Child Restraint Devices Research Articles

Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review

BackgroundAmerican Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in...

Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department

Objective: Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED).Methods: A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities.Results: From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC.Conclusion: Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.

Child passenger safety laws in the United States, 1978–2010: Policy diffusion in the absence of strong federal intervention

This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.

Progress of research on the prophylaxis of child passenger injury

Seat belts and air bags are all designed according to adult, so which used by children will only increase their injury. Children who sitting in the front row do not use any restraint devices have the highest risk in the car accident,but who sat in the back with the appropriate child restraint devices only have the low risk. Education for families and parents that is basics of implementing legislation and promoting child restraint devices, but which need to integrate other method or means of effective intervention is possible. Legislation is one of the most powerful tool to prevent child passenger injury, but how to implement and enforce these laws are more important in developing countries. Key words: Passenger injury; Restraint device; Children

THE USE AND EFFICACY OF CHILD RESTRAINT DEVICES

I appreciated the analysis by Rice and Anderson of the effectiveness of child restraint systems.1 Tennessee was the first state to require the use of child restraint devices, doing so in 1978, and an analysis of their effectiveness in preventing death and preventing or reducing injury was published in 1984.2 That study demonstrated restraint devices to be associated with an 11-fold reduction in risk of death, whereas children traveling in the arms of an adult were exposed to risk of injury or death comparable to that of children left entirely unrestrained (a result that led to the removal of the “babe in arms” exemption from the child restraint law). The reduced relative benefit of child restraint systems (approximately 3-fold) in this most recent study, compared with the first such study (11-fold), might simply reflect variability among studies, but might also reflect 25 years' improvement in other crash-risk factors, including softening of automotive interiors, improvements in highway barriers and other engineering, widespread implementation of emergency medical systems, and so on.

A Review of Current Technology in Child Safety Seats for Infants

Although nearly all infants younger than 1 year of age are restrained when riding as a passenger in a motor vehicle in the United States, there are still problems with misuse of the child restraint devices. This article reviews current technology in child safety seats for infants. The author notes that the essential elements of appropriate transportation of infants include: rear-facing, in the back seat, and secured appropriately in the child restraint device. The device itself must also be securely installed in the vehicle. One lengthy table summarizes the presently-available, rear-facing child restraint devices on the market in the U.S.; for each device, the chart lists the manufacturer, model, type, rear facing weight limit, rear facing height limit, and online retail price. The author cautions that securing the child restraint device to the vehicle is one of the most complex parts of the process. Readers are walked through the process in some detail. The author also outlines the numerous resources available for parents who need assistance with child restraint seats. The author concludes by stressing that, through active advocacy, pediatric health care providers can influence parents tremendously in preventing unnecessary injuries and death from motor vehicle collisions.

Usefulness of Computerized Pediatric Motor Vehicle Safety Discharge Instructions

Abstract Objectives: To determine whether providing child motor vehicle safety recommendations on computerized discharge instructions (CDIs) were useful to parents and modified their use of child‐restraint devices (CRDs). Methods: The subjects were guardians of children seen in an urban pediatric emergency department (ED). An intervention group was given computerized ED discharge instructions that included the National Highway Traffic Safety Administration recommendations for motor vehicle CRDs. A control group was given CDIs without the recommendations. All subjects were subsequently called within four days of the ED visit and asked questions about their knowledge and use of CRDs. They also were queried if the recommendations affected their knowledge or changed their behavior. Results: There were 52 subjects in the control group and 58 in the intervention group. Fifty‐seven percent of the intervention group remembered reading a safety tip (p &lt; 0.001, 95% confidence interval [CI] = 0.32 to 0.62), and 82% of that subset correctly identified it pertaining to motor vehicle safety. Forty‐five percent (n= 33) of those who remembered the safety recommendation in the intervention group supported it being educational (p = 0.067, 95% CI = 0.28 to 0.64). Ten percent of the subjects in the intervention group said the CDIs changed their behavior regarding buckling‐up their child, compared with 0% of the control group (p = 0.473, 95% CI = 0.05 to 0.32). Conclusions: Including CRD information on CDIs is a convenient method of educating guardians of patients about motor vehicle safety in a pediatric ED setting. The data suggest that parents find it educational and a smaller subgroup change their behaviors after receiving them.

