The Car Seat Question
Does your kid really need to sit in one all the time?
Earlier this month, a study appeared that links napping in a car seat with turning blue. Over an 18-month period in New Zealand, 43 babies had a "life-threatening event," and nine of them stopped breathing while restrained in an infant semi-reclined car seat. Their little heads nodded forward, and, without much in the way of neck to stop them, pressed against their chests. This cut off their oxygen supply. The babies in the study didn't die, but according to another study, other car seat sleepers apparently have.
These are the sorts of findings—alarming, but ultimately small in scale—that make me wonder whether I've been had by the car seat police. I hate car seats—what parent doesn't? They're expensive and bulky and awkward and the belts are often hard to snap open and closed (for a while one left me with a permanent sore spot on my thumb). And, to put it mildly, babies and toddlers often don't appreciate being strapped into the seats like saddle bags. They arch their backs and wail in frustration and make you feel like an unfeeling jailer.
If the drive is long enough, at some point you'll be faced with an unwelcome moment of truth: Are you the kind of mother who stops the car when your baby really protests, so you can give him a break in utter safety? Or do you climb into the back seat and grimly release him—to nurse, and oh please, to sleep—while your husband creeps along 10 miles below the speed limit? This is only the first in a series of unwelcome calculations that car seats necessitate: Do you lug yours along for every taxi ride? What about every flight? Can you swear that your child has been properly strapped and buckled in for every trip until he reached the American Academy of Pediatrics-recommended height of 57 inches and weight of 80 pounds?
I can't claim absolutist perfection. Most of the time, however, I dutifully follow the car seat rules. This is how parenthood inexorably forces adulthood upon us. It's one thing to gamble with one's own safety—to conveniently forget to wear a bike helmet or do the jaywalk dance across a busy street. But when kids are involved, you have to be a safety fascist. Because if you don't and your kid goes flying out the windshield—well, it's too awful to contemplate. And also because if you make an exception just this once, your kid will always know they can roll you.
What, then, to make of the blue-turning babies in the New Zealand study? Not much. If you weighed the risk of asphyxiating while car seat napping against death or injury while driving without a car seat, the car seat side of the scale would win, no contest. Some statistics: Crashes kill about 1,200 children a year under the age of 12 in the United States. According to a 2005 study based on the federal Fatality Analysis Reporting System, infant car seats reduced the chance of dying in a crash by 71 percent, and car seats for children ages 1 to 4 reduced the death rate by 54 percent.
Seat belts are pretty good at lowering the death rate, too; they cut it 47 percent for children under the age of 5. In the New York Times Magazine last year, economist Steven Levitt and journalist Steven Dubner argued that this means child seat-belt laws "would likely do just as well—without the layers of expense, regulation and anxiety associated with car seats." I wish they were right. But they're not. Their article prompted a response by Dennis Durbin and Flaura Winston, doctors at the Children's Hospital of Philadelphia and leading researchers in this field. Durbin and Winston tartly pointed out that car seats are a lot more effective at preventing injury in nonfatal crashes, of which there are 450,000 a year. According to Winston, for kids under the age of 6, car seats win out over seat belts at injury prevention by 30 percent to 40 percent.
That is good enough for me. When car seats make kids less rather than more safe, it's generally because parents screw up. A 2000 study found that 9,000 children who fell when their parents put the car seats down on tables or counters—because they weren't buckled in or because the car seats tipped over—had to be treated in the emergency room. This I believe: On one terrible morning, I rushed to get out of the rain while carrying my younger son, Simon, in his car seat. I felt a sickening lightness and then heard a dull thud, and a shriek, as he slid out onto the sidewalk. I'd forgotten to rebuckle his car seat after taking him out of it, who knows why. I picked Simon up and we cried together in the rain. It's one of my lowest of low motherhood moments. But I don't blame the car seat. Toting your kid around in an unbuckled car seat is like off-label drug use. If something goes wrong, you don't sue the manufacturer.
In theory, at least, the problem that the New Zealand study identified wasn't an off-label use. The babies could have stopped breathing while on a drive (as opposed to the common practice of leaving your kid to sleep in his car seat because you need a convenient place to stash him). The researchers suggest "modifying car safety seats so that head flexion is unlikely." Maybe this is an easy engineering fix—and a potential boon to the company that develops a safer car seat. Until then, the researchers have another suggestion: "If possible, an adult should ride in the back seat next to your baby to watch him closely."
Ugh—a new opportunity for car seat one-upsmanship. Now responsible parenthood requires exile to the cramped, sticky, nausea-inducing back seat! This is when I long for the 1970s, when kids bounced around in the way backs of station wagons, footloose and seatbelt free. Except that kids died in car crashes in higher rates back then, too. On this front, at least, our safety-tip-saturated era holds out the promise of less risk. The problem is deciding when you've reached the point of diminishing returns, or absurdity, or whatever you want to call your own limit. It's safer to stay home, after all, than to drive with your kid, car seat or no car seat. But responsible parenthood can't mean acting on every piece of safety information—besides being impossible, that would make your kids crazy. So instead of moving to the back seat to watch over your sleeping baby, maybe try this: Look back at him, and if his head falls onto his chest, make sure he's OK. You get to sit in the front seat, and he gets to breathe.
Emily Bazelon is a Slate senior editor and writes about law, family, and kids. Her forthcoming book, Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Empathy and Character. Find her at firstname.lastname@example.org or on Facebook or Twitter.