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The Healthcare Provider’s Role in Child Passenger Safety

The Healthcare Provider’s Role in Child Passenger Safety. PA Chapter American Academy of Pediatrics Traffic Injury Prevention Project. Goals of Program. Explain the Pennsylvania laws concerning child passenger safety. Describe “best practice”

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The Healthcare Provider’s Role in Child Passenger Safety

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  1. The Healthcare Provider’s Role inChild Passenger Safety PA Chapter American Academy of Pediatrics Traffic Injury Prevention Project

  2. Goals of Program Explain the Pennsylvania laws concerning child passenger safety. Describe “best practice” concerning child safety seats. List key educational messages regarding proper use of child restraints.

  3. Child Passenger Safety Law All drivers are responsible for securing children in the appropriate child restraint system. • All children from birth up to age 4 must be secured in an approved child safety seat anywhere in the vehicle. Violators of this primary law are subject to a fine of $75.00 plus Court Costs, EMS, MCARE, and Administrative Fees. Total cost $161.00 • All children age 4 up to age 8 must be secured in a seat belt system and appropriate child booster seat anywhere in the vehicle. Violators of this primary law are subject to a fine of $75.00 plus Court Costs EMS, MCARE and Administrative Fees. Total cost $161.00 • All children age 8 up to age 18 must be secured in a seat belt system anywhere in the vehicle. Violators of this primary law are subject to a $10 fine plus EMS, MCARE, and Administrative Fees. Total cost $60.00 According to the law (§ 4581. Restraint systems)—subsection Occupant Standards A child passenger restraint system and a child booster seat shall be used as designated by the manufacturer of the system in motor vehicles equipped with seat safety belts and shall meet the Federal Motor Vehicle Safety Standard. Children between the ages of 8 and 18: Must be properly restrained in a vehicle seat belt system.

  4. Hospitals Role in CPS PA Vehicle Code Section 4583 (a) Availability of restraint devices – the hospital, in conjunction with the attending physician, shall provide the parents of any newborn child with any information regarding the availability of loaner or rental programs for child restraint devices that may be available in the community where the child is born. (b) Instruction and education programs –The department shall provide instructional and educational program materials through all current public information channels and to all relevant State and Federally funded, community based programs for maximum distribution of information about this child passenger protection law.

  5. Why Are We Here? Traffic crashes are still the leading cause of unintentional deaths and severe injuries in the United States. Only diseases like cancer, heart disease, and stroke kill more people than motor vehicle crashes. Every day in the United States, an average of 4 children age 14 and younger were killed and 490 were injured in motor vehicle crashes during 2009.

  6. NHTSA Statistics / CRS Use NHTSA 2009 Survey Restraint use for children age 1 to 3 years increased from 92 % in 2008 to 96 % in 2009 Restraint use for all children under age 13 remained unchanged at 89% Note: Restraint use for all children from birth to 7 years old stood at 88 percent in 2009 as compared to 87 percent in 2008 from the 2009 National Occupant Protection Use Survey (NOPUS) 41 percent of 4 to 7 year-old children ride in booster seats Virtually unchanged from the prior year. .

  7. 2010 PA Crash Facts CRS As shown below (2006-2010 crashes involving children under age four), the % of deaths and injuries (within restraint type by row) were lower when restraints were used. From 2006-2010, 82% of the children under age four who were involved in crashes and restrained in a child seat sustained no injury.

  8. 2009 PA Child Traffic Fatalities Age 14 and under by Age Groups <1 - 2 1 - 3 years - 3 4 - 7 years - 12 8 - 14 years -15 Total Child Traffic Fatalities 14 & under = 32

  9. Fatalities & Injuries Fatalities are just the tip of the iceberg: For every 1 death there are: 45 injuries requiring hospitalization and 1100 other injuries requiring medical care.

  10. Three Collisions in a Crash 1st: Vehicle collision 2nd: Human collision 3rd: Internal collision 1st 2nd 3rd

  11. Child Restraint Effectiveness 71% effective in reducing deaths for infants. 54% for 1 to 4 year olds. Reduces the need for hospitalization by 69%.

  12. 5 Ways Restraints Prevent Injury Prevents ejection. Contacts the strongest parts of the body. Spread forces over a wide area of the body. Helps the body to “ride down” the crash. Protects the head and spinal cord.

