How Does Child Size Fit In? Michelle L. Macy, MD, MS Departments of - - PowerPoint PPT Presentation

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How Does Child Size Fit In? Michelle L. Macy, MD, MS Departments of - - PowerPoint PPT Presentation

Sep 04, 2022 128 likes •791 views

The Latest in Child Passenger Safety: How Does Child Size Fit In? Michelle L. Macy, MD, MS Departments of Emergency Medicine and Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, and The Injury Center University of Michigan, Ann

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The Latest in Child Passenger Safety: How Does Child Size Fit In?

Michelle L. Macy, MD, MS

Departments of Emergency Medicine and Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, and The Injury Center University of Michigan, Ann Arbor, MI

Preventing Injury: From Research to Practice to People September 30, 2013

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Conflicts of Interest & Disclosures

  • Dr. Macy has no conflicts of interest or

financial relationships to disclose

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Outline

  • Why I care about child passenger safety
  • How the new recommendations “fit” in
  • What I have learned about disparities
  • Where we can focus on improving use
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A newborn and an NPR story

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Passenger vehicle child occupant deaths per million children, 1975-2011

1st Child Passenger Restraint Law 1st Seat Belt Law Rear-seat Shoulder Belts Air Bags 1st Booster Seat Law

Insurance Institute for Highway Safety analysis of U.S. Department of Transportation Fatality Reporting System. http://www.iihs.org/research/fatality.aspx?topicName=Child-safety accessed July 30, 2013

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Child Passenger Safety

Times have Changed

http://www.weaselsjourney.com/2010_01_01_archive.html http://auto.howstuffworks.com/car-driving- safety/safety-regulatory-devices/child-car-seat1.htm

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Injuries Remain a Problem

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Motor Vehicle Occupant Non-Fatal Injury Rate per 100,000 Population

CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the U.S., 2000-2006. NN Borse et al, 2008

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5 pounds 20 pounds 30 pounds 40 pounds 50 pounds 60 pounds 70 pounds 80 pounds Infant-only seat, rear-facing, never in front seat with passenger-side airbag Convertible safety seat, rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to max weight/height allowed by seat Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies Forward-facing seat with internal harness, weight varies Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning booster seat with lap/shoulder belt (>35-40 lb) as long as child fits Belt-positioning booster seat with lap/shoulder belt as long as child fits 2002 AAP Guidelines – Selecting and using the most appropriate car safety seats for growing children.

The safest place in a vehicle for all children is in the rear seat.

Rear-Facing Car Seat to 1 year and 20 pounds Forward-Facing Car Seat to 4 years and 40 pounds Booster Seat to 8 years and 80 pounds Retired Guidelines – American Academy of Pediatrics 2002

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5 pounds 20 pounds 30 pounds 40 pounds 50 pounds 60 pounds 70 pounds 80 pounds Infant-only seat, rear-facing, never in front seat with passenger-side airbag Convertible safety seat, rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to max weight/height allowed by seat Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies Forward-facing seat with internal harness, weight varies Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning booster seat with lap/shoulder belt (>35-40 lb) as long as child fits Belt-positioning booster seat with lap/shoulder belt as long as child fits 2011 AAP Guidelines for Child Passenger Safety

– Policy Statement originally published online March 21, 2011

The safest place in a vehicle for all children is in the rear seat.

Updated Guidelines – American Academy of Pediatrics 2011

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5 pounds 20 pounds 30 pounds 40 pounds 50 pounds 60 pounds 70 pounds 80 pounds Infant-only seat, rear-facing, never in front seat with passenger-side airbag Convertible safety seat, rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to max weight/height allowed by seat Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies Forward-facing seat with internal harness, weight varies Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning booster seat with lap/shoulder belt (>35-40 lb) as long as child fits Belt-positioning booster seat with lap/shoulder belt as long as child fits

The safest place in a vehicle for all children is in the rear seat.

Updated Guidelines – American Academy of Pediatrics 2011

Infant-only or convertible child safety seat used rear-facing until 2 years of age or until they reach the highest weight or height limit allowed by the seat manufacturer Convertible or combination child safety seat used forward-facing for as long as possible [children 2 years of age and older (or those less than 2 years old who have outgrown their seat’s rear-facing weight or height limit)] Booster seat for all children whose weight or height is above the forward-facing limit for their child safety seat until the vehicle lap and shoulder belt fits properly

2011 AAP Guidelines for Child Passenger Safety

– Policy Statement originally published online March 21, 2011 Images for child safety seats used with permission from the Children’s Hospital of Philadelphia Center for Injury Research and Prevention

The safest place in a vehicle for all children is in the rear seat.

