I know plenty of babies with reflux who play, digest and sleep in their car seat at home. My reflux baby was fairly content if I held her 24/7. There were times when I did put her down in the car seat because I just had to have my hands free. For example, I did need my hands free for my daily two minute shower. Most of the time, she was in my arms or in a sling/carrier or backpack. My arm muscles became hard as rock and my back ached from the constant bending and lifting. It sure was hard work holding her and I longed to put her down.
An article in the August issue of Pediatrics caught my attention. The article reported on car seat injuries that occurred outside of the car. It is estimated that approximately 43,000 infants were treated in the emergency department for a non transportation related car seat injury between 2003-2007. Approximately half of the injuries occurred at home and infants younger than four months of age were most likely to be injured.
I always thought a car seat was a versatile piece of baby equipment. It certainly was a "must have" item for safe transportation in the car. The car seat always came into my house and doubled as an upright positioner so my baby could be seated when I needed my hands free or upright after a feeding. In addition, the car seat was her first high chair when she started solids. Luckily she was never injured but I can see how easily this could happen. A car seat can tip over if placed on a bed or table. Even if a car seat is placed in a crib, a newly mobile infant can roll out, lean over or become trapped between the car seat and the crib. Lately, I have read studies showing that car seats may increase breathing difficulties in young infants and premature babies. There is also concern that prolonged use of a car seat can lead to spine and back problems and changes in the contours of the head, leading to a "flat head" and bald spot where the back of the head makes contact with the car seat. It is believed that a car seat actually puts more pressure on her stomach, causing more back washing and reflux episodes. So even though upright positioning is favorable for digestion, it needs to occur without keeping her legs flexed.
What if your baby with reflux sleeps in her car seat each night and sits in her car seat happy as a clam after each feeding? My daughter preferred sleeping on my chest while I was semi reclined on a pile of pillows. Maybe that is just as likely to cause injuries or worse than using a car seat. Several of the infant wedge/sling/hammock systems for positioning a baby with reflux have been recalled as well. It is difficult to be safe and practical at the same time.
Here are some ideas to help keep your baby upright and safe in any baby equipment:
· Ask the Doctor: Ask the doctor for advice on positioning for digestion, play and sleep based in her age, developmental level, height and weight.
· Read the Manual: Make sure you understand how to safely use the seat, carrier or wedge according to the manufacturer’s recommendations. Use the internet to look up information or contact the manufacturer. Register your equipment so you can receive important safety updates.
· Check her Weight and Height: The manufacturer will specify the weight and height limits for each item. Your baby may be growing rapidly during the first year and need a new car seat or wedge.
· Check her Airway: Observe her carefully by day to make sure she can move freely and breathe easily. A product such as Hug Me Joey can be used to improve the angle of seating.
· Use the Harness: It is important to always use the harness and support system before leaving your baby in a car seat or positioner. Even for a moment. A baby can quickly slip down, roll or get stuck.
· Mix Things Up: Maybe she can sleep in her car seat during the day near you and in her crib at night. Or she can digest in the infant seat by day and use the car seat at night for sleep. This way, she will be in a variety of positions throughout the day.
The American Academy of Pediatrics recommends back sleeping on a firm mattress in a crib. However, many babies with reflux cannot tolerate back sleeping or sleep poorly with frequent night waking when placed on their back. As I talk to parents, I hear about all kinds of sleeping arrangements and strategies to get some rest for both parents and baby. To my knowledge, there has not been a study of how infants with reflux are positioned during their first year. I imagine there are plenty of ways parents and babies manage to get a bit of sleep. I hope you will look at your baby equipment with new eyes and make sure your baby is safe.