  13. NEW AAP Guidelines for Car Seat Use • All infants and toddlers should ride in a rear facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by their car seat's manufacturer. • All children 2 years or older, or those who have outgrown the rear facing weight or height limit for their car safety seat, should use a forward facing car safety seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat's manufacturer. • All children whose weight or height is above the forward facing limit for their car safety seat should use a belt positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 ft 9 inches in height and are between 8 & 12 years old. • When children are old enough and large enough to use the vehicle seat belt alone, they should use a lap and shoulder belt.  All children younger than 13 should be restrained in the rear seat of the vehicle.

  14. Algorithm AAP Policy Released March, 2011

  15. NHTSA New Guidelines

  16. Selecting the Correct Child Restraint Correct selection is based on the child’s: Age Weight Height Physical Development Behavioral Needs

  17. Rear Facing Position “All infants and toddlers should ride in a Rear Facing Car Safety Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer.”

  18. Rear Facing Only (Infant Seat) Rear facing ONLY. Birth/4-5 pounds to 20 – 22 (most models) or 30/35 pounds. When the head is 1” below top of shell. Chicco Key Fit 4-30lbs with newborn/preemie insert

  19. Rear Facing Talking Points Never place a rear facing car seat in front of an active passenger side air bag (front seat). Until age 2, children are at least 75% safer rear-facing than forward-facing. Article Injury Prevention 2007; 13: 398-402 Car Safety Seats for children: rear facing for best protection Children in the second year of life (12-24 mos.) are over 5 times less likely to be seriously injured or die in a crash if riding rear facing. Article Injury Prevention 2007; 13: 398-402 Follow manufacturers instructions for using and installing car seat at the appropriate angle.

  20. Rear Facing & Forward Facing Crash Tests Rear Facing video Forward Facing video

  21. Development of the neck vertebrae

  22. Rear Facing Only (Infant Seat) Supports entire head, neck & back, reducing stress to neck and spine in a crash. May have a 5-point or V-harness. Some have a detachable base. Check instructions for angle and angel indicator

  23. Rear Facing Convertible Rear facing until 20 to 30/45 lbs and a minimum of one year old. Use in a semi-reclined position. Tray not appropriate for premature or small infant. Tray Shield Five Point Harness

  24. Convertible Seats RF Longer Nearly every convertible seat on the market has a 30/35lbs rear facing max. weight limit. These are only three examples of convertible seats that can be used rear-facing to 40 or 45lbs Diono Radian 100, 120 & RXT 40 & 45lbs RF models Graco My Ride 65 Safety Surround 40lbs RF Safety First Complete Air 40lbs RF

  25. Securing Child In Rear Facing Seats Back & bottom flat into CRS. Rolled cloth at crotch strap, if necessary. Rolled blankets at sides for positioning. Harness at or below the shoulders. Retainer clip at armpit level. Always follow the manufacturer’s instructions.

  26. AAP Strengthens Long Standing Advice • The AAP has strengthened its advice that CRs and other sitting devices are not recommended for routine sleep for infants • They have included the warning that infants younger than 4 months are particularly at risk in these seating environments because they “might assume positions that can create risk of suffocation or airway obstruction.”

  27. Pinch Test Test at child’s shoulder Try to pinch webbing up and down Your fingers should slide off Harness straps are too loose

  28. Rear-Facing Back Angle • Back is primary restraint • Balance with comfort and keeping airway open • Range - 30o to 45o- according to manufacturer’s instructions • Newborns more reclined • More upright as child grows • Car bed option for special needs

  29. Forward Facing Position “All children 2 years or older, or those younger than 2 who have outgrown the rear facing weight or height limit of their car safety seat should use a Forward Facing Car Safety Seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat’s manufacturer.”

  30. Forward Facing Convertible “Turn Around Time” Can forward face (after minimum of 1 year and 20 lbs.), longer if seat allows up to 30-35/45 lbs. Starting at 18-24 months in age. Most seats have harnesses that go up to 40lbs. Some car seats have harnesses up to 65 lbs. Seat in upright or semi-upright position. Adjust recline angle to upright Always follow the manufacturer’s instructions.

