ABSTRACT
This 4-month-old boy was found unresponsive in a car seat. The parent rushed him to the emergency room where immediate resuscitation was attempted. When questioned, the parent was unsure of when she had last seen the child alive but was sure he was awake and alert when placed in the car seat. When asked to describe how she had fastened the straps, she said that they were twisted in the same way that they were found when the child was removed from the car seat. She found it difficult to adjust the straps, so twisting them allowed for a tighter fit. She also claimed the child was normally ‘fussy’ and moved a lot when placed in the car seat. It became apparent after questioning the parent that the car seat was used within the home as a place for the child to sleep instead of a crib. The car seat was obtained from another family member and the parent had not been given formal instruction in its use. Written instructions were also not given to the parent along with the car seat. Image 8a is a reenactment showing how the child was found. Image 8b shows the imprint of the car seat strap along the anterior surface of the neck. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig8a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig8b.jpg"/>
What else would you ask the caretaker?
You find out the mother is pregnant and there are other children in the home. What else would you do?
16This child was in the car seat a sufficiently long time for the pressure of the strap to cause an imprint on the child’s neck. This imprint indicates subcutaneous haemorrhage. You would like to know where the car seat was being used – at home or in the car – when the child was placed in it. An important fact to establish is how long the child was in the car seat before he became unresponsive. This helps to address the problem of negligence. If the infant was in the car seat a short time before he became unresponsive, it is less likely that negligence is involved. If the child was in the car seat for a long time before someone noticed he was unresponsive, then it is much more likely that negligence was involved. 1 Another factor to consider is whether padding and attachments to prevent twisting of the car seat straps may have been available but were not used because the parent was unaware they were important, or had been discarded because the parent found it easier not to use them.
In cases like these, the physician must attempt to find out as much as possible because, although product liability may also be a significant causal factor in this infant’s death, neglect by leaving a child unattended in a car seat means that Child Protective Services may also have to intervene and investigate the condition of other children in the family. 2 This mother is pregnant and had this incident not occurred, it is likely she would have used the same car seat for the next infant. You also need to find out what kind of education was given to the parent regarding the use of car seats when discharged from the hospital after this infant’s birth. Although economic circumstances may be difficult, infant car seat design has continued to evolve and car seats are now much safer, and the most modern car seat available should be the one used. Some are even provided free of charge to new parents when their newborn leaves the hospital. The transfer of car seats from friends and family, regardless of good intentions, may mean that outdated equipment, perhaps even those that have been subject to recall by the manufacturer, may be used, placing subsequent infants at risk.
