Use Of Child Restraint Devices Research Articles

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.

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.

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.

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.

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.

US Preventive Services Task Force. Automobile injury--selected risk factors and prevention in the health care setting.

Every year, highway crashes cause tens of thousands of deaths and millions of nonfatal injuries, many of which can be prevented. Following a mandate from the US Preventive Services Task Force, in this article we describe the magnitude of the automobile injury problem, identify injury risk factors that might be reduced by clinically based preventive programs, and review reports of interventions by health professionals to promote the use of child restraint devices, the only area in which we found published evaluations. We conclude that despite the lack of experimental evidence of the long-term effectiveness of clinically based efforts to promote occupant restraint use, such efforts may be warranted because of the enormous social and economic costs of automobile injury. In addition, physicians and other health professionals are urged to consider promoting nonclinical automobile injury prevention measures.

The Use of Child Restraint Devices in Vehicles

To the Editor.— Motor vehicle accidents are the leading cause of death in childhood. 1 Physicians generally agree that many highway casualties are preventable with the use of child restraint devices. The medical profession played a significant role in the implementation of child restraint legislation in the majority of the states. In 1976, Williams 2 observed that 90% of children ride unprotected in automobiles. The US Department of Transportation estimates that two thirds (67%) of infants and 44% of children between the ages of 1 and 4 years are placed in safety seats. 3 On a 360-mile trip through north central Florida and southern Georgia, the authors undertook a preliminary investigation to determine actual child restraint usage in rural areas. One hundred consecutive motor vehicles with small children were studied. The authors directly observed and ascertained whether or not the children were riding in safety restraint devices. Poorly visualized and questionable

Parental beliefs associated with the use of child restraint devices

Parental beliefs associated with the use of child restraint devices

The Use and Efficacy of Child Restraint Devices

The Tennessee Child Passenger Protection Act, mandating the use of child restraint devices for children younger than 4 years, took effect in 1978. In the years 1978 through 1983, eighty-one children younger than 4 years died in Tennessee traffic accidents; only two were in child restraint devices. During this period, as child restraint device use rose from 8% to more than 30%, the number of deaths among children younger than 4 years declined more than 50%. Analysis of supplemental accident reports filed in investigations of motor vehicle accidents involving children younger than 4 years during 1982 and 1983 showed that child restraint devices are highly effective in preventing death and in preventing or reducing injury. Children not in child restraint devices were 11 times more likely to die in an accident than children in child restraint devices. Children traveling in the arms of an adult were exposed to a risk of injury or death comparable to that of children left entirely unrestrained.

Factors associated with the use of child restraint devices.

A thorough behavioral diagnosis of why parents do and do not use car safety seats is important for designing an effective, comprehensive approach to the significant public health problem of childhood motor vehicle occupant deaths and injuries. With a clear understanding of the demographic, knowledge, attitudinal and social support factors related to car seat use, it will be possible to develop or refine program methods and persuasive communication strategies which will have the greatest potential for effectiveness. Project KISS (Kids in Safety Seats) of the Maryland Department of Health and Mental Hygiene surveyed parents of young children in Maryland to identify factors which differentiate child restraint device users from nonusers. A statewide telephone survey was conducted using random digit dialing, a method of computerized sampling for telephone interviewing. The survey instrument incorporated demographic variables and used Fishbein and Ajzen's model of behavioral intention to develop an attitude scale and identify social referents important to parental safety seat use. Of the factors associated with reported use of car seats, the attitudinal variables were extremely significant. Using these variables as well as spouse approval, socio-demographic characteristics, and other preventive health behaviors of parents, resulted in the correct classification of 75.5% of cases and 26.7% of the variance in reported car seat use. Practitioners can use this analysis to design and target effective educational efforts to those individuals who are least likely to use car seats properly and consistently.