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

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

Bed-sharing

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

Sofas

Waterbed

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.  

What Are E-Cigarettes (E-Cigs)?

E-Cigarette Cancer Increased in Teens

E-cigarette cancer chemicals have increased in teens.  Before we get into the details, let's review the background of E-cigarettes.  E-cigs are electronic cigarettes that have liquids that contain many chemicals including nicotine, and fruity and other flavors.  They are battery-powered and mimic cigarettes, but don't have the smell of smoke.  The liquid changes into a vapor due to the heat in an e-cig.  Hence, it’s also called “vaping.”

What is Juuling?

There is a new teen trend called “Juuling.”  Juuling is an e-cig that is thin, looks like a flash drive, and charge in a USB port.  A juul produces less smoke which disappears more quickly. Hence, teens are able to juul at school and home without parents’ knowledge.  In comparison to smoking cigarettes, one juul pod (cartridge) has as much nicotine as a pack of cigarettes.

What are the Signs if Your Teen is Juuling?

The signs of e-cigarette smoking & juuling are:

•     Increased thirst
•     Sore throat
•     Caffeine sensitivity - they decrease their caffeine intake.
•     Nosebleeds
•     Higher rates of pneumonia

E-Cigarette Cancer Causing Chemicals

Juul Looks Like a Flashdrive

They’ve been advertised as a safe alternative to cigarettes.  They’ve also been advertised as an aid to stopping smoking.  Since e-cigs don't burn tobacco, they don't burn the same amounts of tar ans carbon monoxide.  However, e-cigarettes are unsafe, contain high levels of nicotine, and do not help in smoking cessation.  E-cigs and juuls have many cancer-causing chemicals (acrylonitrile, acrolein, acrylamide, benzene and ethylene and propylene oxide, and crotonaldehyde).

Study Showed E-Cigarette Cancer Chemicals Increased in Teens

In a recent study of 100 teens from the San Francisco Bay area by the University of California-San Francisco study: 67 teens used e-cigs only, 16 used both e-cigs and conventional cigs and 20 didn't smoke or vape at all.  Urine and salivary gland fluids tested positive for cancer-causing chemicals in teen smokers.  It revealed that teens who used e-cigs and cigarettes had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that used only e-cigs.  It revealed that the teens that used e-cigs only had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that didn't smoke at all.  Lastly, the study also showed that teens who used fruit-flavored e-cigarettes had significantly elevated levels of acrylonitrile as compared with those who used other flavors, such as menthol. 

Is Advertising Increasing E-Cig Usage by Teens?

The CDC has reported that teens view ads for e-cigarettes more than before; the exposure increased from about 69% in 2014 to about 78% in 2016.  Retail stores have exposed teens to e-cigs the most in comparison to other ads like those found on TV, internet, or magazines.  Since studies show that ads for tobacco products show increased use by teens, it is very likely that ads for e-cigs are also increasing use among teens.

FDA Sued for Delay in E-Cig Regulations

The American Academy of Pediatrics (AAP) and its Maryland chapter, the Campaign for Tobacco-Free Kids, four other public health groups and five pediatricians filed a lawsuit against the FDA for delaying submission product-review applications for cigars and e-cigarettes until August 2021 and August 2022, respectively. This leaves children at increased risk of cancer and other negative side effects from e-cigs.

Learn & Talk About the Risks of E-Cigarettes with Your Kids

It is important to learn all about the signs, symptoms, and risks associated with e-cigarettes.  The U.S. Surgeon General has created a website with lots of information about e-cigs and how to talk to your kids about this.  Remind them to respect their bodies and care for themselves.  Positivity goes a long way.  Talk to them today about e-cigarette cancer in teens. 