Parental report of child restraint device use in an emergency department population

To survey parents regarding use of child restraint devices (CRD) and knowledge of CRD recommendations, parents of children ≤ 14 years of age presenting to an emergency department (ED) provided demographic data and answered questions regarding the family’s restraint use and their understanding of CRD recommendations. Three hundred thirteen adults completed surveys, providing data on 541 children. Decreasing restraint use was reported with advancing child age. Parental restraint use remained constant. Demographics were similar. Optimal infant CRD position was not identified by 27%. Incorrect answers were associated with single parents, lower income, less education, and older child age. Only 41% identified the age for mandatory car seat use. Most identified the safest vehicle position for any child. No variables were associated with correct answers. In conclusion, CRD use decreases with increasing child age. In this study, many parents were unaware of CRD recommendations.

Many Parents Choose Inappropriate Child Auto Restraints

Injury and Poison Prevention| June 01 2001 Many Parents Choose Inappropriate Child Auto Restraints AAP Grand Rounds (2001) 5 (6): 59. https://doi.org/10.1542/gr.5-6-59 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Many Parents Choose Inappropriate Child Auto Restraints. AAP Grand Rounds June 2001; 5 (6): 59. https://doi.org/10.1542/gr.5-6-59 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: car seats, engineering, seat belts, sitting position, teaching, medical devices, seizures, well child visit Source: Kunkel NC, Nelson DS, Schunk JE. Do parents choose appropriate automotive restraint devices for their children? Clinical Pediatrics. 2001;40:35–40. To study the ability of parents to choose appropriate automotive restraints for their children in comparison with standardized guidelines based on weight and sitting and standing height, 460 children from 180 families were evaluated by University of Utah investigators in the setting of a community bicycle fair. Parents were surveyed about which device (car seat, booster seat, lap or shoulder belt) they thought was appropriate for their child, and their choice was compared to the authors’ standardized guidelines. Thirty percent of the time, recommendations called for a more junior level of restraint device than the parents had chosen. Nearly half the parents of children under 40 lbs. believed the lap belt fit their child and 45% of parents would place 2 children in one seat belt if not enough seat belts were available. The authors acknowledge that, when compared to the general population, the parents surveyed may have been more educated (the large majority had at least a high school diploma) and “safety-minded” (given that they were attending a bicycle fair). However, the results of the study show that a large proportion of these safety-conscious parents still made inappropriate choices for child-restraint devices. Improperly restraining a child can be as hazardous as not restraining a child.1 Although anticipatory guidance regarding injury prevention already plays an important role in the pediatrician’s office, this paper illustrates that we must continue to aggressively advise parents about appropriate automotive restraints. Unfortunately, guidelines are confusing and parents may be getting mixed messages from physicians, state laws, and safety commissions. The AAP guidelines are based on weight and age: children should be rear-facing until they are at least 20 lbs. and 1 year of age; forward-facing when older than 1 year of age and weighing 20–40 lbs.; and a booster seat “should be used when the child has outgrown a convertible safety seat but is too small to fit properly in a vehicle safety belt.”2,3 The National Highway Traffic Safety Administration has similar weight-based recommendations and also suggests using a booster seat until the safety belt “fits right.” Finally, the guidelines from the Society of Automotive Engineers recommend using sitting height as the measurement to determine the optimal form of restraint. Clearly, parents (and pediatricians) have ample reason to be confused. Kunkel et al advocate for more uniform state legislation and suggest that car seat manufacturers should include a set of guidelines in the packaging, and recommend that pediatricians educate parents about guidelines. Because of the complexity and variability of the recommendations, education outside physician’s offices about appropriate car seat use is essential. The AAP Committee on Injury and Poison Prevention car safety seat guidelines are now being revised to offer more guidance for transitioning from one seat type to the next, including transition to seat belts. This revision will offer additional user-friendly guidelines that refer to... You do not currently have access to this content.

Parental report of child restraint device use in an emergency department population

Abstract To survey parents regarding use of child restraint devices (CRD) and knowledge of CRD recommendations, parents of children ≤ 14 years of age presenting to an emergency department (ED) provided demographic data and answered questions regarding the family’s restraint use and their understanding of CRD recommendations. Three hundred thirteen adults completed surveys, providing data on 541 children. Decreasing restraint use was reported with advancing child age. Parental restraint use remained constant. Demographics were similar. Optimal infant CRD position was not identified by 27%. Incorrect answers were associated with single parents, lower income, less education, and older child age. Only 41% identified the age for mandatory car seat use. Most identified the safest vehicle position for any child. No variables were associated with correct answers. In conclusion, CRD use decreases with increasing child age. In this study, many parents were unaware of CRD recommendations.

