confessions of a car seat junkie - aap point-of-care-solutions · 2019-08-29 · of child passenger...
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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
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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.
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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.
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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
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5 children per day
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“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
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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
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Belt Positioning BoosterSeats Work!
39% Reduction
59% Reduction
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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.
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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
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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.
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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
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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.
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THERE ISGOOD NEWS!
Motor Vehicle Occupant Fatalities Among Children 19 and Under from 2000–2014
Source: Safe Kids Worldwide.
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Source: National Safety Council. 2016.
But…
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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.
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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
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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
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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
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It is ALL about The Force
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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.
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Video
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F = MAF = (kg)(m/s/s)
We must learn tocontrol the force!
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More About Force
1. Force per unit of area is key.
2. Minimize acceleration into the impact.
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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.
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Kids Are Not Little Adults
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Why are kids
different?
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Kids lack anterior superior iliac
spines
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Submarining
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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/
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Seat Belt Syndrome
Intra-abdominal injuries Contusions Spinal injuries
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CervicalSpine
~40% of all C-spine injuries in children
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Why are kids
different?
Vehicle beltsystems are designed for
adults!
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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Treat with confidence. Trusted answers from the American Academy of Pediatrics.Treat with confidence. Trusted answers from the American Academy of Pediatrics.
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
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American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788–793.
2011 AAP Policy Statement
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Benjamin Disraeli. AZQuotes.com, Wind and Fly LTD, 2019. https://www.azquotes.com/quote/79239, accessed August 13, 2019.
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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.
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Durbin DR, Hoffman BD, and AAP Council on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5):e20182460.
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2011 2018
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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
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Durbin DR, Hoffman BD, American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2018;142(5):e20182460.
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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
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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
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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
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Timing for Turnaround Varies
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
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Why Rear-Facing?
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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.
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What about the legs?
3 yr, 32 lb, 36 in
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Arms and Legs Are Safer Rear-Facing!
National Automotive Sampling System Crashworthiness Data System
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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
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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
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When Do Kids Exceed Limits?
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
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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
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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
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Belt Positioning Booster Seat
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Is There a Time That Belts Fit?
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
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Step 4 –Seat Belt
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It’s All About the Fit!
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Misused Seat Belt
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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
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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–?
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The Best Seat
Fits the child
Fits the car
Can be used correctly every ride
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Installation
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Installation
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FIND EXPERT RESOURCES IN
YOUR COMMUNITY!
Public Safety Officers
MAY NOT BE CERTIFIED!
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You can easily find Certified Child
Passenger Safety Technicians
in your community.
www.seatcheck.orgwww.nhtsa.gov
www.safekids.org1-866-Seat-Check
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AAPCar Seat Guide
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THE TAKE HOME MESSAGE:
Just because you can, doesn’t mean you should…
Delay car safety seat transitions as long as possible!
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Questions?
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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
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Thank you
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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
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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