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Despite increase in correct car seat position, booster seat use declined

Joseph O'Neil

CHICAGO —  Although the use of the rear-facing car safety seat position among infants and toddlers has increased from 12% to 61% since 2009, the use of booster seats and other safety precautions among older children has significantly declined, according to a recent presentation at the AAP 2017 National Conference & Exhibition.

“One thing that we as physicians can share is that children are safer in the rear facing position, for as long as they can be rear-facing,” Joseph O’Neil, MS, MPH, FAAP, from the automotive safety program at Riley Hospital for Children, said in an interview with Infectious Diseases in Children. “It helps protect the head, neck and spinal cord. It provides support for the biggest bony structures of the body like the ribs and the back, and it allows the car seat to cocoon around the child to provide an extra layer of protection.”

To examine car safety implementation in Indiana for children 12 years and younger, the researchers assessed the use of rear-facing car seats, top tether use, booster seat use and seating position in an observational, cross-sectional survey. This survey included those who drove children 15 years and younger, and individuals were recruited at 25 convenience locations in the summers between 2009 and 2015. Safety precautions were monitored by Certified Child Passenger Safety Technicians.

Participants provided their demographic data through a written survey, and safety technicians gathered data on the child’s demographics, vehicle seating location, types of restraints used, the direction of the car safety seat (CSS) and appropriate use of harnesses or safety belts with CSSs. O’Neil and colleagues also assessed data on children younger than 24 months, children in forward-facing CSSs, booster seat use and seating position for those 12 years and younger.

“Parents often worry about the damage that may be done from the child’s feet leaning up against the backseat of the car, yet this is the softest part of your car,” O’Neil told Infectious Diseases in Children. “In addition, children’s knees, ankles and hips are very good at absorbing shock. You can cast a leg, but you can’t do anything for the brain.”

As part of their review, O’Neil and colleagues included 4,876 drivers, 7,725 children aged 15 years and younger, and 1,115 children between the ages of 0 and 23 months. The researchers observed that the use of rear-facing seating increased from 84% to 91% within the study years, with the most notable increase in this practice observed in the 12- to 17-month cohort (12%-61%). O’Neil and colleagues noted no significant changes in the 12- to 23-month age group.

Top tethers, including the seat belt system or the lower anchor, were used in an average of 27% of the 1,653 vehicles assessed that used a forward-facing CSSs. Of those that used forward-facing seats and the lower anchor, 66% also used the top tether.

Additionally, a decrease in booster seat use was observed in children aged 4 to 7 years (72%-65%). Concerning vehicle seating placement, 85% of children aged 12 years and younger were seated in the back seat; however, children aged 8 to 12 years had 31% placed in the front seat.

“Older kids want to sit in the front seat because that is where ‘cool’ people sit,” O’Neil said. “However, when you think about the ligamental laxity of the neck, that does not tighten up until children are about 12 or 13 years old. If they are sitting in front of an airbag and it goes off, that is tremendous force on the head and neck —which is why we want young children in the backseat.” – by Katherine Bortz

Reference:

O’Neil J, et al. Trends in child passenger safety practices in Indiana from 2009-2015. Presented at: The 2017 AAP National Conference & Exhibition; Sept. 16-19; Chicago.

Disclosure: Infectious Diseases in Children could not obtain disclosure information before publication.