Car Seats are for Cars: Leaving Baby in Carseat Lowers Oxygen, Increases SIDS

By Catherine McKenzie
Originally at Mothering, Issue 136
A version of this article is also at Pathways for Family Wellness
The Car Seats Group

"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 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, 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 including 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 a car base. 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 sameposition, 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.

Timothy R. Littlefield, MS, is affiliated with an Arizona clinic that treats plagiocephaly. In an article in the Journal of Prosthetics and Orthotics, he notes that 28.6 percent of infants who attended the clinic between 1998 and 2000 spent 1.5 to 4 hours daily in car seats or swings, and nearly 15 percent were in them for more than four hours per day. Another 5.7 percent of infants were allowed to sleep in these devices.1 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.2

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.” 3 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 infants spend on their backs.

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 ( [1]), 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 off 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. “Offering a variety of carriers supports correct postural development for the child.”

Physical Strain for Parents

An infant car seat can weigh nearly as much as the newborn inside it. Yet it’s common to see people walking around a shopping mall or grocery store holding a car seat by the handle, the baby strapped inside. This can be hard on anyone’s back, but new mothers are particularly vulnerable.

A woman “maintains [the hormone] relaxin in her system for a good nine months after birth, and relaxin makes the joints loose,” says Ohm. “That’s something you need for birth to be able to open up the whole pelvic opening, but it’s a weakening factor, in a sense, if you’re going to do some heavy lifting.”

Infant seats are designed to be portable, but they are still awkward to carry, according to Ohm. “You have to hold it away from your body so your leg isn’t kicking it, so your whole upper spine is tilted over.” Ohm often sees new mothers with injuries from this kind of lifting and discourages them from doing it unnecessarily.

If a parent does want to keep his or her child in the car seat while out on a trip, using a compatible stroller or universal car-seat carrier (a stroller frame that accommodates different brands of car seats) is much easier on the back than trying to carry the seat by the handle.

Adds to the Burden of Baby Baggage

It’s not the babies themselves who so weigh down new parents in the early weeks after birth—a newborn weighs, on average, less than eight pounds. Instead, it’s the bulky diaper bag, the stroller, the spare clothing—all the trappings that modern parents feel obliged to carry around. The infant car seat has become part of that baggage.

One of the main reasons that parents buy portable car seats is so they can remove a sleeping infant from the car without waking him or her. There are certainly times when this is handy, but the strategy can easily backfire. I remember several shopping trips that began with my daughter asleep in her car seat, but only ten minutes later she was awake and screaming to be held. I would end up carrying her and the car seat—separately—for the rest of our trip. I discovered that it was often simpler to wake her and put her into the sling, where she would frequently fall back to sleep again anyway.

Besides, an infant seat is usually an inefficient way to transport a baby. Placed on the floor of a doctor’s waiting room, it is at the perfect height for being accidentally tripped over or kicked. It’s downright hazardous when placed on a chair or table—something most manufacturers advise against. Outside the car, the seat becomes just one more thing to lug around. Leave it in the back seat and you may find yourself feeling remarkably light and free.

Lack of Touch

Recently, friends of ours came over for dinner with their six-week-old son. He had been sleeping in the car, so they left him in the car seat and set it down near the dining table. When he woke up, they amused him by rocking the seat and dangling toys in front of him. We decided to go out after dinner, so they clipped the seat into their compatible stroller, and we went for a walk. Finally, when it was time for them to go home, they put the seat back in the car and drove away. Their son had spent the entire three hours of their visit in his infant seat.

Spending excessive amounts of time in an infant seat deprives a baby of touch and stimulation. Imagine, for a moment, what would have happened had our friends left their baby seat in the car. Their son would have been held in someone’s lap, jiggled, walked around, perhaps put on the floor with a few toys. In all likelihood, he would have been talked to more and made eye contact with the people around him. It would have been a little less restful for his parents, but more interesting for him.

Andrea, a mother from Oakville, Ontario, was given a travel system when her first son was born. “It was a neat gadget to have,” she says, “so we used it a lot in the first couple of months. It was convenient to take him in and out of the car without disturbing him.” But by the time Andrea’s second son came along, she and her husband had mastered the use of their baby sling. “We made a conscious choice to carry him often to promote attachment,” she says.

