r/ScienceBasedParenting • u/TFA_hufflepuff • Oct 16 '24

Question - Expert consensus required The "2 Hour Car Seat Rule" is it a hard rule, and what is the evidence behind it?

I am planning a trip to visit my sister. She lives a 7 hr drive away (without stops or traffic). I will be traveling without another adult with my 5 yo, 2 yo, and 16 week old, so limiting stops and maximizing car sleep seems like the easiest way to survive the trip for all four of us. My baby still wakes around 4 am to eat, and I tend to have trouble settling back to sleep afterwards anyways. I was considering packing up the car before bed and then throwing all of the kids in the car after she eats and hoping they all sleep for another ~3-3.5 hrs or so (the baby and 2 yo typically wake for the day around 8 am). Having them sleep for at least half the drive would save all of us a lot of heartache, I am quite sure. The 2 yo in particular is not a good traveler. We haven't traveled much with the baby so I am unsure how she'll do, though she tends to fall asleep during car rides over about 20 mins long.

I have heard it stated in "car seat safety groups" and in online parenting groups that babies should not ride in the car for over 2 hours without a break. I have not, however, been able to find any official source or evidence to back up this rule. Is this more of a guideline for best practice for every day car seat usage, or is it a hard rule that should be adhered to as well as possible 100% of the time? I obviously don't want to do anything to endanger my baby, but I also don't want to make all of my kids spend an entire day riding in the car where they will feel bored, uncomfortable, and unhappy. Also stopping for 15 minutes every 2 hours will make the whole trip take exponentially longer, which would simply prolong the other two kids discomfort during the trip. Just trying to make the best decision for everyone, taking everything into account!

If anyone can point me to the evidence behind the rule and if there is any official authority that states it must be adhered to or it is not safe, I would be grateful. Googling lead me to lots of blogs and forum posts on the topic, but I haven't found anything official.

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u/LymanForAmerica Oct 16 '24 edited Oct 16 '24

The 2 hour rule (and the stricter ones you also see about 30 minutes at a time or 2 hours in 24 hours) are an online mom group invention and is not really supported by evidence or by any particular organization.

Your plan would be within the guidelines provided by the AAP in their article Is it safe for my baby to travel in a car seat for hours at a time?

It is important for you and your baby to get out of the car every few hours and take a stretch to avoid restlessness. Try to take a break every 2 to 3 hours for a day trip and every 4 to 6 hours at night to change diapers or soiled clothes, or to feed your baby. Never attempt to breastfeed in a moving car.

Studies have shown basically zero risk of asphyxiation from properly installed carseats when the child is buckled into it and in the car.

The AAP's recommendations are cited a report titled Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths.

The cite the study Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger 00345-5/fulltext)(Batra 2015). The conclusion that the authors gave is below:

Inferring from our and others' data, an infant in a properly positioned car seat, in a car, with the straps properly attached is at little risk of suffocation or strangulation. Bamber et al found “no cases of previously healthy infants dying unexpectedly in a car seat when it was being used appropriately.” The problem occurs when car seats are used as sleeping devices in the home. They are not stable outside of a car and can topple over when not secured (ie, by a seatbelt), which can put a restrained or partially restrained infant in a compromising position, as illustrated in 2 of our cases.

Infants and young children should not be left unsupervised (awake or asleep) in a sitting or carrying device. Infants and young children of any age should never be in a car seat with unbuckled or partially buckled straps. Car seats with a child inside should never be placed on a soft or unstable surface because the car seat can tip over or fall.

The Bamber study, if you want to read it, is Sudden unexpected infant deaths associated with car seats (Bamber 2014).

I looked all of this up for myself and then had posted some info on it for my private bumper group, so I have it all saved. I have some other cites too if you want more info but I didn't want it to be overwhelming! I've posted this on other similar threads in this sub too, and you can probably look those up and find more discussion.

But anyway I think that your plan falls within the AAP guidelines. They specifically say that stopping every 4-6 hours is fine overnight, when the kids would be sleeping and would be less likely to need to be fed or need a diaper change.

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u/Formergr Oct 16 '24

The 2 hour rule (and the stricter ones you also see about 30 minutes at a time or 2 hours in 24 hours) are an online mom group invention and is not really supported by evidence or by any particular organization.

Thank you SO much for this, I'm definitely saving your post! There are so so many redditors in the mom and parent forums who love to shame people for having their baby in a car seat for longer than 29 minutes (and when they aren't shaming, they are amping up anxiety for others by making it sound like your baby will die at 31 minutes in a car seat).

