Preventing Positional Asphyxia in Car Seats
Keeping your newborn and toddler safe from suffocation

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As a new parent, ensuring your newborn is properly restrained in a correctly installed car seat for the first time is vital. Among infants who have died from Positional Asphyxia (suffocation), 69% of these died while riding in a car seat from being improperly secured. Positional asphyxia, can occur in newborns and infants if they are improperly secured in a rear-facing car seat or if the car seat is not installed properly. When an infant's head tilts forward due to uncontrolled neck flexion, the chin can press down against the chest. This position can narrow the airway, making it difficult for your baby to breathe normally. The reduced airflow can lead to serious health risks, including suffocation.

The following is a comprehensive overview on the risks associated with positional asphyxia, and provides recommendations to ensure your baby's safety while in their car seat.

Questions, please call 323-491-6197

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​Risk of Positional Asphyxia from Improperly Positioning and Use of Car Seat

In a study of 11,779 sleep-related newborns and infants' deaths, 69% occurred in car seats due to positional asphyxia from being improperly restrained and positioned (Liaw et al., 2019). The downward gravitational force of the head is associated with incorrect car seat use, in addition to, but not limited to:

• Incorrect angle of the car seat (not following car seat instructions)
• Incorrect use of newborn insert
• Baby in a car seat with loose or unbuckled harness straps
• Excessive use of padding around the baby or on harness straps
• Sleeping in a car seat, inside or outside the vehicle (car in stroller, etc.)
• Lack of constant adult supervision while the child is in a car seat
• Face covered with fabric or other shade cover on a car seat

Improperly positioned in car seat

• Airway patency at risk or blocked
  • This means the baby might not able to breathe, because airflow passing to and from the respiratory system, and through oral and nasal passages are blocked or reduced
    
• Not following manufacturer instructions
• Talk with an NHTSA-certified Child Passenger Safety Technician by calling 323-491-6197

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​Preventing Positional Asphyxia in Newborns and Infants in Car Seats

This image demonstrates the anatomically correct position of a newborn's or infant's upper respiratory tract when their head and back are properly supported in a car seat, following the manufacturer's instructions.

• By maintaining a 45-degree angle, you can significantly reduce the risk of positional asphyxia (suffocation).

Proper head and neck support is crucial for your child's safety
When the car seat is installed correctly and your baby is properly restrained, their head will stay tilted back, keeping the airway open. This position allows for normal airflow and ensures that your baby can breathe comfortably while in their car seat.

• Head back
• Airway open
• Successful breathing

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Additional car seat safety tips

• Car seats are not designed for safe sleeping or for unsupervised awake time. Always remember to NEVER leave a child unattended in a car seat (Devitt, 2012; How to Keep Your Sleeping Baby Safe: AAP Policy Explained, 2023).
  
• Car seats are only be used while in the car and when in use the child must always be supervised by a responsible adult.
• Whenever possible, have an adult ride in the back seat with your baby. This allows you to monitor your baby's head and neck position as well as their breathing.
• Only use the harness straps to position your baby correctly. Never add pillows or blankets, as they can compromise safety.
• Always make sure that the straps are fully buckled.Ensure that harness straps are snug. For rear-facing seats, the top shoulder straps should be positioned at or below your child’s shoulders, and the chest clip should be level with their armpits.
• Seek guidance from a certified Child Passenger Safety Technician National Car Seat Call Center. They can teach you how to install and use your car seat correctly for maximum safety.

Questions, call 323-491-6197

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Back to Rear Facing Car Seats

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Recommended Citation
(APA 7 Edition)

DeCarli, J. (2024, January). Positional Asphyxia in Infants and Toddlers in Car Seats (Public Health Behavior Solutions, Ed.). Pro Car Seat Safety. https://www.procarseatsafety.com/positionalasphyxia.html

References

Cote, A., Bairam, A., Deschenes, M., & Hatzakis, G. (2007). Sudden infant deaths in sitting devices. Archives of Disease in Childhood, 93(5), 384–389. https://doi.org/10.1136/adc.2007.119180

Devitt, M. (2012). AAP expands recommendations on SIDS and other Sleep-Related Deaths. American Family Physician, 85(9), 918–923. https://www.aafp.org/afp/2012/0501/p918.html

How to keep your sleeping baby safe: AAP Policy explained. (2025). HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

Liaw, P., Moon, R. Y., Han, A., & Colvin, J. D. (2019). Infant deaths in sitting devices. PEDIATRICS, 144(1), e20182576. https://doi.org/10.1542/peds.2018-2576

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