Talking to Your Patients' Families About Car Seat Safety

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Even though child safety seats and booster seats are proven to save lives, National Highway Traffic Safety Administration research shows that three out of four child safety seats are incorrectly installed. Here we provide you with valuable information to discuss this issue with parents.

New Advice

The American Academy of Pediatrics (AAP) has new suggestions for parents of low-birth weight infants, infants born prematurely and toddlers.

• For the best protection, keep children in a rear-facing car seat longer than previously recommended. Recent research suggests that toddlers through 23 months who ride rear facing in a car safety seat are more than five times safer than those in the same age group who ride in forward-facing seats.
• A new AAP clinical report, "Safe Transportation of Preterm and Low-Birth Weight Infants at Hospital Discharge," suggests that preterm and low-birth weight infants and other infants at risk for adverse cardiorespiratory events or episodes of apnea should have a period of observation by trained hospital staff of 90 to 120 minutes in a car safety seat before hospital discharge. Parents should also be advised that car safety seats should be used only for travel. You can download a copy of the report at www.aap.org.

Starting the Conversation

Just as you ask patients and parents about diet, development and exercise, car seat safety should be addressed at wellchild visits to ensure that parents use the right seats and install them correctly. While this goal is ideal, sometimes it can be a challenge, given the extensive amount of preventive care that is often discussed during these visits. Knowing where to refer parents for additional support is important.

This discussion may be most critical when parents are anticipating a change in car seats based on certain growth milestones. Here are some general guidelines for when to bring up the topic:

• During the very first newborn visit. (Talking to parents prior to delivery is ideal.)
• At 4 months — to encourage the purchase of a convertible car seat, which will allow the child to remain rear facing well into the second year of life.
• At 3 years — in anticipation of reaching 40 pounds.
• At 7-8 years — in anticipation of using a seat belt, usually when a child is between the ages of 8-12 and 4 feet 9 inches.

Proper Installation

Refer parents to a child safety seat inspection station. This is important for first-time parents and those with children graduating from one safety seat to another. Parents benefit from the educational assistance provided and are taught how to correctly install and use their seats. You can refer them to www.preventinjury.org for more information and the closest inspection stations.

Such help has proven successful. A recent journal article in Accident Analysis & Prevention showed that after just one intervention, there was a significant reduction in the number of rear-facing child safety seats (18.8 percent) and forward-facing child safety seats (64.0 percent) that had at least one misuse.

Marilyn Bull, MD
Morris Green Professor of Pediatrics,
Indiana University School of Medicine
Kohl’s Center for Safe Transportation of
Children, Riley Hospital for Children
317-274-4846
mbull@iupui.edu