confessions of a car seat junkie - aap point-of-care-solutions · 2019-08-29 · of child passenger...

Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Confessions of aCar Seat Junkie

What Every Pediatrician Must Know About Child Passenger Safety

Benjamin Hoffman, MD, FAAP, CPST-IChild Passenger Safety Technician InstructorOregon Health and Science University


Disclaimers & Disclosures The presenter has no relevant financial relationships with the manufacturer(s) of any

commercial product(s) and/or provider of commercial services discussed in this presentation.

The presenter does not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.

Statements and opinions expressed are those of the presenter and not necessarily those of the American Academy of Pediatrics.

Mead Johnson sponsors programs such as this to give healthcare professionals access to scientific and educational information provided by experts. The presenter has complete and independent control over the planning and content of the presentation, and is not receiving any compensation from Mead Johnson for this presentation. The presenter’s comments and opinions are not necessarily those of Mead Johnson. In the event that the presentation contains statements about uses of drugs that are not within the drugs' approved indications, Mead Johnson does not promote the use of any drug for indications outside the FDA-approved product label.


Objectives By the end of this talk, you should be able to:

1. Discuss basic principles of child passenger safety (CPS) science, including:• Epidemiology• Physics• Anatomy and physiology of children• Crash dynamics

2. List 5 ways car safety seats help prevent injury to children.3. Discuss best practice recommendations for appropriate child

passenger restraint.4. Identify and access CPS resources in your community, including for

children with special health care needs.


Car CrashesKill More Kids Than Any Other Cause

Source: Centers for Disease Control and Prevention.

Chart1

0

Motor Vehicle

Unintentional Injury

Homicide

Cancer

Suicide

Congenital Anomalies

Heart Disease

All Others

Ages 1–182007–2017

Deaths

35663

31319

20458

18945

18318

10704

6401

47599

Sheet1

Deaths

Deaths

Motor Vehicle35663

Unintentional Injury31319

Homicide20458

Cancer18945

Suicide18318

Congenital Anomalies10704

Heart Disease6401

All Others47599

Sheet1

Deaths


5 children per day


“If a disease were killing our children in the proportions that injuries are, people would be outraged and demand that thiskiller be stopped.”

C. Everett Koop, MDFormer U.S. Surgeon General


0

20

40

60

80

0-1 year 1-4 years

715461

47

Death

Injury

Source: National Highway Traffic Safety Administration.

Car Safety SeatsWork!

Decreased Risk with Car Safety Seats

Chart1

0-1 year0-1 year

1-4 years1-4 years

Death

Injury

71

54

61

47

71

61

54

47

Sheet1

0-1 year1-4 years

Death7154

Injury6147


Belt Positioning BoosterSeats Work!

39% Reduction

59% Reduction


Not All Kids Ride Restrained

Source: U.S. Department of Transportation, National Highway Traffic Safety Administration. The 2013 National Survey of the Use of Booster Seats. June 2014.


Restraint Use Rates Have Not Improved

Source: U.S. Department of Transportation, National Highway Traffic Safety Administration. Occupant Restraint Use in 2011: Results From the National Occupant Protection Use Survey Controlled Intersection Study. January 2013.

Child Restraint Use Among Children Under Age 8, 2002–2011


Restraint Use Rates Have DECREASED2013–2015

Source: U.S. Department of Transportation, National Highway Traffic Safety Administration. The 2015 National Survey of the Use of Booster Seats. September 2016.


Car Safety Seats Are Hard To Use Correctly

Critical Misuse72.6%

Source: U.S. Department of Transportation, National Highway Traffic Safety Administration. 2004.

Chart1

RF Infant

RF Convertible

FF Convertible

FF Only

Booster

Series 1

Critical Misuse by Restraint Type

84

84

82

79

40

Sheet1

Series 1Column1Column2

RF Infant84

RF Convertible84

FF Convertible82

FF Only79

Booster40

To resize chart data range, drag lower right corner of range.

Chart1

Critical MisuseCritical MisuseCritical Misuse

Correct UseCorrect UseCorrect Use

72.6

27.4

Sheet1

Critical MisuseCorrect Use

72.627.4


Almost Every Caregiver ofNewborns Makes Errors!

Data source: Hoffman BD, Gallardo AR, Carlson KF. Unsafe from the start: serious misuse of car safety seats at newborn discharge. J Pediatr. 2016;171:48–54.

Chart1

No ErrorsNo ErrorsNo Errors

1 Or More Misuse Errors1 Or More Misuse Errors1 Or More Misuse Errors

Any Errors

Positioning Errors

Installation Errors

14

277

223

197

Sheet1

Any ErrorsPositioning ErrorsInstallation Errors

No Errors14

1 Or More Misuse Errors277223197

To update the chart, enter data into this table. The data is automatically saved in the chart.


