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Proper Car Seat Positioning (Part 1)

Proper car seat positioning is very important, especially in newborns. Positioning of the head, neck, and trunk is beneficial in preventing torticollis. Studies have shown that 1 in 60 children have or develop torticollis, and also, 57% of twins have torticollis (Guo, 2014). Torticollis, which means “twisted neck” is caused by damage or shortening of the sternocleidomastoid muscle, which is found in the neck. It can be caused environmentally, or occur during or shortly after birth. If a baby’s head always remains tilted sideways, this will cause the neck muscles to become tight and eventually cause torticollis. The asymmetrical posture can also be due to low muscle tone, developmental delay or other problems such as tightness or thickness in the muscle, or even due to a tumor in the muscle. The best thing to do is to limit the amount of time spent in car seats, swings, and infant carriers (Guo, 2014). Another type of torticollis is called Congenital Muscular Torticollis (CMT) and this can be caused in-utero position, limited space in the uterus, traumatic birth, multiple birth, or due to low amniotic fluid. Since babies sleep on their backs, stretching of the neck and upper back does not occur the same as it would during tummy time (Guo, 2014). Children with torticollis present with an abnormal neck posture where their head is rotated to one side and laterally flexed to the other side.

When a newborn utilizes the car seat, it is important to know they do not have enough strength to hold their heads up, therefore their head can fall sideways or downwards. A newborn’s head can stay in a safe position by making the harness straps of the car seat comfortable, but not too tight to prevent them from slouching. This way, they will have the proper support to keep their body and head straight. Also, by reclining the car seat to about 45 degrees from vertical (never more than 45 degrees), allows proper positioning as well. This will allow the baby’s head to stay back and their chins should not touch their chest. The baby’s chin should never touch their chest because it can interfere with their breathing. Another tip for proper car seat positioning to prevent torticollis is by rolling up a diaper cloth or receiving blanket and placing it on the side of the baby’s head that falls to the side (The Car Seat Lady). As the baby gets older and is able to maintain proper head control, then it is okay to have the car seat sitting upright. If the baby falls asleep in the car seat, it is recommended to recline the car seat so that the head does not droop down.

It is not recommended to use a head support device that did not come with the car seat. Also, do not place anything behind a baby’s head or under their neck. Many head supports that come with the car seat may not be beneficial for the baby as well. They are known to be ineffective and may even make the condition worse. It is important to read the manual of the car seat before removing the head support (The Car Seat Lady).

When the baby is not sitting in a car seat, supervised tummy time is extremely important to allow stretching of the neck and trunk muscles. Tummy time for a newborn should occur in small intervals of time throughout the day, and once the baby is able to tolerate tummy time, the amount of time can be increased (Guo, 2014). If a baby drops their head down, it is also good to shake a rattle a little above their head, which will cause them to extend their head more. Another way to keep the baby’s head up is to roll up a blanket or towel and place it under their chest. This will cause their head to slightly elevate since a towel is propping them up. The baby will be able to tolerate this position better, rather than without any support.

(Continued in next week’s issue)