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

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

Conflicts of Interest & Disclosures • Dr. Macy has no conflicts of interest or financial relationships to disclose

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

A newborn and an NPR story

Passenger vehicle child occupant deaths per million children, 1975-2011 1 st Child Passenger Restraint Law 1 st Seat Belt Law Rear-seat Shoulder Belts Air Bags 1 st 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

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

Injuries Remain a Problem

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

Retired Guidelines – American Academy of Pediatrics 2002 5 20 30 40 50 60 70 80 pounds pounds pounds pounds pounds pounds pounds pounds Infant-only seat , rear-facing, The safest place in a vehicle for never in front seat with all children is in the rear seat. passenger-side airbag Rear-Facing Car Seat to 1 year and 20 pounds Convertible safety seat , rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to Forward-Facing Car Seat to 4 years and 40 pounds 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 Booster Seat to 8 years and 80 pounds 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.

Updated Guidelines – American Academy of Pediatrics 2011 5 20 30 40 50 60 70 80 pounds pounds pounds pounds pounds pounds pounds pounds Infant-only seat , rear-facing, The safest place in a vehicle for never in front seat with all children is in the rear seat. 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

Updated Guidelines – American Academy of Pediatrics 2011 5 20 30 40 50 60 70 80 pounds pounds pounds pounds pounds pounds pounds pounds Infant-only or convertible child safety seat Infant-only seat , rear-facing, The safest place in a vehicle for used rear-facing until 2 years of age or until The safest place in a vehicle for never in front seat with all children is in the rear seat. they reach the highest weight or height all children is in the rear seat. passenger-side airbag limit allowed by the seat manufacturer Convertible safety seat , rear-facing until child is at least 1 year of age Convertible or combination child safety seat and 20 lbs, then forward-facing to used forward-facing for as long as possible max weight/height allowed by seat [children 2 years of age and older (or those Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies less than 2 years old who have outgrown their Forward-facing seat with internal harness, weight varies seat’s rear -facing weight or height limit)] Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning Booster seat for all children whose weight or booster seat with lap/shoulder belt (>35-40 lb) as long as child fits 2011 AAP Guidelines for Child Passenger Safety Belt-positioning booster seat with lap/shoulder belt as long as child fits height is above the forward-facing limit for – Policy Statement originally published online March 21, 2011 their child safety seat until the vehicle lap Images for child safety seats used with permission from and shoulder belt fits properly the Children’s Hospital of Philadelphia Center for Injury Research and Prevention

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

Upper Weight Limits for Rear-Facing Car Seats

Most Rear-Facing Car Seats Above 30 pounds 3 of 62 seats 45# max 18 of 62 seats 40# max 30 of 62 seats 30-35# max 11 of 62 seats 22# max

Size Range for Rear-Facing Car Seats 22 pounds 30-35 pounds 40 pounds 45 pounds

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

Weight Limits for Forward-Facing Car Seats

Forward-Facing Car Seats Minimum Weight 1 of 42 seats 25# min 18 of 42 seats 22# min 23 of 42 seats 20# min

21% Forward-Facing Car Seats Max 70-80 Pounds 9 of 42 seats 70-80# max 21 of 42 seats 65# max 4 of 42 seats 50# max 8 of 42 seats 40# max

Size Range for Forward-Facing Car Seats 40 pounds 50 pounds 65 pounds 70-80 pounds

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

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

Weight Limits for Booster Seats

Booster Seats MINIUMUM Weight Limits 43 of 73 seats 40-50# min 4 of 73 seats 33# min 26 of 73 seats 30# min

23% Booster Seats Max 120-125 Pounds 4 of 73 seats 80# max 52 of 73 seats 100-110# max 17 of 73 seats 120-125# max

Size Range for Booster Seats 80 pounds 100 pounds 120-125 pounds

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

Geometry of Seat Belts and Child Anthropometry 30% of shoulder belts fit 6-8 year olds Bilston LE, et al. October 2007

Examples of Belt Fit Bad Belt Fit Good Belt Fit Images from: http://www.iihs.org/research/topics/boosters/default.html

Height and Booster Seats <8 years

Overlap Size & Child Safety Seats

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)

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

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

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