Sexual Abuse by MSU’s Former Dean on Medical Students

Olympics Sexual Abuse -  Photo by Claudia Soraya on Unsplash

On Tuesday, March 27, 2018, William Strampel, former dean of Michigan State University's (MSU) osteopathic medical school from 2002 to 2017, was arrested Monday evening and taken to jail on four charges — one felony and three misdemeanors.  He was charged with sexual assault and sexual harassment against four (4) former medical students at MSU.  He also failed to deal appropriately with complaints about Larry Nassar.  The Michigan Attorney General’s Office has an ongoing investigation of the role others at the school may have played in crimes committed by Mr. Nassar, the former MSU and USA Gymnastics physician accused by more than 250 girls and women of sexual abuse. 

Nassar Sentencings

In January 2018, Former U.S. Olympics Medical Doctor, Nassar was sentenced to 175 years for sexual abuse of over 250 female athletes.  Prior to that he was sentenced to 60 years jail time for ownership of thousands of images of child pornography.  

Nassar Coverup

How did he do so much to so many young girls and ladies? He sexually abused over 250 girls and women.  Surely, people knew.  Now, Strampel, his ex-boss at MSU Medical School has been charged with sexual assault and harassment of female medical school students.  Nassar was USA Gymnastics' national medical coordinator since 1996 until he was fired in 2015.  In April 2014, when Amanda Thomashow, a MSU student, complained about Nassar's sexual abuse of her on campus, Mr. Strampel stopped Nassar from treating students for two (2) months, then came up with protocols, in order to prevent the same "misunderstanding" from happening again.  However, Strampel never told anyone at MSU or the authorities the accusations, Nassar's conduct, or Strampel's plans.  In August, only two (2) months later, another woman complained again.  Nassar admitted he didn't follow any of Strampel's guidelines. 

Nassar Fired

One has to wonder why?  Simply, Strampel admitted to Michigan State police and the FBI that he never followed up to see if Nassar was following the protocols.  Protecting MSU's reputation may have indeed had something to do with it.  However, Strampel was also protecting himself.  Authorities have since found evidence to Strampel’s own crimes on his work computer.  Allegedly, investigators found about 50 photos of pornography, many of them he solicited from MSU students Also, shockingly, a video of Nassar performing “treatment” on a young female patient. So Strampel knew all along, but did nothing to stop, prevent, or report it.  Clearly, he was protecting himself.

Female Gymnastics Athletes Accuse Nassar

Mr. Nassar's sexual abuse of female athletes was not limited to USA Gymnastics, it also included his time spent with the USA Olympic team at Karolyi Ranch (now closed, former US Women's National Team Training Center and a US Olympic Training Site), MSU, Twistars gymnastics club in Michigan, his office, and his home, sometimes while parents were in the room.  He'd explain that his intravaginal therapy was medical treatment for their hip and physical injuries.  However, even if there weren't hip injuries, he would still perform his intravaginal treatments.  He also didn't use exam gloves.

Female Gymnastics Athletes Resist Nassar’s “Treatment”

These young girls felt uncomfortable with his treatments, but didn't know that it was sexual abuse.  They didn't want his treatments anymore.  Mattie Larson gave herself a head injury in order to avoid going to Karolyi Ranch.  She was abused from the time she was 14 years old for five (5) years until she retired in 2011 at 19 years old.  Olympic Gold medaist, Aly Raisman was one of many young women who confronted Larry Nassar in court prior to his sentencing regarding the sexual abuse.  She had spoken in a most compelling, strong and determined manner.  The video of Aly Raisman's court speech is compelling beyond words.  Other Olympic gold gymnasts, Simon Biles and Gabby Douglas state they were abused by Nassar as well.  Lawsuits by Aly Raisman and another olympic gymnast, McKayla Maroney have been filed against MSU, USOC, and USA Gymnastics. 