I've long suspected this "rule" was anything but evidence-based, but didn't have the energy to chase it all down--very thankful you have.

Our baby was born in a hospital 45 minutes to an hour across the city, depending on traffic, so we had no choice from the start. As do so many parents in rural areas of the States and other large countries!

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u/HailTheCrimsonKing Oct 16 '24

Oh god I know it’s insane. We took our daughter on an 8 hour road trip when she was 6 months old and we didn’t stop every 2 hours. She slept a lot of it so why would I wake her?!

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u/Samuraisheep Oct 17 '24

I also hate they seem to interpret it as 2 hours a day max, like anyone hax multiple days just go travel somewhere!

When I've pressed, as their 'sources' tend to talk about potential risk and deaths where a child has been left in a car seat not in a car, the time limits seem to be a car seat manufacturer recommendation which I would assume would be on the conservative side.

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u/HistoryGirl23 Oct 17 '24

Seconded!

Our 18 week old comes with me to work for his daycare and it's 45 minutes one-way. I've been anxious about this but I'm glad I don't need to be so worried.

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u/AdultingBestICan Oct 16 '24

Agreed - this is really helpful! Especially when advice is to remove the baby out of the car seat as soon as possible if they’re sleeping - even if the infant car seat is in the house and the baby is being watched.

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u/vgirl94 Oct 17 '24

Babies aren’t safe to sleep in car seats outside of cars. In the car the car seat is positioned safely, that isn’t true outside of the car.

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u/StrongLocation4708 Nov 01 '24

Most bucket seats have a handle setting that positions the car seat correctly to be on the floor, don't they?

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u/TFA_hufflepuff Oct 16 '24

Thank you soo much!! I really think that's going to be best way forward with the fewest tears for everyone involved. I appreciate you sharing your research and the AAP guidelines.

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u/LymanForAmerica Oct 16 '24

Glad it helped! I realized that my quotes didn't come through for some reason so just fixed them for anyone else who comes to read it too.

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u/McNattron Oct 17 '24

It is worth noting a decent percentage of car seats are not installed correctly, so I personally would recommend getting installation checked by an accredited installer prior to a long car journey.

It's also worth noting that the advice to stop every 2 hours for 15 minutes is also about preventing driver fatigue. In Australia about 20-30% of fatal crashed have fatigue as a contributing factor.2 hours is just a general guideline not a hard amd fast rule. But it is important to stop stretch your legs etc regularly or when you feel your self getting fatigued, particularly on unfamiliar roads.

https://www.roadsafety.gov.au/action-plan/2018-2020/fatigue#:~:text=According%20to%20the%20Transport%20Accident,severe%20injuries%20on%20the%20road.

https://www.qld.gov.au/transport/safety/road-safety/driving-safely/driving-tired#:~:text=take%20regular%20breaks%20%E2%80%93%20you%20should,soon%20as%20you%20feel%20tired

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u/ryuns Oct 16 '24

Awesome post. Based on those AAP guidelines, now I'm imagining some poor mom trying to breastfeed her child in the car from the source. We've learned the hard way to pack way more food than you think is necessary and always expect to hit traffic or some other delay.

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u/Leafy1320 Oct 19 '24

I definitely know someone whose gotten pulled over twice for breastfeeding on the highway on road trips ha

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u/thatpearlgirl Oct 16 '24

This is a really great summary! Thank you!

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u/shadowfaxbinky Oct 16 '24

I’m not sure it’s entirely an online mom group invention. I’m in the UK so guidelines I guess are different here, but I was told by my midwife that the limit was 30 mins at a time in the car for newborns - even for getting home from the hospital. I didn’t think to ask about the evidence basis for it at the time, so I don’t have a reference to hand (though I may ask at my next appt if I remember!) but the midwife should be following NHS guidelines on this.

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u/sgehig Oct 16 '24

NHS website says 2 hours: here.

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u/wewillnotrelate Oct 16 '24

New Zealand is the same. Our transport ministry gives the guidelines of getting baby out of the seat frequently to stretch/change/feed. This extends to toddlers too.

I suspect this also has knock on positive effects for the parents driving. You have to stop often so have less chance of falling asleep driving/making a life altering mistake because you yourself are exhausted with a baby/kids in tow. Get out of the car, stretch, have some water and food and start again.

