Child Safety Seat Use Research Articles

Commentary

Commentary

A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles

ObjectiveTo measure the effect of the WHO Safe Communities model approach to increasing child restraint use in motor vehicles.DesignPre- and post-intervention observations of restraint use in motor vehicles in several...

Prevalence and pattern of child restraints use in cars, Mashad, Iran

IntroductionAlthough some law reinforcements has recently decreased the high rate of death attributable to road traffic crashes in Iran, there are still no laws necessitating the use of child safety...

Incidence and total lifetime costs of motor vehicle-related fatal and non-fatal injury by road user type in the United States

BackgroundEach year, more than a million people are killed in motor vehicle crashes worldwide. Crashes place a tremendous burden on societies not only in terms of lives lost but also...

Translating research to practice: effective strategies to reduce motor vehicle injuries among American Indian tribes

BackgroundAmerican Indians/Alaska Natives have the highest motor vehicle-related death rates of all racial and ethnic groups in the United States. The Centers for Disease Control and Prevention's Injury Center worked...

Incidence and Total Lifetime Costs of Motor Vehicle–Related Fatal and Nonfatal Injury by Road User Type, United States, 2005

Objectives: To estimate the costs of motor vehicle–related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Methods: Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. Results: Motor vehicle–related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle–related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). Conclusions: The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available.

The inclusion of adult vehicle occupants in matched cohort studies of child restraint effectiveness: a study of potential bias

ObjectiveTo determine whether either the inclusion of adults in matched cohort studies of passenger vehicle occupants or modification of age effects by collision severity biases child restraint risk ratios biases...

Penetrating pediatric trauma owing to improper child safety seat use

We present a case of a 15-month-old child with a history of thoracic impalement after improper safety seat restraint. The foreign body was stabilized with bulky dressings in the field before transport. Imaging revealed possible pulmonary artery involvement; and consequently, a thoracotomy was done to obtain vascular control before removal. We use this case to highlight prehospital care and operative management of a patient with foreign body impalement.

Are we there yet? Canada's progress towards achieving road safety vision 2010 for children travelling in vehicles

This study examines safety seat use among Canadian children and evaluates child safety seat use relative to the national policy for child occupant safety, Road Safety Vision 2010. Using a probability sample, roadside observations of car safety seat use were collected from May to October of 2006 for 13,500 children aged from birth to 9 years in 10,084 vehicles at 182 sites in nine Canadian provinces and one territory. Observations revealed that 89.9% of Canadian children were restrained in some type of restraint. However, only 60.5% of these children were restrained in the correct safety seat. When comparing rates of correct use across provinces, results were not significantly different in provinces with booster seat legislation and those without this legislation. This data may be useful for healthcare practitioners and policy makers to develop interventions aimed at increasing appropriate car safety seat use for children in Canada.

A comparison of booster seat use in Canadian provinces with and without legislation

Background:The use of booster seats continues to be low, despite their effectiveness in reducing injury in motor vehicle collisions. Many jurisdictions have introduced legislation requiring the use of booster seats....

Management of cervical spine injuries in young children: lessons learned

Previous studies have shown that the correct use of car safety seats can protect infants and children from vehicular injury. Although child passenger devices are increasingly used in the US, motor vehicle crashes continue to be the leading cause of death and acquired disability in infants and children younger than 14 years of age. These events are likely related, at least in part, to the high percentage of children who are unrestrained or improperly restrained. The authors present 2 cases of severe cervical spine trauma in young children restrained in car safety seats during a motor vehicle crash: 1) a previously healthy 14-month-old girl who was improperly restrained in a forward-facing booster seat secured to the vehicle by a lap belt, and 2) a previously healthy 30-month-old girl who was a rear seat passenger restrained in a car safety seat. This study points out the unique challenges encountered in treating cervical spine injuries in infants and young children, as well as the lessons learned, and emphasizes the significance of continuing efforts to increase family and public awareness regarding the importance of appropriate child safety seat selection and use.

Child Passenger Safety: Direction, Selection, Location, Installation

The most significant risk factor for death and serious injury in a car crash is the failure to use a size-appropriate restraint system. Providing accurate car safety seat anticipatory guidance to families is the standard of care. Guiding families on the best car seat for best protection can be done with the four messages, direction, selection, location, and refer, if needed, to community resources for correct installation. Addressing special issues that impact use of a car seat on each and every ride, including challenging behaviors and obesity, will transfer to many other situations. Data support a new recommendation that children stay rear-facing in size-appropriate car seats until they reach the highest weight and height allowed for rear-facing by the manufacturer of the convertible seat. Premature graduation to the next seat type/size/position increases risk of injury. A driver who is distracted by a cell phone, food, or something else, becomes a risk factor for a car crash. State laws may lag behind best practices. Advocacy for stronger laws, better enforcement, and best practices at the local, state, and national levels is a critical role for the pediatric professional community.

