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Regarding car seats, physics trump state laws
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SAN FRANCISCO — When it comes to car seat best practices, PCPs should counsel parents to concern themselves less with the often-minimal regulations mandated by their state, and more with real-world physics, according to presenters at the 2016 AAP National Conference and Exhibition.
John O’Neil, MD, MPH, FAAP, a child passenger safety technician at Indiana University, and Benjamin Hoffman, MD, FAAP, a child passenger safety technician instructor at Oregon Health and Science University, stressed that parents should delay car safety seat transitions — e.g., from a rear-facing car seat to front-facing, and from a front-facing seat to a booster seat — for as long as possible.
Rear-facing seats should be used until the child is at least 2 years of age. Forward-facing car seats, with a harness, should be used until at least age 4. After that, parents should use a seatbelt-positioning booster seat until the belt fits correctly across the child, which generally occurs at 8 to 12 years. All children younger than 13 years should be seated in the rear of the vehicle, no matter the type of restraint used. Such measures, they said, do a better job than state regulations to counteract the often deadly physics involved in car crashes, where force and mass can cause extensive internal and external damage.
“Just because you can, doesn’t mean you should,” O’Neil said. “There are transitions you can make, from rear-facing to forward-facing, to booster, to seat belt. You want to delay those transitions as long as possible, which is really hard to frame for families, because of how they often think about development. They will say, ‘I’m so excited about his 1-year check-up, and I can finally turn the car seat around.’ You should be saying, ‘Oh my God, you are going to increase his risk for death by 532%. Do you really want to do that?’”
According to the presenters, citing 2014 National Highway Traffic Safety Administration (NHTSA) data, properly installed car seats decrease the risk for death by 71% among children aged 1 year and younger. Among children aged 1 to 4 years, the risk for death is reduced by 54%.
However, in 2013, 2% of children aged 1 year and younger rode in vehicles unrestrained, according to the NHTSA. That rate was 5% among children aged 1 to 3 years old, 9% among those 4 to 7 years, and 11% among youths aged 8 to 12.
However, even when used, car seats are often installed incorrectly, according to Hoffman and O’Neil. Citing 2004 NHTSA data, they said the overall critical misuse rate was 72.6%. In addition, citing Hoffman’s own research, they said 95% of families of newborns made an average of 5 errors when installing a car seat in a vehicle for the first time.
“You have all taken care of newborns, and many of you have had newborns, and you’ve dealt with families in the newborn nursery, and you know how chaotic that time can be — not the best time to be asking parents to do a really complicated thing that, even under the best circumstances, 80% of people make a mistake doing,” O’Neil said. “… The children need us to do better, and we need to do better.”
O’Neil and Hoffman also noted that while many families turn to police and fire department personnel to demonstrate how to install a car seat, it is important to confirm they are certified for instruction first.
“You will always find a firefighter willing to help with this, which is beautiful, because they are awesome and they don’t know how to say ‘No,’” Hoffman said. “Some of the most creative, innovative attempts at installing a car seat were done by firefighters or police officers. So it is not safe to assume that they are certified.”
The presenters recommended that pediatricians reach out to certified resources, such as a children’s hospital. In addition, a list of all certified resources in each state is available at nhtsa.gov.
“I promise you, there is nothing that makes a car seat technician happier than getting a call from a pediatrician,” O’Neil said. “When I talk to the car seat community, the most common question I get is, ‘How can we get in touch with pediatricians?’ And I say, ‘I’m working on it,’ so go find your car seat technicians.” – by Jason Laday
References: O’Neil J, Hoffman B. Confessions of a car seat junkie: What every pediatrician must know about child passenger safety; AAP National Conference & Exhibition; Oct. 22, 2016, San Francisco.
Disclosure: The researchers report no relevant financial disclosures.