Andrea’s decision may have been an intuitive one, but it is well supported by research. In a Columbia University study, researchers gave either a baby seat or a soft, wearable infant carrier to mothers of low socioeconomic status who had recently given birth. After 13 months, the researchers found that the babies who had been transported in wearable carriers were significantly more likely to demonstrate a strong attachment to their mothers. 4

Car seats are very good at doing what they are supposed to do: protecting children in the event of an automobile accident. But there is no evidence to suggest that staying in a car seat after the ride is over offers a child any benefit. Using a car seat as a baby carrier for hours each day, as many of the parents in Timothy Littlefield’s study did, is a practice well worth questioning.

Catherine McKenzie is a freelance writer and La Leche League leader. She lives in Ontario, Canada, with her husband and two daughters. She can be reached via e-mail at 


1. Timothy R. Littlefield, "Car Seats, Infant Carriers, and Swings: Their Role in Deformational Plagiocephaly," Journal of Prosthetics & Orthotics 15, no. 3 (2003): 102-106.
2. Ibid.
3. John Persing, MD, et al., American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery, "Prevention and Management of Positional Skull Deformities in Infants," Pediatrics 112, no. 1 (July 2003): 199-202.
4. E. Anisfeld et al., "Does Infant Carrying Promote Attachment? An Experimental Study of the Effects of Increased Physical Contact on the Development of Attachment," Child Development 61, no. 5 (Oct 1990): 1617-1627.


  1. Also car seats, swings and anything that would position babies in a curled in position will decrease their oxygenation and restricts their breathing.
    Here is a study on it.
    PEDIATRICS Vol. 108 No. 3 September 2001, pp. 647-652

    Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats

  2. Slings, wraps, soft structured carriers etc are simply AMAZING. I have been babywearing since 2001. I often get comments about it.
    A checker at the gas station said to me, doesn't it bother you to always have your baby on you? My wife just kept the baby in the car seat, it was so much easier. I simply replied with, I like to keep my baby close, I don't mind.
    I LOVE carrying my babies, wouldn't trade it for anything.
    Currently, I highly recommend moby or sleepy wraps. I am currently using a Podaegi, a Korean inspired carrier.

  3. We whole-heartedly recommend the Moby Wrap. Found here: (or on eBay!) Because I know you are in CF (Alicia), they can also be purchased at Covenant Medical Center in the gift shop up on the 3rd floor (where you weigh babies). We purchased all of our Moby Wraps on eBay so I know there are good deals out there. We have used it in a variety of holds from 10lbs (at birth) to 30lbs (at 13 months).

    I also loved the Over The Shoulder Baby Holder for quick trips into the store - it is fast and easy to use with lighter babies (up to about 20lbs). After that, they are too heavy - but ours was used a LOT until our son was 22lbs. (or on eBay)

    The 3rd babywearing item that we used all the time in the first 3 months was a well-made Snugli (NOT the imitation ones that are sold at Target & WalMart - they are terrible and uncomfortable). The real good Snulgis hold a baby upright on your chest - not quite as easy and fast to throw on as the Over-The-Shoulder, but holds baby a little more securely in a pack-like pouch. We used these for longer walks when our son was still small enough to get 'lost' in the bigger wraps while out hiking/walking/running errands.

    I nursed in the Moby only 4 times - while walking! And I know other mothers who did as well on more regular occasions, so I know it can be done. That is another advantage to baby-wearing (your milk supply stays higher, mom's and baby's stress hormones stay lower, and you have a happier baby and your hands are free! -- not to mention a whole lot of other benefits...)

    I will do a 'slings and things' post here soon and other people can chime in with their favorites as well. :)

  4. I find it weird how many people recommend stretchy wraps. I had one & hated it. I'd much rather have a gauze or woven, which can be safely used for back carries & much heavier kids (I wore a 40 lb 4 year old a few times with my gauze).

    Babywearing is definitely getting more common, but I still see far too many babies carried in car seats or in travel systems with both sunshades over them, even when they're inside & clearly awake. The most depressing thing I've seen is people with a screaming newborn being ignored while the parents push it around in the carseat.

