to care for children at Kings County Hospital & Downstate Medical Center in urban Brooklyn. As a resident, I cared for children at Tampa General Hospital & All Children's Hospital in St. Petersburg, Florida. These experiences helped shape the Pediatrician I am today.

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