WARNING: This story may be distressing to some readers 

A 9-month-old baby on an outing to visit her grandparents died after becoming caught in the harness of her car seat while drinking a bottle of milk. 

Coroner Janet Anderson said the “tragic death” was a sad reminder of the dangers of leaving young children unsupervised in child restraints - even for short periods.   

“Babies and children should never be left unattended while buckled into safety restraints, even for short periods of time. Asphyxiation can occur very quickly, with devastating consequences.” 

In a recently released decision, the coroner said the baby girl, a twin who was born in November 2019, was much loved and cared for. 

In August 2020, her parents took the girls and their other siblings to visit their grandparents. 

The adults took their two young sons and one of the twins inside but left the other buckled in her car seat inside their van so she could finish drinking a bottle of formula. 

They left the van’s sliding door open so they could see her from the house. They also checked on her several times as she finished her bottle, leaning back in the seat. 

But when the father went to collect her about 10 minutes later, he found her leaning forward and her lips were purple. 

Coroner Janet Anderson says she wants to draw attention to the need for extreme care with infant equipment. Photo / Ethan Griffiths 

Efforts were made to revive the baby and she was rushed to Rotorua Hospital before being transferred to Auckland’s Starship children’s hospital, where tests showed she had severe brain damage. She died four days later having never regained consciousness.   

Coroner Anderson found that at some time between her parents’ checks, the baby girl became caught in either the straps or buckle of her car seat harness. 

The car seat wasn’t strapped into the van, and while the chest harness was secured, the crotch strap was left unbuckled, and the straps had been left loose. 

This meant the baby was able to move around and potentially slide downwards, impeding her breathing. Due to a lack of oxygen, the coroner said she suffered severe and irreversible brain damage within a short period. 

The coroner said the case was a reminder that babies and children should never be left unattended while buckled into safety restraints, even for short periods of time. 

She said there were prominent warnings on the baby’s car seat, which are also available on Plunket’s website and apply to not just car seats but also prams, strollers, portable cots and child restraints. 

Plunket’s website says: “Always check that harnesses are used correctly. If babies can slide down in a bouncer or car seat, they may get tangled in the straps. Using a five-point harness according to the manufacturer’s instructions, and keeping a close -eye on your baby, can help prevent this from happening.” 

Coroner Anderson said the sad case highlighted the importance of being alert to safety warnings and ensuring that car seats and other devices are always used in accordance with the manufacturer’s instructions. 

Plunket’s principal clinical adviser, Karen Magrath, told NZME any death of a child was an absolute tragedy. 

She said whānau with questions about how to keep children safe in car seats, or any other safety concerns, could talk to their Plunket nurse, call PlunketLine or look at the safety information on their website. 

Catherine Hutton is an Open Justice reporter, based in Wellington. She has worked as a journalist for 20 years, including at the Waikato Times and RNZ. Most recently she was working as a media adviser at the Ministry of Justice.