THERE ISGOOD NEWS!

Motor Vehicle Occupant Fatalities Among Children 19 and Under from 2000–2014

Source: Safe Kids Worldwide.


Source: National Safety Council. 2016.

But…


Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in theUnited States. N Engl J Med. 2018;379(25):2468–2475.


The laws of physics ALWAYS trump

the law of the land.

Wikipedia. https://en.wikipedia.org/wiki/Albert_Einstein_in_popular_culture

Phun with Physics


Would you catch a 10-pound bowling ball dropped from a 3rd story window?

F = MA

Force = 10 lb x (32 feet/sec)/(.94sec)

330 lb of momentum


Stops in 1 second

Acceleration = 45 feet/sec/sec

A car traveling at 30 MPH hits a tree…

10-pound child

Momentum = 10 lb (45 feet/sec/sec) = 450 lb


It is ALL about The Force


More About Force1. A body in motion

stays in motion until some opposing force causes it to stop.

2. Energy is preserved.Human Tissue + Energy =

Injury

Portrait of Isaac Newton circa 1689. Public domain via Wikimedia Commons.


Video


F = MAF = (kg)(m/s/s)

We must learn tocontrol the force!


More About Force

1. Force per unit of area is key.

2. Minimize acceleration into the impact.


5 Ways Restraints Prevent Injury

Prevent ejection.

Allow body to “ride down” with vehicle.

Contact the strongest body parts.

Distribute force over most extensive area.

Protect the head, neck, and spinal cord.


Kids Are Not Little Adults


Why are kids

different?


Kids lack anterior superior iliac

spines


Submarining


Abdominal Organs

Source: A.D.A.M. Interactive Anatomy. Available at http://aia5.adam.com/content.aspx?productId=117&pid=1&gid=001135

Source: Graph Diagram. Available at http://graphdiagram.com/male-anatomy-pictures/


Seat Belt Syndrome

Intra-abdominal injuries Contusions Spinal injuries


CervicalSpine

~40% of all C-spine injuries in children


Why are kids

different?

Vehicle beltsystems are designed for

adults!


Basics of Best Practice 1. Location

o Rear seat is best until 13 years

2. Directiono Rear-facing vs. forward-facing

3. Selectiono Pick the best method/device for a childo Manufacturer limits

4. Installationo Know the basicso Know the resources in your communityo Follow specific manufacturer instructions


American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788–793.

2011 AAP Policy Statement


Benjamin Disraeli. AZQuotes.com, Wind and Fly LTD, 2019. https://www.azquotes.com/quote/79239, accessed August 13, 2019.


McMurry TL, Arbogast KB, Sherwood CP, et al. Rear-facing versus forward-facing child restraints: an updated assessment. Inj Prev. 2018;24(1):55–59.


Durbin DR, Hoffman BD, and AAP Council on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5):e20182460.


2011 2018


Durbin DR, Hoffman BD, American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5):e20182460.

Algorithm to Guide Implementation of Best Practice Recommendations for Optimal Child Passenger Safety


Durbin DR, Hoffman BD, American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5):e20182460.


2019 Best Practices

No more 5X safer to age 2

No data specifying age 2

Source: Centers for Disease Control and Prevention. https://www.cdc.gov/features/passengersafety/index.html


Type Direction

LowerWeightLimit(lb)

Weight Limit(lb)

Length Limit (in)

InfantCarrier Rear Only 3, 4, 5 22–35 29–35

ConvertibleRear Then

Forward3, 4, 5 30–50 43–49

Rear-Facing Seats


Most infants will outgrow rear-facing

only seats by length, not

weight!

Growth chart developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). Modified 4/20/01. https://www.cdc.gov/growthcharts


Timing for Turnaround Varies



Why Rear-Facing?


This photo illustrates how a rear-facing car safety seat can cocoon and protect a child,compared to a forward-facing seat, in a crash.


What about the legs?

3 yr, 32 lb, 36 in


Arms and Legs Are Safer Rear-Facing!

National Automotive Sampling System Crashworthiness Data System


Rear-Facing Take Home

Best Practice:Rear-facing as long as possible,

up to the limit of the seat

Key Time Points:Birth, 6, 9, and 12–24 months


Forward-Facing Seats

Type DirectionLower Weight

(lb)

Higher Weight

(lb)

Convertible Rear then Forward 20 40, 50, 65, 80+

Combination Forward only(Booster) 20 40, 50, 65, 80+

3-1 Rear/Forward/Booster 2040, 50,

65


When Do Kids Exceed Limits?