  5. I use a sleepywrap and love it. Since I am a full time worker and office manager of a small office (3 people) and my boss wanted me back asap, she was wonderful enough to have me bring my baby to work with me until DD was 12 weeks old. I wore her or she slept in a pack and play for ten weeks at the office. I also used the sleepywrpa to nurse her. Have done that in the office, the mall, etc and nobody even knew she was nursing. My mom couldn't get over the fact that we were all walking around the mall with DD nursing and me pushing our 2 year old in a stroller. I think she was nervous for me that my breast would pop out or something. lol. I had a Baby Borjn that I used for my son and now use it with DD on ocassion (DH likes to carry her in this one). Funny - I just never think of not wearing baby. I hardly use my stroller.

  6. Even worse: moms who take their sick babies to the pediatrician's office in the carseat and place it on the floor on on a chair with baby still strapped in and crying as they sign in and wait to be seen. If your child ever needs to be held close it's when they're ill!!

  7. Our favorite wrap is the Moby ~ we have 3 different styles of the wrap and have used it from birth to 18 months (so far). We wrap it in multiple ways depending on what the occasion is. My husband babywears as often as I do - and our older child also uses a little Moby Mini for his bears!

  8. Sweat Pea ring slings are my preferred baby wearing apparatus. Here is the link:

  9. I wear my baby everywhere when we are out, and part time at work as well. My husband understood the reasons, he wears or carries her also - but it came home to him yesterday in a restaurant as we listened to a baby in a carseat cry and cry. He commented on how the babies who seem to be crying a lot in public are most often not being held. We always see them in carseats or strollers, distant from a parent and rarely talked to during the day. My three and a half month old is on me and talked to by people ALL DAY, and is extremely sociable already.

  10. If I only had to pick one sling, I'd pick the Moby (it got the most use around here), but one of my kids liked the ring sling better. My youngest is 2.5 yrs, and we still use the ring sling (for a hip carry) and the Ergo (on my back). You can never have too many slings/baby carriers. :)

  11. Both hubby and I used the Over the Shoulder Baby Holder (ring sling)for our son, now 2 1/2, from the day he was born until around 19 months or so. He still fits, but he's a bit too heavy to carry in it now. We now use the Moby to carry him, as it distributes his weight more evenly. LOVE babywearing!!!

  12. My favorite, most versitle carrier is the Moby wrap. I also often use my ring sling because it's easier to get off and on I bought my ring sling from and it has lasted through two children. I occasionally use my Mei Tai on the back, but all three of my children have preferred being carried on my front or side.

  13. My favorite carrier is the Moby. It really secures a newborns head and makes it easy to wear them most of the day. My newest napped in the Moby until he was 6 months old, every day/ every nap.
    I also use a ring sling because it's very easy to put on and take off with a sleeping child in it and it's easy to nurse in, although I have nursed in the Moby wrap. I purchased my ring sling from and it has lasted through two of my children.

  14. I was in the pharmacy just the other day and a lady commented how wonderful it was to see baby NOT in a stroller. I have a sling that was made for us by a friend in which DD spends a great deal of her day when we are out and about. I get frequent comments about how happy DD seems to be all the time when we are out "in public". She rarely cries because when we are close like this virtually all day long, I've come to know what her (more subtle) cues are for needs and I can take care of them sooner, eliminating the need for her to fuss for attention. I frequently get comments on how alert and smart she seems for her age - well, she's not screaming for attention all the time, so she can actually learn! :)

  15. That EXACT same things happens to us everywhere we go - people comment on how content and happy our baby is - how alert and attentive and sociable he is. People say things to each other like, "I wish I had that when I had my babies" or "He looks so comfortable!" or "Look at that - hanging out on his mom just like when he was inside" -- Like the previous poster mentioned, our son rarely cries. He doesn't need to because he is always right there heart-to-heart on mom or dad. Babywearing makes for really content, happy, healthy babies!

  16. When we had our daughter, friends convinced us to accept a hand-me-down infant seat because they swore their baby slept in it well and we wouldn't want to wake her up transferring her. Well, we used it and I think I took it out of the car maybe twice, each time backfiring for the many reasons you mentioned. Finally, I stopped removing the carseat and started using my ring sling every time we went somewhere. SO. MUCH. EASIER. So much less to carry! So much more comfortable! This time, we are jumping straight into convertible territory and I will keep my moby or ring sling handy for those dashes in and out.