Determining the Proportion of Children Too Heavy for Age-Appropriate Car Seats in a Practice-Based Research Network

more information is needed on how trends in childhood weight might influence legally compliant child safety seat (CSS) use. to determine the proportion of child passengers who cannot comply with one state's CSS law because of weight. 6 practices in a practice-based research network provided data on patient demographics, heights, and weights. The authors calculated percentages of children above age-appropriate CSS weight cutoffs (20, 40, and 80 pounds, respectively) for the cohort below 6 years. there were 717 participants below 6 years of age. Among all infants (<12 months), 16.4% weighed >20 pounds. Among children 12 months to <6 years old, 20% weighed >40 pounds. One weighed >80 pounds. There were no significant differences among racial groups. There was wide variation among practices, but differences did not achieve statistical significance. many children in this diverse cohort were too heavy to be compliant with the state CSS law.

Transportation of infants and children in motor vehicles

This article reviews the transportation of infants and children in motor vehicles, focusing on some safety issues that could be modifiable. The authors report that despite all 10 provinces and three territories of Canada having laws requiring the use of child safety seats, many injuries and deaths are directly attributed to nonuse or misuse of child restraints. Parents and caregivers need to understand the current legislation in their province or territory, as well as how to properly install and use child restraint systems. The authors emphasize the importance of first educating pediatricians and family physicians, who can then influence parents and family members regarding child transportation safety. The article offers recommendations for selecting and using the most appropriate car safety seats for growing children, based on provincial legislation and peer-review literature available at the time of publication. The article also provides clinicians with essential knowledge for discussing safe travel with parents, and identifies opportunities for clinician advocacy for enhancing child passenger legislation in Canada. Topics include common car seat errors or misuses, rear-facing car seats, forward-facing car seats, booster seats, seat belts, booster seat legislation advocacy, sales tax exemption for child passenger restraints, aftermarket products and devices, seating position, seat installation, and placement of the child in the seat. Physicians are encouraged to make use of various publications available from Transport Canada, Safe Kids Canada and the AAP for advising their patients.

Ride Safe: A Child Passenger Safety Program for American Indian/Alaska Native Children

In American Indian/Alaska Native (AI/AN) communities, child safety seat (CSS) use rates are much lower than in non-native communities. To reduce this disparity, Indian Health Service (IHS) staff developed, pilot-tested, and implemented Ride Safe, which provided education, training, and child safety seats for children aged 3-5 participating in Tribal Head Start Centers. Focus groups, key informant interviews, and technical review guided program development and implementation. Progress reports and child safety seat use observations, conducted at the beginning and end of three program years (Fall 2003 to Spring 2006), assessed program reach and impact. To examine CSS use, we used three multiple logistic regressions, including a conservative intent to treat analysis. Ride Safe reached approximately 3,500 children and their families at 14 sites in six states, providing over 1,700 parents/family members with educational activities, 2,916 child safety seats, and child passenger safety (CPS) technician certification training for 78 Tribal staff. Children were 2.5 times (OR = 2.55, p < .01) as likely to be observed in child safety seats comparing Rounds 1 and 2 data, with the most conservative model showing that the odds of being observed restrained were 74% higher (OR = 1.74, p = or<.01) after implementation of the program. The Ride Safe Program effectively increased child safety seat use in AI/AN communities, however, observed use rates ranging from 30% to 71% remain well below the 2006 all US rate of 93%. Results from CSS educational and distribution/installation programs such as Ride Safe should be considered in light of the need to increase distribution programs and enhance enforcement activities in AI/AN communities, thereby reducing the disparity in AI/AN motor vehicle injuries and death.