Spinal trauma: New guidelines for assessment and management in the out-of-hospital environment

The keys to appropriate management of patients with spinal trauma lie in attending to life-threatening injuries, avoiding unnecessary movement of the spinal column, and carefully documenting patient reliability, MOI, history, physical examination findings, interventions, and responses to interventions. Who should be immobilized? Any victim of trauma complaining of neck or back pain, any patient with neurologic symptoms compatible with a spinal cord injury, and any patient who has an altered mental status or distracting injury should be immobilized. Given that not a single survivor of an SCI from World War I was alive by the start of World War II, one can appreciate the advances that have been made in the care of patients with spinal cord injuries. Exciting research is being conducted to explore the possibility of spinal cord regeneration by implanting tissue over which axons would regrow and make the appropriate connections, and pharmaceutical companies are spending millions to find an agent that will successfully salvage cells in human trials; however, a cure still seems elusive. Despite the marvels of modern research, prevention is still the key, including public education relative to wearing seat belts, instructing parents in the use of child restraint devices, encouraging people to jump rather than to dive when testing the depth of water (first time, feet first), enforcing driving under the influence laws, and outlawing such practices as spear tackling in football. In the meantime, EMS and ED personnel have a phenomenal opportunity to truly act as patient advocates by becoming familiar with new immobilization guidelines, honing their assessment skills, and providing anticipatory, compassionate care to those with neurologic deficits.

Resident educational interventions on child restraint devices are ineffective in influencing parental behavior † 683

Objective: To evaluate the use before and after intervention of Child Restraint Devices (CRD's) and seat belts of children and drivers of families who had been seen in a children's hospital clinic setting. A pediatric resident sponsored Car Seat/Seat Belt Display booth in the outpatient clinic setting was the intervention.

Comparison of Reported and Observed Use of Child Restraint Devices and Seat Belts † 684

Objective: To determine the difference in reported and observed behavior regarding parents' and childrens' use of Child Restraint Devices(CRD's) and safety belts in a children's hospital outpatient population.

Child restraint device use in patients leaving a children's hospital.

To determine the frequency of and factors associated with the use of child restraint devices (CRDs) in patients leaving an urban children's hospital. Verbally administered survey, followed by observation of CRD use. Main parking area at an urban children's hospital with mandated use of parking attendants. A convenience sample of 295 parents or guardians who were leaving the hospital and were accompanied by at least 1 child younger than 48 months. Eighty percent of the respondents were female; 77% of the respondents were white and 22% were African American. Two hundred thirty-five (80%) used CRDs. Subjects who were at risk of CRD noncompliance included nonwhite individuals (adjusted odds ratio [OR], 6.6; 95% confidence interval [CI], 3.0-14.5), those whose primary source of medical care was from a public clinic (OR, 2.4; 95% CI, 1.1-5.3) or from a specialty clinic (OR, 2.4; 95% CI, 0.8-6.6), and those who were older than 24 months (OR, 8.7; 95% CI, 3.5-21.9). Parental education and income level were not important predictors of CRD compliance controlling for race, primary medical care source, and age. Study participants were observed for incorrect CRD use; 30% (30/ 99 of infants younger than 12 months were incorrectly placed in the forward-facing position, and 23% (54/ 235 of all CRD users did not use its harness. Patients who use public clinics or pediatric subspecialists as their primary source of medical care, especially those who are African Americans, are at risk of CRD noncompliance. Children's hospitals should take an active role in improving CRD use in these patients.

Child Care Centers

Child passenger safety, a major public health concern, has been addressed by state laws mandating use of child restraint devices. Usage rates in poor and minority communities are disproportionately low. To determine the influence of the child care center within these communities to improve routine use, an educational clinical trial, based on social learning theory was designed. Two urban child care centers enrolling high-risk 2- through 6-year-old children were monitored for correct child restraint use during a 5-month educational intervention at one center. Key features of intervention programming included weekly, developmentally appropriate presentations by the staff to the children and documented parental awareness of the child care center's policy advisory regarding child restraint use. Results demonstrate statistically significant (p < .01) increases in use at the intervention center. This study finds that child care center policy and programming can be effective in promoting child passenger safety.

Taxicabs and child restraint.