First Male Gymnastics Athlete Accuses Nassar

On March 2, 2018, Jacob Moore became the first male athlete to accuse Nassar of sexual abuse. How many other men will follow?  Time will tell; but I wouldn’t doubt that there’s many more.  He and his sister filed a lawsuit against, stating they were sexually abused and harassed by Nassar.  Moore, his sister, along with 200 women filed a federal lawsuit against Nassar, USA Gymnastics and MSU. Moore states that Nassar brought Moore to his basement treating his shoulder injury with genital and pubic acupuncture.

Fallout from the Scandal

In the fallout of the scandal, many more people in position of high authority in their perspective organizations have resigned, been suspended, or fired.  Their involvement, lack of action, suppression of information, ability to ignore and look away, essentially helped  Nassar commit his many crimes against these ladies.  MSU's President Lou Anna Simon and Athletic Director Mark Hollis, USA Gymnastics Board of Directors’ Chairman Paul Parilla, Vice Chairman Jay Binder and Treasurer Bitsy Kelley all resigned after Mr. Nasar'sNasar's sentencing.  USA Gymnastics suspended former U.S. women’s national team coach John Geddert, the owner of the Twistars. US Olympic Committee (USOC) CEO Scott Blackmun resigned as well. How many more will fall?  Undoubtedly many more will fall.  Wait and see.  

Talking to My Patients About Sexual Abuse?

It is important to talk to both our daughters and our sons about sexual abuse.  It’s important to discuss details. Of course, age appropriate conversations need to take place.  As a pediatrician, whenever it’s time to examine genitalia, I’ve always done so with the parent/trusted adult in the exam room.  I talk with children about feeling safe when a parent or a trusted adult is around, that know one should look at you, touch you, or touch your private boy/girl parts, mouth, or bottom alone, not even a girl doctor like me. 

How Do I Talk with My Kids about Sexual Abuse?

On a personal note, we have had this conversation with our son several times since he was seven (7) years old.  The talk has changed over the years.  As his body self-awareness increased, suddenly, I realized I was only discussing his “front” genitalia.  One day, I asked my young son, “What if someone wants to touch you butt?  What if they want to put something in your mouth?”  Shockingly, his young self said, “Okay.”  I had to teach him that it wasn’t okay.  Does Mommy or Daddy every put anything in your mouth?  Your butt? Then, he realized it wasn’t okay.  

Nowadays, I talk with him directly about Larry Nassar, how he groomed these girls and the boys, the horrible secrecy, the bravery of the girls and the boys who tell their stories.   Frankly, he needs to know that these monsters exist, that they don’t look like monsters, that their friendly at first, until they trap you.  But they can be stopped. He can avoid them, and needs to talk about them just like these women and young man did. 

I’ve also taught him that if he sees something happening to someone else, he needs to say something.  Children sometimes don’t want anyone to know what they’ve seen. They may not feel safe.  They may not feel their parents can be safe if they tell.  So, it’s important to let them know that abuse can be reported anonymously by calling 1-800-FL-ABUSE.  Silence is dangerous.  

How to Talk About Sexual Abuse with Your Children

It is so important to talk with our children about sexual abuse.  These brave young girls, women, and young man have helped open doors to this conversation.  No one ever thinks it will happen to their children.  Usually, it's by someone the child knows, as opposed to a total stranger.  In fact, the sexual abuser usually grooms them to make them feel special.  The MeToo Movement showcases exactly how important it is for parents to discuss sexual abuse with their children.  It is an uncomfortable discussion.  But it’s never enough conversation.  Repetition over the different ages is crucial, as children’s understanding increases with age.  Parents are the key.  Reading the AAP article about sexual abuse can help you start this conversation, recognize risk factors, and prevent sexual abuse from happening to your children.  Talk about it, the abuse you talk about today may be the abuse you prevent tomorrow.

Gun Violence in America & March for Our Lives

America had a truly historical moment on Saturday, March 24, 2018.  The March For Our Lives was led by the student survivors of Marjory Stoneman Douglas High School, Parkland, FL.  There were 800,000 teens and adults who attended the March in Washington, DC.  Many more attended in cities across the U.S. to demand change in gun laws and talk about gun violence in America.

