Car bed restraint systems

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 (Davis and Shah, 2018, AAP 2009). The two models currently available in the United States accommodate infants ranging from 2 kg (4.5 lb) 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). 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 a Car Seat Tolerance Screen (CSTS) for all infants born at less than 37 weeks gestation, which involves monitoring in a semi-upright position prior to discharge from the hospital to detect possible apnea, bradycardia, or oxygen desaturation (AAP 2009). Several studies summarized by Davis and Shah, 2018 indicated similar rates of cardiorespiratory events for infants in car beds and rear-facing child restraints. They also recommend a repeat CSTS at 4 weeks after discharge. In addition, the AAP recommends minimizing time spent in a child restraint system.

9-15-21