  31. Forward Facing Convertible Seat Harness: 5-Point (recommended) Tray Shield Harness in the reinforced slots at or above shoulders. Generally, must use top slots when forward facing.

  32. Forward Facing Only Seats Forward facing for children over 1 year and 20 to 40-65 lbs. Some HW models may even go to 80 lbs. (Seat shown) Some can ONLY be used with the harness. Some have a removable harness. Britax Regent FF min 1yr. 22lbs to 80lbs. 53” or less

  33. Forward Facing Combination Seats Combination child safety seat / boosters: Forward facing only. Most have a 40 pound weight limit for the internal harness. Some car seats may accommodate higher weights, 50-65lbs. Must remove the harness and use with lap and shoulder belt for the BPB when reach max. harness weight or height. Combination Harness/BPBHarness to 70lbs and a booster to 120lbs.

  34. Harness Rules: Forward 1. Slots: Convertible Seats: Top slot or above the reinforcement bar. Forward Facing Only Seats: First level at or above the shoulders. 2. Harness Retainer Clip: Armpit or Mid-chest level. 3. Tightness: SNUG Should not be able to pinch any slack in the harness.

  35. Four Elements to Achieve a Correct Installation Direction – Rear facing vs forward facing. Location in the vehicle. Children are 37% less likely to die when seated in a back seat. Seat selection is based on the needs of all passengers. Correct belt path – Follow the manufacturer’s instructions. Tight Installation.

  36. LATCHLower Anchors and Tethers For Children

  37. LATCH Lower Anchor Locations in Vehicles

  38. TETHERS

  39. Why Use a Tether Strap?(Credit: Lower Anchors and Tethers for Children – 2005, Safe Ride News Publications) Tether strap can improve performance of CR when its use is recommended by the manufacturer. Reduces the forward movement and rotation of the seat Adds additional stability to CR installation

  40. Belt-Positioning Booster “All children whose weight or height is above the forward-facing limit for their car safety seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.”

  41. Booster Seats Provide a transition from CR with harness to a vehicle lap and shoulder belt. Minimum weight ranges: 30-40 lbs. Maximum weight ranges: 60-120 lbs. Max. height limits vary Backless booster High back booster

  42. Why a Booster Seat? Protects children too large for a CR with harness but too small for a simple seat belt. Increases crash protection from injuries Incorrect belt fit because there is no booster seat Correct belt fit with belt-positioning booster

  43. Basic Booster Seat Reminders WARNING: Belt-positioning booster seats can only be used with lap and shoulder combination safety belts. Belt-positioning booster seats must NEVER be used with just a lap belt. Courtesy Children’s Hospital of Philadelphia Play Video

  44. Securing Children In Booster Seats Requires Lap & Shoulder belt. BPB fits flat on vehicle seat between safety belt anchors. Lap belt positioned low across top of thighs and shoulder belt across chest. Knees bend comfortably. Child has appropriate head restraint. Shoulder belt positioners

  45. Seat Belt Syndrome Spinal cord or soft tissue damage due to: -Improper placement of lap belt over the abdomen. -Lap belt that rides up onto abdomen.

  46. Lap and Shoulder Belts “When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder Seat Belts for optimal protection.”

  47. 4. Shoulder belt crosses center collar bone and center chest. 3. Lap belt fits low on hips, touching thighs. 2. Knees bend comfortably at the edge of the seat. Seat Belts 1. Sit all the way back. 5. Must be able to stay for the entire trip.

  48. Proper Belt Fit Prevents… Courtesy Children’s Hospital of Philadelphia

  49. CHILD PASSENGER SAFETYFOR SPECIAL NEEDS

  50. AAP Policy Statement Status • Safe Transportation of Newborns at Hospital Discharge • By AAP Committee on Injury, Violence, and Poison Prevention • Published in 1999 Reaffirmed in 2003, 2006 • Safe Transportation of Premature and Low Birth Weight Infants – now a Clinical Report • By AAP Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn • Published in 1996 Released May 2009 • Selecting and Using the Most Appropriate Car Safety Seats for Growing Children: Guidelines for Counseling Parents • By AAP Committee on Injury, Violence, and Poison Prevention • Published in 2002 Under revision – completion in 2010?

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