Gun Violence in America

A March led by our minors is amazing.  Even more amazing is that they included all others affected by gun violence in America, including domestic gun violence victims, police gun violence victims, and more.  This was not just a march to stop school shootings and school violence.  They made a statement that "Enough is Enough". 

Articulate Teens

They were also incredibly articulate.  In an era when so many think children are just children, it was wonderful to see them show the world that our American children can stand up for themselves, provide valuable statistics to support their positions, and be able to address our Congressional leaders with words and action.  They are stating that when they are eligible to vote, that they will vote based on this sole cause.  Many don't believe they will follow through on their actions.  However, many don't realize that once your voice has been heard, you are a force to be reckoned with always.

Students Speak Up

Several students stood out.  Emma Gonzalez spoke and stood in silence for about 6.5 minutes to honor to victims of the Marjory Douglas High School shooting on February 14, 2018.  This was less than the duration of the school's shooting.  It was symbolic of the time that students and teachers died, were injured, and were hiding in fear.  The silence was deafening and powerful.  

Samantha Fuentes, another Parkland school shooting survivor with gun wounds on both legs and shrapnel on her face stood up for herself and her friend, Nicholas Dworet, who died and would've turned 18 years old on the day of the march.  Overcome with emotion, she vomited behind the podium and persevered with her speech and led the crowd in a Happy Birthday song to her beloved dead friend.  She was courageous and empowered.  David Hogg, another survivor stated, "The people in power are shaking."  The most popular chant at the march was "Vote Them Out." 

Young Children Speak Too

Dr. Martin Luther King Jr.'s granddaughter, 9-year-old, Yolanda Renee King, spoke as well, stating, she dreams of "a gun-free world, period." And 11 year old, Naomi Wadler, stood for the disproportionate number of black females killed by guns.  She said, "For far too long, these names ... have been just numbers. I'm here to say 'never again' for those girls, too." There are many more amazing children that made their voices heard.  Undoubtedly they are coping with tragedy in many ways.  This is their chance to cope and have an active role in shaping and owning their future.

Gun Law Changes the Students Want

The students have detailed explanations in their "Manifesto to Fix America's Gun Laws," as listed in their words, in their guest editorial in the Guardian.  These are the  nine (9) gun law changes they request, as written by the editorial staff students of the Marjory Stoneman Douglas newspaper, the Eagle Eye: 

1. Ban on semi-automatic weapons that fire high-velocity rounds
2. Ban accessories that simulate automatic weapons (e.g. bump stocks)
3. Establish a database for gun sales and universal background checks
4. Change privacy laws to allow mental healthcare providers to communicate with law enforcement
5. Close the gun show loophole and loophole for second-hand gun sales
6. Allow the CDC to make recommendations for gun reform
7. Raise the firearm purchase age to 21
8. Dedicate more funds to mental health research and professionals
9. Increase funding for school security

Democracy at Work

This march shows how a democracy works.  It shows that everyone can use their voice.  It has empowered many of our youth for the future.  The future is in our children.  Wait and watch because gun violence is only the beginning for these children, these future lawmakers, these activists; their future has so much more ahead!

Lead Poisoning

A 9 month old infant girl from Connecticut was found to have lead poisoning.  Doctors discovered that the young infant had a high lead level during her routine physical exam.

CDC Report

According to a report (http://bit.ly/2wBf8LJ) by the Centers for Disease Control & Prevention (CDC) on August 31, 2017, her blood lead level of 41 micrograms per deciliter of lead was much higher than  acceptable.  According to CDC, an acceptable blood level is up to 5 micrograms per deciliter.

Home Investigation

Investigators reviewed the home in detail.  Although there was lead paint on two of the windows in the home, the infant girl was not able to reach those windows, so she couldn't have contracted lead poisoning from them.  In addition, the her 3-year-old and 5-year-old siblings didn't have lead poisoning, so the windows were not the source of the lead.  