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Rear-Facing Car Seats

Infant-Only/Infant Carrier Convertible

GENERAL REAR-FACING CAR SEAT FIT TIPS

  • Harness strap fed through slots that are AT OR BELOW the top of the child’s shoulder
  • Child’s head should be at least 1 inch below the top of the car seat shell
  • Child must be under the rear-facing maximum weight limit
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Upper Weight Limits for Rear-Facing Car Seats

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Most Rear-Facing Car Seats Above 30 pounds

3 of 62 seats 45# max 11 of 62 seats 22# max 30 of 62 seats 30-35# max 18 of 62 seats 40# max

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Size Range for Rear-Facing Car Seats

22 pounds 30-35 pounds 40 pounds 45 pounds

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Forward-Facing Car Seats

Convertible Combination

GENERAL FORWARD-FACING CAR SEAT FIT TIPS

  • Harness strap fed through REINFORCED slots that are AT OR ABOVE the top of the shoulder
  • Top of the child’s ears should be below the top of the car seat shell
  • Child must be under the forward-facing maximum weight limit
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Weight Limits for Forward-Facing Car Seats

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Forward-Facing Car Seats Minimum Weight

1 of 42 seats 25# min 23 of 42 seats 20# min 18 of 42 seats 22# min

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21% Forward-Facing Car Seats Max 70-80 Pounds

9 of 42 seats 70-80# max 8 of 42 seats 40# max 4 of 42 seats 50# max 21 of 42 seats 65# max

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Size Range for Forward-Facing Car Seats

40 pounds 50 pounds 65 pounds 70-80 pounds

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A NOTE ON LATCH: LOWER ACHORS in most vehicles have a 40 to 48 pound weight limit Children at this weight should have their car seat secured using the seat belt The TOP TETHER SHOULD* STILL BE USED when the car seat is installed with a seat belt *BUT families need to confirm with both vehicle and car seat owner’s manuals

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Booster Seats

Combination High-Back Backless

GENERAL BOOSTER SEAT FIT TIPS

  • Until the child has proper seat belt fit without a booster seat
  • Child must be under the maximum weight limit
  • NOTE: some booster seats use LATCH but the seat belt does the work of securing the child
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Weight Limits for Booster Seats

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Booster Seats MINIUMUM Weight Limits

26 of 73 seats 30# min 4 of 73 seats 33# min 43 of 73 seats 40-50# min

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23% Booster Seats Max 120-125 Pounds

17 of 73 seats 120-125# max 4 of 73 seats 80# max 52 of 73 seats 100-110# max

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Size Range for Booster Seats

80 pounds 100 pounds 120-125 pounds

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Hey Mom! When are we going to get there? And WHEN CAN I GET OUT OF THIS BOOSTER SEAT?

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Geometry of Seat Belts and Child Anthropometry

Bilston LE, et al. October 2007

30% of shoulder belts fit 6-8 year olds

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Examples of Belt Fit

Good Belt Fit Bad Belt Fit

Images from: http://www.iihs.org/research/topics/boosters/default.html

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Height and Booster Seats

<8 years

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Overlap Size & Child Safety Seats

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Data Source

  • National Survey of the Use of Booster Seats

– 2007, 2008, 2009 (21,000+ child passengers) – Cross-sectional study conducted by the National Highway Traffic Safety Administration (NHTSA)

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Data Source

  • National Survey of the Use of Booster Seats

– 2007, 2008, 2009 (21,000+ child passengers) – Cross-sectional study conducted by the National Highway Traffic Safety Administration (NHTSA)

  • Direct observation of restraint use among child

passengers who appeared <13 years

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Data Source

  • National Survey of the Use of Booster Seats

– 2007, 2008, 2009 (21,000+ child passengers) – Cross-sectional study conducted by the National Highway Traffic Safety Administration (NHTSA)

  • Direct observation of restraint use among child

passengers who appeared <13 years

  • Arriving at gas stations, fast food restaurants, day care

centers, recreation centers

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Data Source

  • National Survey of the Use of Booster Seats

– 2007, 2008, 2009 (21,000+ child passengers) – Cross-sectional study conducted by the National Highway Traffic Safety Administration (NHTSA)

  • Direct observation of restraint use among child

passengers who appeared <13 years

  • Arriving at gas stations, fast food restaurants, day care

centers, recreation centers

  • Probability sample of sites in 16 geographic areas
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Variables

  • Child Age (driver report)

– Age categories: <1 year; 1 to 3 years; 4 to 5 years; 6 to 7 years; 8 to 10 years; 11 to 12 years

  • Race/ethnicity (driver report)