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Motor vehicle-related injuries are the leading cause of death among children, adolescents, and young adults. To systematically review evidence of the effectiveness of counseling people of any age in primary care settings about occupant restraints or alcohol-related driving to prevent injuries. MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, and Traffic Research Information Service; published systematic evidence reviews; experts; and bibliographies of selected trials. Randomized, controlled trials (RCTs); controlled clinical trials (CCTs); or comparative observational research studies that evaluated behavioral counseling interventions feasible to conduct in primary care or referral from primary care. Investigators abstracted data on study design, setting, patients, interventions, outcomes, and quality-related study details. Trials report that counseling to increase the use of child safety seats leads to increased short-term restraint use (7 CCTs, 6 RCTs). Interventions that included a demonstration of correct use or distribution of a free or reduced-cost child safety seat reported larger effects. Few trials described the effect of counseling children 4 to 8 years of age to use booster seats (1 RCT); counseling older children, adolescents, or adults to use seat belts (1 CCT, 2 RCTs); or counseling unselected primary care patients to reduce alcohol-related driving behaviors (no trials). Most of the relevant trials were published before the widespread enactment of child safety seat legislation and had methodological flaws. The incremental effect of primary care counseling to increase the correct use of child safety seats in the current regulatory environment is not established. The effectiveness of primary care counseling to reduce alcohol-related driving has not been tested. Studies are needed.

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: U.S. Preventive Services Task Force Recommendation Statement

An assessment of the independent effectiveness of primary care interventions to increase the proper use of child safety seats, booster seats, and lap-and-shoulder belts to prevent motor vehicle occupant injuries (MVOIs) and to prevent alcohol-related MVOIs in adolescents and adults. The U.S. Preventive Services Task Force reviewed evidence on the effectiveness of counseling in primary care about the proper use of child restraints in motor vehicles to prevent injury, as well as evidence on the impact of primary care counseling to prevent alcohol-related MVOIs in adolescents and adults. This included information gathered in the process of making their 1996 recommendation, as well as the accompanying systematic review of English-language articles published through 2005. Current evidence is insufficient to assess the incremental benefits, beyond the efficacy of legislation and community-based interventions, of counseling in the primary care setting to improve rates of proper use of motor vehicle occupant restraints. (I statement) Current evidence is insufficient to assess the balance of benefits and harms of routine counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired. (I statement).

Using a Computer Kiosk to Promote Child Safety: Results of a Randomized, Controlled Trial in an Urban Pediatric Emergency Department

The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4-66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use. These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.

Parent Driver Characteristics Associated with Sub-Optimal Restraint of Child Passengers

Objectives. To identify parent driver demographic and socioeconomic characteristics associated with the use of sub-optimal restraints for child passengers under nine years. Methods. Cross-sectional study using in-depth, validated telephone interviews with parent drivers in a probability sample of 3,818 vehicle crashes involving 5,146 children. Sub-optimal restraint was defined as use of forward-facing child safety seats for infants under one or weighing under 20 lbs, and any seat-belt use for children under 9. Results. Sub-optimal restraint was more common among children under one and between four and eight years than among children aged one to three years (18%, 65%, and 5%, respectively). For children under nine, independent risk factors for sub-optimal restraint were: non-Hispanic black parent drivers (with non-Hispanic white parents as reference, adjusted relative risk, adjusted RR = 1.24, 95% CI: 1.09–1.41); less educated parents (with college graduate or above as reference: high school, adjusted RR = 1.27, 95% CI: 1.12–1.44; less than high school graduate, adjusted RR = 1.36, 95% CI: 1.13–1.63); and lower family income (with $50,000 or more as reference: <$20,000, adjusted RR = 1.23, 95% CI: 1.07–1.40). Multivariate analysis revealed the following independent risk factors for sub-optimal restraint among four-to-eight-year-olds: older parent age, limited education, black race, and income below $20,000. Conclusions. Parents with low educational levels or of non-Hispanic black background may require additional anticipatory guidance regarding child passenger safety. The importance of poverty in predicting sub-optimal restraint underscores the importance of child restraint and booster seat disbursement and education programs, potentially through Medicaid.

Magazine information on safety belt use for pregnant women and young children

To assess the information on safety belt use for pregnant women and infants in maternity and baby magazines, we reviewed 2003 issues of the three top-selling monthly baby and maternity magazines. Articles on safety belt use during pregnancy and child safety seat (CSS) use for infants, and advertisements of the CSS, automobiles, or CSS-related products were examined for their informational content. Of the 9418 pages in the maternity magazines, 46 pages were on infants, 16 pages on pregnant women and 162 pages displayed advertisements. Of the 9750 pages in the baby magazines, 34 pages of articles addressed CSS use; no articles addressed the issue of pregnant women; 83 pages were advertisements. Although the magazines showed accurate information in general; its amount was not sufficient, and little specific information on appropriate use and selection of a CSS was seen. Some information was misleading and even incorrect: specifically related to when to start using a forward-facing seat, what products are attachable to the CSS, and the reuse of a CSS. Greater amounts and accuracy of safety information in these magazines would help pregnant women and parents acquire important safety knowledge that healthcare providers are falling short of providing in Japan.