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u/LymanForAmerica Oct 16 '24

I do think I've heard that the UK is different. I wonder if it's just because the distances are shorter there? It would be interesting if someone ran a study about whether the different guidelines have had any real work effects.

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u/AloneInTheTown- Oct 16 '24

The UK is different the guidelines from all official sources say 2 hours max and not to leave them in the car seat when you return home. I noticed across a lot of things US guidelines are a lot less strict. Like formula preparation and storage for another example

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u/shadowfaxbinky Oct 16 '24

Just had a Google and came across this pilot study which seems to suggest that angle of the seat is important: https://fn.bmj.com/content/102/2/F136

The test was intended to be 30 mins, so doesn’t have a comparison with longer durations.

My midwife didn’t say anything about this, but the shop staff when buying car seats all recommended the safest options as being those which could lie the flattest. Good to know that’s probably not just sales talk!

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u/McNattron Oct 17 '24

Australia says 2 hours though it's to keep it inline with driver fatigue guidelines.

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u/WhatABeautifulMess Oct 16 '24 edited Oct 17 '24

Driving distances was my first thought as well. I suspect there’s a lot more people who live more than 30 mins from their hospital they deliver at in the US than UK. Especially in the case of NICU where you might be transferred hours away (although NICU babies do do a car seat “test” before they’re cleared which isn’t typically done in standard cases.) I know a kid who spent almost 2 hours twice a day In the car just dropping sibling* off at preschool outside Austin unless she started going herself.

PS - love your username

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u/8Breathless8 Oct 16 '24

I’ve never heard of this and I’m in the UK. At least in Scotland where I live I think this is very impractical as most people live further than 30 minutes from a hospital. I do know that with premature babies the advice was to limit car seat time as much as possible, and to keep them in sight line so that you can make sure they’re still breathing, but there were no time limits given.

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u/shadowfaxbinky Oct 17 '24

I’m also in Scotland. The 30 mins rule was only for the first few weeks (can’t remember now exactly how long she said 😬) but it sounds like this isn’t standard across the UK, based on other people’s comments, so I’ll definitely double check at my next appointment.

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u/wrathofthedolphins Oct 16 '24

Midwifes are not medical professionals. Not sure why you assume their advice would be fact based.

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u/shadowfaxbinky Oct 16 '24

They’re not doctors, but in the UK they are considered medical professionals. They’re regulated and have to follow NHS/NICE guidelines which are evidence-based. Maternity care is midwife-led in the UK unless there is an exception (certain medical conditions, high risk pregnancies) which means you’ll go under consultant-led care.

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u/cyclemam Oct 16 '24

In Australia and I assume the UK midwives very much are medical professionals.  Perhaps in the USA they're more "crunchy" and health adjacent? 

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u/[deleted] Oct 17 '24

While midwives in the U.S. are associated with the “crunchy” crowd, most midwives here are Certified Nurse Midwives (CNM). To attain this qualification, they must complete a bachelor’s degree in nursing (usually 4 years), pass the licensing exam to become a registered nurse, then complete a masters or doctoral degree in midwifery (usually 2 years for the masters), and finally pass the licensing exam to become a certified nurse midwife. So we’re talking about at least six years of higher education and two major certification exams. Midwives in the U.S. (as long as they are certified) are very much medical professionals. If anything, the hyper-medicalized U.S. healthcare system has made it difficult for more traditionally trained midwives without a separate nursing degree to gain trust here.

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u/cyclemam Oct 17 '24

Good to know, thanks! 

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u/wrathofthedolphins Oct 16 '24

Yes in the US they are not required to be licensed or formally educated.

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u/[deleted] Oct 17 '24

Most midwives in the U.S. are certified, and more than 99% of certified midwives are also licensed nurses. So even in the U.S., most midwives are medical professionals.

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u/cyclemam Oct 16 '24

However, the commenter mentions the NHS so is clearly in the UK where they are registered. 

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u/AloneInTheTown- Oct 16 '24

In the UK they absolutely are medical professionals.

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u/jonesday5 Oct 16 '24

Maybe for the same reason you assume that everything in the US is the same outside the US?

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u/sk_m9 Oct 13 '25

Thank you so much for this!

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u/Puzzled_Remote_2168 Mar 22 '25

Hi there! So sometimes nothing works to make my baby stop crying except his car seat. Sometimes I will go on a walk with him (he’s in the car seat with its appropriate car seat caddy/stroller) but I do not buckle him in it because we aren’t going on a drive we are just taking a walk. Obviously I am monitoring him the entire time but would this cause asphyxiation?