Car Bed Restraints

For infants with documented breathing problems or who cannot otherwise tolerate the semireclined positions, a car bed is a suitable alternative to a rear-facing infant restraint. The three models currently available in the United States accommodate infants ranging from birth weight to 15 kg (35 lb). In a car-bed restraint, the infant lies flat, preferably on its back. The car bed is placed on the vehicle seat, with its long axis perpendicular to the direction of travel and the baby’s head toward the center of the vehicle (not next to the door)
Car bed installed with seatbelt
. Depending on the car bed model, the infant can be placed on its back, which is preferred, on the stomach, or on the side. In a frontal crash, the occupant restraint forces are distributed along the entire length of the infant’s body, while a harness or other containment device keeps the baby in place during rebound or rollover. In a side impact, however, the infant’s head and neck are more vulnerable in a car bed than in a rear-facing restraint, especially if the impact is on the side nearest the head and there is significant intrusion (Weber 1990). Field data from the United States and other countries are sparse but have not revealed any protection deficiencies with this configuration.

The American Academy of Pediatrics prefers the use of the semireclined, rear-facing position, but recognizes the issues of positional apnea (Bull 2009, Degrazia et al. 2010, Nagase et al. 2002). It currently recommends that all infants born at less than 37 weeks gestation be monitored in a semiup–right position prior to discharge from the hospital to detect possible apnea, bradycardia, or oxygen desaturation (AAP 1999b).