Teething Bracelet

The baby girl's parents bought her a homeopathic magnetic bracelet to help with teething pain.  She had used the bracelet for teething relief, chewing on it, causing her to ingest the lead.  The homeopathic community believes magnets help with healing.  Tests on the beads of the bracelet revealed that it contained 17,000 parts per million (ppm). According to the U.S. Consumer Product Safety Commission (CPSC), for the most part, products containing 90 to 100 ppm are considered safe.

Chewing & Lead Poisoning

Please be careful with items that your child may chew on.  Sadly, each year, there are recalls on children's jewelry due to high levels of lead and cadmium poisoning (https://drsilvatotstweensandteens.com/2010/02/cadmium-jewelry-poisoning.html).  Infants and toddlers place objects in their mouths as part of their development and natural curiosity.  They learn about their world orally, in this fashion.  Depending upon the lead level in a child's body, lead poisoning has long-term consequences including, but not limited to lower IQ, speech delay, behavior problems, seizures, and death.  Treatment does not necessarily reverse the negative effects of lead on the brain and body.

Routine Physical Exam & Lead Testing

Please remember to follow-up with your pediatrician for your child's physical exam, as so much is done at these visits, including lead level testing, if recommended.  Consider buying a lead surface test kit for your children's toys or objects they may place in their mouths, as lead poisoning is a nightmare for any family to handle whether from teething bracelet or toys.

Children in Football and Other High Impact Sports

Concussions & Concussion Symptoms

Concussions in Children

Traumatic Brain Injury

Support & Resources

Starting this summer, Tylenol will now have standardized dosing for their Infants' & Children's products. In 2009, the FDA made several safety recommendations, including changing the concentration of Tylenol so that it is unform regardless of the age of the child. That's precisely what they've done. As a result, the measuring devices will also change. The current concentrated Infant's Tylenol will cease to be manufactured.

The idea behind this standard concentration is to decrease the risk of overdosing a child. In this case, safety and standardization go hand in hand. An overdose of Tylenol can result in liver damage and/or death. This change is particularly helpful if you have children of various ages in your home. When exhausted in the care of your sick child, you will no longer risk choosing the wrong bottle (i.e. the wrong concentration) in the store or at home. Hence, your child is less likely to be overdosed or even underdosed.

This will have an impact if/when you choose to give your child Tylenol. It also will have an impact when you ask your child's Pediatrician for dosing questions. Why? Because both past & new formulations will be available in the market at the same time. So, your child's doctor will need to know the concentration of the specific bottle you have at home in order to tell you what dosage of Tylenol is appropriate for your child. In reality it won't be a big deal. But it is best to be prepared, as there is likely to be some confusion until all of the old formulations are truly a thing of the past.

On May 4, 2011, The Consumer Healthcare Produscts Association announced that other manufacturers of Acetaminophen (generic Tylenol) will also change their formulations so that their concentrations will also standardized to 160 mg/5 ml.

For more information regarding the change in Tylenol concentration and measurement, please go to http://www.chpa-info.org/

Photo by CPSC

About two (2) weeks ago, the U.S. Consumer Product Safety Commission (CPSC) (http://www.cpsc.gov/) proposed a new standard that cribs manufactured for sale or resale must have four (4) fixed sides. If passed, it is predicted that as early as Summer 2011, drop-side cribs will be banned sale, re-sale or use in stores, hotels, and daycare centers.

What should you do if you have a one? Stop using it. Contact the manufacturer or search their website. Many are offering kits that will immobilize the rail. If no such kit is available, please consider replacing your crib. Although the deaths have been few, your child could become one of the rare ones. It is not worth taking the chance.

You can also go to the CPSC’s Crib Information Center @ https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/cribs.

If you have further questions, you can call the CPSC Recall Hotline at (800) 638-2772.