Post on 19-Jan-2016
Car Seat Safety: What Every Pediatric Practice Should Know
(that was never taught in residency or RN classes)
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Housekeeping Details
Webinar February 21, 2012
Dr. Alisa BaerPediatrician & NHTSA Certified Child Passenger Safety
Instructor
What every pediatrician needs to know about car seats
thecarseatlady.com
Why is this IMPORTANT?
Car Seat Safety is the ONLY topic
the AAP recommends
discussing at EVERY
well child visit
Car Crashes are the #1 Cause of
DEATH and INJURY for Kids 3-14 Yrs
95% of all car seats are NOT used
properly
BUCKLING UP
BABY
http://www.theartzoo.com/pictures/accessories/rainbow-shoelaces.jpg
LOOSE
SNUG
Most Shoulder Strap Covers TOO LONG
• Talk to the child: “Your straps are snug like a hug”
• Talk to the parent: Validate: child will notice straps being
snugger - suggest that parent replies “your straps are giving you a hug because they love you” the 1st time - & afterwards ignore or distract
Encourage: Allow child to buckle themselves as much as possible
Praise: frequent praise for participation & behavior
“Routine Book” to ease transitions
Buckling Up Behavioral Strategies
STAY WARM &
STAY SAFE
No Coats or Snowsuits
Snowsuit ON OFF
Falsely Snug Dangerously Loose
Swaddle OVER Straps
Magic Coat Trick #1
NOT SAFE in Bulky Coats
Dress for 50 Weather UNDERStraps
o
Put Coat on OVER
Straps
Magic Coat Trick #2
Unzip Jacket & Get Straps SnugZip Jacket OVER Straps
•Car seat = Parachute: 2 things you would never do when wearing a parachute harness:
1. loosen your harness because it was “too tight”
2. Wear anything fluffy under your harness
•Demonstrate in the office how to buckle baby in properly
Buckling Up Talking Points
Head Position &
Airway Obstruction
WITH
WITHOUT
Most Head Inserts are REMOVABLE & OPTIONAL
Many Parents Buy “Aftermarket” Inserts
Chin-To-Chest
Tonkin SL. NZ Med J 1998
Normal AirwayAirway Occluded with Head Flexion
WITH head insert - chin on chest
WITHOUT head insert -
Airway unobstructed
Head Inserts often WORSEN Head Position
WITH head insert - chin on chest
WITHOUT head insert -
airway unobstructed
Head Inserts often WORSEN Head Position
Rolled Burp Cloths
Snug Straps Proper Recline
45o
2 Steps to a SAFE Head Position
•10% hospitalized at least 1 night
•85% of the injuries due to falls
•65% fell out of the car seat
•15% fell from a height:•Shopping cart•Table•Counter Top
8,300 Infants per Year Injured in
Car Seats NOT During a Crash
Shital N, et al. Pediatrics 2010
Rear-facing Only Convertible
Why Rear-facing?
...it’s 5 TIMES SAFERthan forward-facing
(even for 2 year olds)!Henary B, et al. Injury Prevention
2007
12-month-old Forward Facing
Why Rear-facing? Younger child’s head is larger in proportion to body
Why Rear-facing? Younger child’s bones are still
changing from cartilage to bone
Cartilage Bone
Image (C) VolvoBurdi AR et al. J Biomech 1969
0-12 month
1-3years
3-6years
adult
12-month-old Rear Facing
Rear-Facing until age 2 (at least!)
Too Heavy
Too Tall
35-45 pounds usually
Head 1 inch below top of seat usually
AAP Committee on Injury, Violence & Poison Prevention. Pediatrics. 2011Watson E, et al. BMJ. 2009
O’Neill J, et al. Clinical Pediatrics 2011
Reasons Drivers Chose Forward Facing Direction for a Child Younger than 2
Years
O’Neill J, et al. Clinical Pediatrics 2011
Parents believe child is too big for rear-facing long before child
actually is
Of these ONLY ONE child actually had outgrown their rear-facing
seat
O’Neill J, et al. Clinical Pediatrics 2011
Reasons Drivers Chose Forward Facing Direction for a Child Younger
than 2 Years
But what about their legs?
3y 2m - 37 lbs
1y 2m - 18 lbs
2y 2m - 35 lbs
3y 6m - 38 lbs
3y 4m - 34 lbs
2y 1m - 27 lbs
2y 1m - 27 & 32 lbs
Forward-facing kids also sit in
uncomfortable-looking positions
2y 5m - 38 lbs
3y 10m - 38 lbs
2y 10m - 40 lbs
and so do adults...
note: putting feet on airbag (as shown) is dangerous
Besides, there are MORE leg injuries to forward-facing
kids than rear-facing kids
Arbogast KB, et al. Annu Proc Assoc Adv Automot Med. 2002
she won’t wake up
with a stiff neck
...but you sure would
Rear-facingTalking Points
Parents are listening!
O’Neill J, et al. Clinical Pediatrics 2011
• Minimum of 2 years is just that - a minimum
• Validate:
• 12-15 months is typically the most difficult time for kids in car seats (or any device with straps) - as kids realize that these completely limit their independence & mobility
• Legs will look scrunched & uncomfortable - but child will be comfortable
Rear-facing Talking Points
To keep older child happy:
• Remove head rest so child can see better out the rear window
• Sit the car seat more upright (when manufacturer allows) to give child better view
Rear-facing Talking Points
Forward-Facing 5-point harness as long as possible
Too Heavy
Too Tall
Usually 40-65 pounds (few to 85 pounds)
Shoulders at top shoulder strap slotOR
Top of ears at top of seat
7y 6m - 55 & 76lbs
Forward-Facing Head Movement
Head is SAFER With a TETHER
LATCHTethers are part of...