Forward-Facing Take HomeBest Practice:

Forward-facing harness as long as possible,up to the limits of the seat

AT A MINIMUM:4–8 years

Key Time Points:4–10 years


Belt PositioningBooster Seat

TypeLower Weight

Limit(lb)

Higher Weight

Limit(lb)

Belt PositioningBooster

30, 40 80–105

Combination/3-1 30, 40 80, 100, 120


Belt Positioning Booster Seat


Is There a Time That Belts Fit?



Step 4 –Seat Belt


It’s All About the Fit!


Misused Seat Belt


Correct Seat Belt 1. Sitting upright

o Back against vehicle seat

2. Legs bend comfortably

3. Shoulder belt across clavicle and sternum

4. Lap belt low across hipso Not resting on abdomen

5. Child can sit that way the entire ride


Booster/Seat Belt Take Home

Best Practice:Booster until seat belt fits correctly

AT A MINIMUM:8–12 years/4’9”

Key Time Points:8–?


The Best Seat

Fits the child

Fits the car

Can be used correctly every ride


Installation


FIND EXPERT RESOURCES IN

YOUR COMMUNITY!

Public Safety Officers

MAY NOT BE CERTIFIED!


You can easily find Certified Child

Passenger Safety Technicians

in your community.

www.seatcheck.orgwww.nhtsa.gov

www.safekids.org1-866-Seat-Check


AAPCar Seat Guide


THE TAKE HOME MESSAGE:

Just because you can, doesn’t mean you should…

Delay car safety seat transitions as long as possible!


Questions?


Take Home Messages Best practice based on real world physics Delay transitions

o Lose relative protection every step

Rear-facing to weight/height limit of seato Rear-facing until at least 2 years

Forward-facing until weight/height limit of seato Forward-facing in a harness until at least age 4

Belt positioning booster seat until seat belt fits correctlyo Generally 4 years to 8–12 years

• Depends on child and vehicle Rear seat until at least 13 years of age


Thank you


Share the latest AAP car safety seat guidelines, including new recommendations for rear-facing riders, with the families in your care. Car Safety Seats: 2019 Guide for Families helps parents make informed decisions about car safety seat selection and use.

Included in this 49-page, annually updated brochure, is information on the various types of car safety seats (installation tips and common questions), LATCH attachment system, airbags, and lap and shoulder seat belts, plus feature comparisons of more than 225 car safety seats, belt-positioning booster seats, and travel vests!

Available for purchase at:shop.aap.org/car-safety-seats-2019-guide-for-families-50pk-brochure


Visit Pediatric Care Online today for additional information on this and other topics.

pediatriccare.solutions.aap.orgPediatric Care Online is a convenient electronic resource for immediate expert help with

virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools.

Don’t have a subscription to PCO?Then take advantage of a free trial today!

Call Mead Johnson Nutrition at 888/363-2362or, for more information, go to

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Slide Number 1Disclaimers & DisclosuresSlide Number 3Slide Number 4Slide Number 5Objectives Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Not All Kids Ride RestrainedSlide Number 13Slide Number 14Car Safety Seats Are Hard To Use CorrectlySlide Number 16THERE IS�GOOD NEWS!Slide Number 18Slide Number 19Slide Number 20Slide Number 21A car traveling at 30 MPH hits a tree…Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Kids Are Not Little AdultsSlide Number 31Slide Number 32SubmariningAbdominal OrgansSeat Belt SyndromeCervical�SpineSlide Number 37Slide Number 38Slide Number 39Basics of Best Practice Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 482019 Best PracticesRear-Facing SeatsMost infants will outgrow rear-facing only seats by length, not weight!Timing for Turnaround VariesWhy Rear-Facing?Slide Number 54What about the legs?Slide Number 56Rear-Facing Take Home Forward-Facing SeatsWhen Do Kids Exceed Limits?Forward-Facing Take HomeBelt Positioning�Booster SeatBelt Positioning Booster SeatSlide Number 63Is There a Time That Belts Fit? Step 4 –�Seat BeltIt’s All About the Fit!Misused Seat BeltCorrect Seat Belt Booster/Seat Belt Take Home The Best Seat InstallationInstallation FIND EXPERT RESOURCES IN YOUR COMMUNITY!Slide Number 74Slide Number 75Slide Number 76THE TAKE HOME MESSAGE:Slide Number 78Take Home MessagesSlide Number 80Slide Number 81Slide Number 82

confessions of a car seat junkie - aap point-of-care-solutions · 2019-08-29 · of child passenger...

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