Buckle Up! Buckle Up!

Buckle Buckle Up! Up! Advocacy AM Report Duty and Szalkowski-Lehane 11/4/09

Case • 11mos old girl, follow up from MVA one week ago • Taken to ED by EMS- some scratches and bruising, but sent home • Now well appearing, playing and interacting appropriately • Scratches/ bruises are largely healed.

Case • What more do you want to know? • What counseling would you provide?

Statistics • 2005, 1,335 children ages 14 years and younger died as occupants in motor vehicle crashes • Approximately 184,000 were injured. • Among children under age 5, in 2006, an estimated 425 lives were saved by car restraint systems

– Properly used car seats are 71% effective at preventing fatalities

CDC national center for injury prevention and control

Statistics • Almost 40% of children riding with unbelted drivers were themselves unrestrained. • Child restraint systems are often used incorrectly • Approximately 73 percent showed at least one critical misuse.

CDC national center for injury prevention and control

Utah Restraint Laws • All motor vehicle passengers required to wear a seat belt – Primary offense for age 18 and younger • Fine not more than $45

– First offense dismissed if provide proof of acquiring a car seat or child restraint

– Secondary offense for age 19 and older • Fine of $45

– Reduced to $15 if complete a traffic safety class

www.utcodes.org

Child Restraint Laws • Children age 4 and under must be in an approved child safety seat • Children aged 4-8 must be in an approved booster seat • Children age 8-18 must be in an approved booster seat OR seat belt

www.utcodes.org

Child Safety Seats • Rear facing until 1 year of age AND 20 pounds • Forward-facing car seat between 1-4 years and 20-40 pounds • Children between 4-8 years and 40-80 pounds should use a booster seat with the shoulder and lap belt

– Children under age 8 do not need a booster seat if at least 57” tall (4’ 9”)

• Children should sit in the back until at least 12 yrs of age

www.utahsafetycouncil.org

The Case for Rear Facing Car Seats • Compared the injury risk between rear-facing (RFCS) and forward-facing (FFCS) car seats for children less than 2 years of age • Children in FFCSs were significantly more likely to be seriously injured than children restrained in RFCSs in all crash types • Effectiveness estimates for RFCSs were found to be 15% higher than those for FFCSs Henary et al., Inj Prev. 2007 Dec

So many types… • Rear-facing • Convertible • 5 point strap vs Overhead shield 5-point harness— attach at the shoulders, at the hips, and between the legs

Overhead shield— a padded tray-like shield that swings down over the child

Installation • Install tightly in the vehicle and ensure the harness fits snugly. • If you can move the seat more than an inch side to side or front to back, it’s not tight enough. • Correct angle • Proper belt path for reverse vs forward • 1-866-seat-check

Installation • LATCH system

– Lower Anchors and Tethers for Children – Eliminates need to use belts – Anchors in back seat for use with compatible car seats – Most cars & car seats after Sept 1, 2002 – Cannot use both LATCH and belt.

The Case for Booster Seats • Compared booster to seat belt-only in ages 4-7yrs • Assessed pattern of injury • The odd’s of injury were 59% less for kids in boosters • While in boosters kids had no injury to abdomen, neck, spine, back or lower extremities

Exemptions • Buses, car models 1966 and older • If there are no shoulder belts, then children more than 40 pounds may use the lap belt only without a booster seat • Physician’s note stating the child is unable to wear a seat belt for medical reasons

Most Common Car Seat Mistakes

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Not using the car seat every time

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Using old car seats, none>6 yrs old

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MVAs are leading cause of death for children in the US

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No manufacturer instructions Old plastic is brittle Accident history

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Do not use secondhand car seats unless the original instructions booklet and manufacturer’s date and model number are on the car seat

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Turn forward-facing too soon

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Removing from booster seat too soon

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Child doesn’t fit or is bored

Max 100 pounds for some booster seats

www.utahsafetycouncil.org

Common Mistakes •

Car seat installed/used incorrectly – Read manufacturer’s instructions – Car seat not strapped down tightly, harnesses too loose, retainer clip too low – Car seat not buckled into the car

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Not using a locking clip – Cars pre-1996 may not have locking seat belts

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Holding a child in parent’s lap

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Child riding in front seat – Never place a rear-facing car seat in the front seat with an air bag present

What if I was just in an accident?

• Replace a car seat that has been involved in a MVA unless... – Seats that were in a minor crash may still be safe to use. The NHTSA considers a crash minor if all of the following are true:

• The vehicle could be driven away from the crash. • The vehicle door closest to the car safety seat was not damaged. • No one in the vehicle was injured. • The air bags did not go off. • You can’t see any damage to the car safety seat.

www.nhtsa.dot.gov

Happy Children in Car Seats • • • • • •

Start early Be consistent Use encouraging words and a caring voice Set a good example Take along a “travel bag” Properly fitting car seat

Car Seat Check Points • 662-CARS

Bottom Lines

• Check manufacturer recommendations • Car seats save lives, but need to be installed properly – Rear-facing is safest

• Car seats are complicated • Remember the rules: – 1 and 20 – 1-4 and 20-40 – 4-8 and 40-80

Sources • • • • •

http://www.utcodes.org/TrafficSafety/Safety Restrain http://www.utahsafetycouncil.org/safety resources/buc http://www.nhtsa.dot.gov/people/injury/childps/ChildRe http://www.aap.org/family/carseatguide.htm Henary B, Sherwood CP, Crandall JR, Kent RW, Vaca FE, Arbogast KB, Bull MJ. Car safety seats for children: rear facing for best protection. Inj Prev. 2007 Dec;13(6):398-402.