LowerAnchors andTethers forCHildren
Lower Anchors
Rigid Attachment Flexible Attachment
• Safety must be a NON-NEGOTIABLE
• Majority of parents enter into a negotiating relationship with child at age 4 regarding where and how child will be restrained in vehicle - this should NOT be the case
• Many children outgrow their convertible seat before they are ready for a booster
• Advise parents to look for seats with high shoulder strap slots & weight limits
• Minimum to transition from 5-point-harness to booster:
• 4 years AND 40 pounds AND able to sit still in a booster
Forward-facing Talking Points
Nomenclature
5-Point-Harness(Car Seat)
Booster
High Back Booster
Backless Booster
Booster = Positioning Device
iihs.org
Dangers of Poor Lap Belt Fit
Spinal Cord InjuryPhoto: CIREN
Dangers of Poor Lap Belt Fit
Photo: CIREN
Intestinal Rupture
Splenic Laceration
Bladder Rupture
Why Doesn’t Lap Belt Fit Properly Without a Booster?
16-months
5 years
adolescent
1
23
4
56
1
2 3
4
5 6
1 2
NUMBER OF BONES IN THE HIP & PELVIS
Images (C) BoneClones
Hip Bones Underdeveloped
Kids Slouch to Allow Knees to Bend
Dangerous!Lap Belt on Abdomen
How Does a Booster Improve Lap Belt Fit?
Poor Good Lap Belt Fit With Booster
Lap Belt: On AbdomenKnees: Don’t Bend
Naturally Child will Slouch
No Booster
With Booster
Poor Good Lap Belt Fit With Booster
Lap Belt: On AbdomenKnees: Don’t Bend Naturally Child will Slouch
No Booster
Lap Belt: Flat on ThighsKnees: Bend Naturally Child WON’T Slouch
For belted children, abdominal injuries were the 2nd most common injuries (head injury was most
common)
For booster children, there was a notable absence of abdominal injuries
Photos: CIRENArbogast KB, et al. Pediatrics 2009
Boosters Can Eliminate Abdominal Injuries
iihs.org
Dangerous
Uncomfortable
Shoulder Belt Rubbing Neck is NOT Dangerous
... but putting the shoulder belt UNDER your arm or BEHIND your back IS VERY DANGEROUS
Dangerous head movement with shoulder belt under arm
or behind back
BoosterShoulder belt
under armShoulder beltbehind back
Boosters Help Prevent Head
Injuries
Slouching Head Injuries
Excessive Head Movement with Slouching
Booster: YesSlouching: No
Booster: NoSlouching: Yes
How Much Difference Does a
Booster Make?
Arbogast KB, et al. Pediatrics 2009
Boosters Prevent 45% More Injuries than a Seat Belt
38% Reduction
Additional 45% Reduction
4-8 year old children
Arbogast KB, et al. Pediatrics 2009
Are High Back Boosters SAFER than Backless Boosters?
large study found no difference in
injury rates between the 2 booster types
Everyone NeedsWhiplash Protection
Good =
to Top of Ears
Carpools
64% of parents of 4-8 year-olds
carpool...
Macy ML, et al. Pediatrics 2012
• Of the parents who use a booster for their child in their own car...•Only half always have their child use a booster when riding with friends who do not have boosters
•1 in 5 do not always ask other drivers to use a booster seat for their child
Common Obstacles to Booster Usage
... But I Can’t Fit 3 Boosters in My Vehicle
Narrowest Booster: Bubble Bum (12 inches)
Bubble Bums Make 3-Across Possible
(tiny) Volkswagen Golf
... But I Can’t Get My Hands in to
Buckle the Child in the Booster
1 2 3 4
Booster with belt fastened
Climbing under
belt
Tightening seat
belt
Readyto
go!
Climbing into a Buckled Belt
...But How is Abby Supposed to Carry a
Booster Around With Her All Day?
Lightest Booster:Bubble Bum - weighs 1
pound
• INVOLVE THE CHILD
• Teach child 5-step-test & how a booster works
• If buying a new seat, let child select (from 2 or 3 choices)
• Empower parent to resist the peer pressure (from child and other parents) to stop using a booster sooner than is safe
• Backless is just as safe as High Back (in most cases)
• State Laws are NOT enough to keep kids safe - most kids need a booster until age 10-12
• Squirmy kids - lock the belt
Booster Talking Points
Back Seat Until AT LEAST Age 13
EVERYONE Buckles Up
Mayrose J, et al. J Trauma 2006
Cummings P, et al. JAMA 2004Ichikawa M, et al. Lancet 2002
5 Pounds 90 Pounds18Gx =
20mph crash
Resources
Resources Slide Show• Printable Tip
Sheets for Parents• Many in
Spanish and in other languages
• Posters for your office
• Technical Information
• Local Resources
Thank you for participating today!
An evaluation form is available on our website: http://www.miemss.org/EMSCwww/CPSHome.htm; or,
it can be emailed to participants. Upon receiving the evaluation, we can send you a certificate for
participation and information about our other materials and services available on child passenger safety.