– Non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other race

  • Number of passengers (direct observation)

– Seat location and restraint use

  • up to 9 passengers in the first 3 rows
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Variables

  • Driver Age
  • Driver Restraint Use
  • Vehicle Type
  • Region
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Restraint Use by Race/Ethnicity for Each Age Group

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

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Age-Appropriate Restraint Use by Race/Ethnicity: <1 Year Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

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Overall Restraint Use by Race/Ethnicity: <1 Year Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

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Target for Rear-Facing Car Seat Use <1 Year Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

HP2020 Objective: Increase Rear-Facing Car Seat Use to 95%

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Age-Appropriate Restraint Use by Race/Ethnicity: 1 to 3 Years Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

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Overall Restraint Use by Race/Ethnicity: 1 to 3 Years Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

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Target for Forward-Facing Car Seat Use 1 to 3 Years Old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rear-facing Forward-facing Booster/Belt Unrestrained White Black Hispanic Other

HP2020 Objective: Increase Forward-Facing Car Seat Use to79%

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Age-Appropriate Restraint Use by Race/Ethnicity: 4 to 5 year olds

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat Booster Seat Belt Unrestrained White Black Hispanic Other

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Overall Restraint Use by Race/Ethnicity: 4 to 5 year olds

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat Booster Seat Belt Unrestrained White Black Hispanic Other

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Target for Booster Seat Use 4 to 5 year olds

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat Booster Seat Belt Unrestrained White Black Hispanic Other

HP2020 Objective : Increase Booster Seat Use to 47%

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Age-Appropriate Restraint Use by Race/Ethnicity: 6 to 7 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

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Overall Restraint Use by Race/Ethnicity: 6 to 7 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

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Target for Booster Seat Use 6 to 7 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

HP2020 Objective : Increase Booster Seat Use to 47%

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Overall Restraint Use by Race/Ethnicity: 8 to 10 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

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Target for Seat Belt Use 8 to 10 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

HP2020 Objective : Increase Seat Belt Use to 86%

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Overall Restraint Use by Race/Ethnicity: 11 to 12 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

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Target for Seat Belt Use 11 to 12 years old

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Car Seat/Booster Seat Belt Unrestrained White Black Hispanic Other

HP2020 Objective : Increase Seat Belt Use to 86%

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Unrestrained Findings

  • Unrestrained children more likely to be

– With an unrestrained driver – Sitting in the front seat – Older than 3 years – In a vehicle with 4 or more child passengers – Minority race/ethnicity

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Sitting in the Front Seat by Age and Race/Ethnicity

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-3 years old 4-5 years old 6-7 years old 8-10 years old 11-12 years old White Black Hispanic Other

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Sitting in the Front Seat by Age and Race

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-3 years old 4-5 years old 6-7 years old 8-10 years old 11-12 years old White Black Hispanic Other

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Front Seat Findings

  • Children in the front were more likely to be

– With an unrestrained driver – Hispanic ethnicity – Older than 5 years of age

  • Children were less like to be in the front if

– There were 3 or more child passengers

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Discussion

  • Age-appropriate child restraint use in the

United States is below targets

– Few children were rear-facing after age 1 – Less than 2% of children older than 7 years used a booster seat – More than one in four children older than age 7 years were sitting in the front seat

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Discussion

  • There are gaps in age-appropriate restraint use

between white and nonwhite

  • Disparities are most concerning for unrestrained

minority children

  • Reasons behind the differences
  • Knowledge
  • Cultural beliefs/social norms
  • Socioeconomic factors
  • Family size

– May require targeted and tailored programs

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Limitations

  • No socioeconomic status data collected
  • Age-appropriate restraint may not match the

size-appropriate restraint

  • Restraint use at these community sites may

not reflect other settings

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Take-Away Message

  • Continue your efforts to bring restraint use up
  • Close the racial/ethnic gaps in restraint use
  • Talk with drivers about their own restraint use

and safety for older child passengers

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Resources for Providers & Parents

  • Safe Kids Worldwide – 12 Michigan Coalitions

– http://www.safekids.org/coalition/safe-kids-michigan

  • American Academy of Pediatrics

– http://www.healthychildren.org (On the Go) – http://www2.aap.org/sections/ipp/CPSCurriculum.cfm (online Child Passenger Safety Curriculum)

  • National Highway Traffic Safety Administration

– www.safercar.gov (Parents Central)

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Questions?

Contact Information

Michelle L. Macy, MD, MS Departments of Emergency Medicine and Pediatrics Child Health Evaluation and Research (CHEAR) Unit University of Michigan Email: mlmacy@umich.edu Phone: 734.936.8338 www.chear.org