For young urban families who may not own a car, taxicabs are a common mode of transportation. We surveyed the frequency of taxicab use involving children younger than age 4 years in a Baltimore, Md, clinic population and studied pediatric occupant safety issues, including taxicab child restraint law exemptions, taxicab occupant morbidity/mortality data, and taxicab child restraint device availability. In our inner-city clinic, 84 (78%) of 108 families reported that they did not own a car and 64 (76%) of those without cars rode with their small children in taxicabs at least monthly (n = 28), weekly (n = 27), or daily (n = 9), all without child restraints. Thirty-five of 50 states (70%) plus Washington, DC, exempt taxicabs from child restraint laws. Only 11 (27%) of 41 states with safety belt laws exempt taxicabs. There were 106 reported taxicab occupant fatalities from 1986 to 1990 in the United States, including 11 children and adolescents. National and state data on motor vehicle occupant morbidity do not separately examine taxicabs. Individual taxicab fleets we contacted would not release injury data. Of 50 urban taxicab fleets in four states (Delaware, Maryland, New Jersey, and Pennsylvania), only three (6%) offered child restraint devices by advance telephone request. There was no difference in availability based on state taxicab exemptions from child restraint laws. We conclude that taxicab use involving young children is common in this inner-city population. Data on taxicab occupant injuries are needed. Child restraint law exemptions for taxicabs should be eliminated. Education about, and enforcement of, child restraint laws for taxicabs is needed. Recent local legislation linking child restraint device availability to taxicab licensure should be encouraged.

Use and misuse of automobile child restraint devices.

To determine demographic, social, and behavioral characteristics that are associated with correct child restraint device (CRD) use. Cross-sectional. Fast-food restaurant parking lots in southeastern Michigan. Children younger than age 4 years and their drivers. Consecutive sample. None. Seven hundred seventeen child passengers were observed for 11 dimensions of CRD use and 661 of their drivers were interviewed. Three hundred ninety-four (55%) of the children were in CRDs, but 248 (63%) of those children were incorrectly restrained. A 43-point misuse index was constructed based on scores assigned for different types of misuse. Seven variables (ie, age of child, race of parent, driver as a parent, days driving, number of occupants, perceived comfort of CRDs, and belief that the social norm supports CRD use) were highly predictive of CRD use. In contrast, only three factors (ie, age of child, education of the driver, and knowledge of the CRD law) were minimally predictive of correct use. Since correct use of CRDs represents such a complex behavior, the best strategy to address the widespread problem of CRD use may be through the design of less complicated CRDs.

Determinants of the acquisition and utilization of automobile child restraint devices: a survey among Dutch parents

On behalf of the Dutch Road Safety Association a survey of the use of child restraint devices (CRDs) in The Netherlands was conducted. In a population of 420 parents of children younger than 5 years old, 95% possessed at least one CRD, while 83% of the owners always, or most of the time, used a CRD when transporting a young child. It appeared that while the decision to buy a CRD was mainly determined by beliefs concerning safety and comfort provided by CRDs, the actual use of CRDs was determined primarily by the reaction of restrained children. Parents, once in possession of a CRD, seem to agree on the safety and comfort of CRDs. Not until they start using it do some parents find that their child responds irritably. For parents not using a CRD regularly, this seems to be the main reason for their behaviour. Another significant determinant, although less influential, appeared to be the perceived social influence of partners of the respondents and of road safety experts. The practical implications for health education include the recommendation to separately address parents who are already in possession of a CRD and parents who are not. Furthermore, some theoretical implications are discussed.

Failure of hospitals to promote the use of child restraint devices

Failure of hospitals to promote the use of child restraint devices

Failure of hospitals to promote the use of child restraint devices.

Motor vehicle accidents are the leading cause of death in children. In 1977, Tennessee adopted the nation's first law requiring the use of child restraint devices (CRDs), but despite extensive promotional efforts, a majority of young children still travel unrestrained. We surveyed all acute-care hospitals in Tennessee to determine their policies regarding CRDs. Of 109 hospitals with obstetric services, 28 (26%) had a policy calling for discharged newborns to be transported in CRDs; only seven (5%) of 128 pediatric services had such a policy. It is time for hospitals and professional organizations to adopt policies to ensure that the parents of every child discharged from an obstetric or pediatric unit are educated concerning CRD use laws and are able to comply with them. Pediatricians should consider incorporating "discharge in child restraint device" into their routine discharge orders.