Doctor recommends “two-hour rule” for babies sleeping in car seats – here’s why

Doctor recommends “two-hour rule” for babies sleeping in car seats – here’s why
Doctor recommends “two-hour rule” for babies sleeping in car seats – here’s why

A doctor warns parents and educators against letting small children sleep in a car seat for more than two hours, especially unsupervised.

In a recent TikTok, London-based doctor Sermed Mezher explained the so-called “two-hour rule” for child car seat use and used a heartbreaking example to illustrate what can go horribly wrong if this rule is not followed.

According to the National Health Service (NHS), and based on the recommendations of many car seat manufacturers, the general rule is that a baby should not be in a car seat for more than two hours at a time. The NHS cites research showing a “link between long journeys in car seats and breathing difficulties in young babies.”

In the caption of the post, published on June 24, Mezher explained that proper use of a car seat is “essential” for the toddler’s safety while driving, but he gave an example of why “overuse” of these car seats, even outside the vehicle, can be dangerous.


“They’ll do fine in a car seat” — wait for it. Using car seats for toddlers is essential for safety during travel, but it’s important to understand the risks associated with leaving toddlers in car seats for long periods of time, especially for unsupervised naps. Here are the main reasons why prolonged car seat use outside of travel can be dangerous: Risks of Prolonged Car Seat Use for Toddlers 1. Positional Asphyxia: Difficulty breathing: Car seats can cause a toddler’s head to slump forward, constricting their airway and making it difficult to breathe. This condition, known as positional asphyxia, can lead to reduced oxygen levels and suffocation. Immature airway control: Toddlers, especially newborns, have limited muscle strength and control of their airways. They may not be able to reposition themselves if their airway is blocked. 2. Sudden Infant Death Syndrome (SIDS): Increased risk: Research has shown that infants who sleep in car seats are at an increased risk of SIDS. The inclined position of the car seat can contribute to breathing difficulties and affect sleep quality, both of which are factors associated with sudden infant death syndrome. Safe sleep guidelines: The American Academy of Pediatrics recommends that infants sleep on a firm, flat surface without inclines, which is not the case with car seats. #Babies #Parents

♬ Suspense, horror, piano and music box – Takaya

“It can be so tempting to let your baby continue sleeping in their car seat, but for one family, it has been disastrous,” Mezher said in the TikTok, which has received over 1.1 million views so far.

Amelia “Mia” Smith, a 17-month-old child, died in 2015 after her daycare provider left her to sleep in a car seat at home. The cause of death was positional asphyxia, a type of suffocation.

“…(In positional asphyxia) a baby’s head can slide forward in the car seat, cutting off breathing through the nose and mouth,” Mezher explained.

He recommended that babies under three months should not be left in the car seat for more than 30 minutes at a time, and babies under two years should not be left in the car seat for more than two hours.

Car seat
Stock photo of a child car seat for safety in the back seat of a car. A doctor warns parents and caregivers against letting young children sleep in the car, especially unsupervised…

Stock Photo/Getty Images

Regular breaks – at least every two hours – are essential on long journeys with a baby in a car seat. “This allows you to take your baby out of the seat and give them a chance to stretch and move around,” the NHS explained.

“When you reach your destination, you should remove your baby from the car seat and, if he or she is sleeping, place him or her in a crib or stroller with a firm, flat surface.”

Mezher’s post with these critical warnings has so far been shared almost 24,000 times.

The American Academy of Pediatricians warns that seating aids – such as car seats, strollers, swings and infant carriers – are not recommended for normal sleep in the hospital or at home, especially for infants under four months of age. The Lullaby Trust also advises avoiding long car journeys with premature babies and young children.

Child car seats and sudden infant death syndrome

Studies on the link between car seats and sudden infant death syndrome (SIDS) have found that “young babies are at risk of developing breathing problems if they sleep in a sitting position for too long.”

Sleep-related infant deaths are the leading cause of “postneonatal infant mortality,” according to an article in the Journal of Pediatrics. “Infants and children 2 years of age and younger should be properly restrained and not left unattended in seating and carriers,” the article states.

“Car seats should not be used as sleeping places outside the vehicle, and children should never sit in a car seat with the belts unfastened or partially fastened. The face of infants in slings should be visible and above the edge of the sling, the face should not be covered by fabric, and the chin should not be tucked into the chest.”

Newsweek contacted Mezher via email and asked for further comment.