A decade-long study of sleep-related deaths in infants has found that in more than 90 percent of cases involving car seats, the safety devices were not being used as directed. The study, which was published Monday in the journal Pediatrics, analyzed 11,779 sleep-related deaths in infants and found 3 percent of those fatalities occurred in a sitting device, with car seats being the product most commonly reported.

“While car seats are always the best place for babies when they are being transported in a vehicle, that doesn’t mean they are the safest place when they’re sleeping outside of the car,” Dr. Jeffrey D. Colvin, study co-author, said in an American Academy of Pediatrics (AAP) news release about the study.

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Strollers, bouncers, swings and other infants seats were also classified as sitting devices in the study. Researchers found that the majority of deaths involving sitting devices occurred at home under the supervision of a parent. But when compared to deaths involving non-sitting devices, babies who died while in a sitting device had higher odds of being under the supervision of a babysitter or child care provider.

“It’s not only that doctors – pediatricians – need to educate their families, the parents of their patients,” Colvin said. “They also need to have parents educate anyone who is taking care of their infant, whether it’s a grandparent, babysitter or child care provider, that car seats are not substitutes for cribs and bassinets. The same is true for bouncers, swings and strollers.”

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The AAP does not recommend that babies be placed on an incline for sleep, as head elevation may lead to a position that could result in asphyxia. It also does not recommend any products for sleep that require restraints, especially if the product rocks. It recommends babies be placed in a supine position for sleep by caregivers until 1 year of age, and that loose bedding and soft objects be kept out of the sleep area.

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The study comes weeks after Fisher-Price pulled more than 4 million Rock ‘n Play Sleepers over infant deaths tied to the product. Some of the infants had rolled over in the product while unrestrained, while others were unable to breathe because of their position.