  17. I don't like wraps, but my slings are indispensable. Having several children, I need my hands free! Plus, I LIKE snuggling my babies. I became a mom because I wanted to be a mother and be with my children. They are little for such a short time. I will miss baby wearing my littlest is too big. My children love it as well. My 3 year old still loves for me to carry him in the sling, Mei Tai, or Bei Bei.

  18. We have a Sleepy Wrap, and a Hotsling. Love them both!

  19. Cheers!! I'm so glad to see so many supporters of a non-infant-carrier system! I can get my kids (BOTH OF THEM!) in and out of their rear facing convertible car seats, and one into a sling, FAR faster than my friend (who also has two children almost the exact same age as mine), and she's got the fancy travel system. Pick up that baby! ;)

  20. After trying many types of carriers with my 5 children, I would not be without a sling and a Baby Trekker! I made sure my son's girlfriend had both when she was expecting my first grandchild and again now that my daughter is expecting. Both will be babies in arms, not seats.

  21. Great blog. Also I would add that using a car seat for anything other than safety protection in the car also renders the car seat unsafe. Every time it is put on the floor, knocked against a wall or put in and out of the pushchair it becomes weaker and will not function properly in the unfortunate event of a car accident. Car seats should always be left in the car!

  22. I used to use a ring sling, and with a sleeping baby found I could place the baby in the car seat, still cuddled up in the sling, and remove and carry an unwakened, still cosy baby at the other end. So much easier!

  23. We have a detachable carseat that we dont really ever take out of our car. We have a Maya Wrap that we borrowed from a friend (she used it with her son from the time he was 3 to 4 months old until just reciently, at 3 years old!) My mother in law was worried about how much weight it would carry, because it doesnt look strong enough to hold up much, with just the two rings. Then my wife had her brother (22 years old) sit in it while she was wearing it...that ceased any worry that MIL had :D

  24. As a preschool Montessori teacher who has been dealing with a large number of children with sensory disorders, I can definitely say that leaving your child in his car seat is not recommended. A lot of children with sensory issues are coming from homes where they spent a great deal of time sitting in swings, bouncy seats, car seats, etc and not on the floor and being held. As a mother of 2 I can say that yes, I did use the car seat as a carrier when going to the store or out to eat, but would try to make sure my children came out of the seat as soon as possible. They would get passed around the table or get to play on the floor as soon as we got home. I enjoyed your post. Thank-you.

  25. I tried slings and wraps with DD as a newborn and she was terrified. She hated swaddling too. Not that I am defending carseats! I just carried her with my hands is all.

    Around 5-6 months she started to accept the Hotsling, which I love b/c it's just a little loop and you can stuff it in a purse. I carry that thing with me everywhere.

    I also fell in love with the mobywrap but at 14 months she doesn't use it much anymore...she wants to be running around with us.

    Here's hoping the new baby will want a sling/wrap!

    I will admit there is a nice benefit to a bucket seat if you have a newborn in winter. You can get a cover for the seat and they will never be exposed to the cold. This is why we used one w/ DD born in november. (And please only use the stretchy covers that go over the top of the seat, like a shower cap).

  26. The danger with the convertible car seats is that you're putting your 6lb child in a seat that can be modified to fit a child 40lbs heavier.

    I'd rather buy 2 separate car seats and have one more specifically designed for my infant, and then change to one that's meant for them as a toddler.

    I agree about having you child in the car seat as little as possible though. This is my favourite carrier right now:

  27. With all due respect to the Montessori teacher, sensory processing disorders are NOT due to children being left in bouncers, car seats, etc. My daughter has a sensory processing disorder DESPITE being worn in a Moby Wrap and then carried in an Ergo carrier ... cosleeping ... extended nursing ... We did not even own an infant seat or bouncer, and she hated the car seat so thoroughly that she spent the least possible amount of time in it. Sensory processing disorder is a neurological disorder. My parenting did not cause it. My younger daughter had the same upbringing and does not have a disability.

  28. I used the Moby and I loved it when my baby was little but when he was about 5 months and 25 lbs (lol) we got a Boba. Front facing dug into my arm pits really bad and my son started pulling everything down so we put him on the back. I know it's not kissably close but it's still better than not attached at all. We never use a stroller and as a result I'm 10 months of infertility!!!



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