1. TM The Best Advice for Every Ride Update on the New Guidelines for Child Passenger Safety Benjamin Hoffman, MD, FAAP Associate Professor of Pediatrics/ Certified Child Passenger Safety Technician Instructor University of New Mexico TM Prepared for your next patient.

2. TM Disclaimers Statements and opinions expressed are those of the authors 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 presenters 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.

3. TM Objectives By the end of this presentation you should be able to: - Discuss new best practice guidelines for child safety seat use - Describe the data behind the new guidelines - Counsel families to follow the best practice guidelines for child passenger safety

4. Whats Killing Children? Top 5 Causes: Ages 1 to 15 from 2001-2007 4.3 Child Occupants were Killed EACH DAY in 2007 MV Traffic Ages 1-15 Source: CDC N = 54,900

5. TM Source: CDC

6. TM THERE IS GOOD NEWS! Number of Passenger Fatalities 0-16 years of age Source: CDC

7. TM THE TAKE HOME MESSAGE: Just because you can, doesnt mean you should… Delay Car Safety Seat transitions as long as you can!

8. TM REAR FACING CAR SAFETY SEATS 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 seats manufacturer Source: CDC AAP

9. TM REAR FACING CAR SAFETY SEATS ARE SAFER! Injury Risk Forward vs Rear Facing: 0-23 months old o 1.8x increased injury risk forward vs. rear-facing 12-23 months o 5x increased injury risk Why? o Spread crash energy over entire back of child o Protection for head and neck Courtesy of Bonnie Kozial, AAP

10. TM TYPES OF REAR FACING SEATS Birth to 2 years 5-40 lb REAR FACING o Infant Carriers Rear only Lower limit birth, 4, 5 lb 22-40 lb weight limit o Convertible Rear as long as possible Lower limit birth, 5 lb 30-45 lb weight limit

11. TM 3 years, 32 lbs., 36 in. BUT WAIT… WHAT ABOUT THE LEGS? Courtesy of Michelle Cisweski, Safe NM

12. Arms and legs are safer rear facing! Rear-Facing Forward-Facing 86% 8% 57% 25% 7% Spine – 7% Percentage of AIS 2+ injuries NASS-CDS

13. TM FORWARD FACING CAR SAFETY SEAT All children 2 years or older, or those younger than 2 who have outgrown the rear facing 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 seats manufacturer AAP

14. TM FORWARD FACING CAR SAFETY SEAT 20-50 lb Forward Facing >40 models >40 pounds Many 65 or 80 lb

15. TM BELT POSITIONING BOOSTER SEAT All children whose weight or height is above the forward-facing limit of 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 tall and are between 8 and 12 years of age. AAP

16. TM BELT POSITIONING BOOSTER SEAT Children 4-8 years old o 45% decreased injury risk Compared to seat belt o ~60% decreased injury risk Compared to unrestrained Courtesy of Benjamin Hoffman, MD, University of New Mexico

17. TM SEAT BELTS Courtesy of Benjamin Hoffman, MD, University of New Mexico

18. TM SEAT BELTS 49 and taller Correct Fit: o Sitting upright with back against vehicle seat o Legs bend comfortably on vehicle seat o Shoulder belt across clavicle and sternum o Lap belt low across hips Not resting on abdomen o Child can sit that way the entire ride Courtesy of Benjamin Hoffman, MD, University of New Mexico

19. TM WHERE TO SIT IN THE CAR All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection Courtesy of Benjamin Hoffman, MD, University of New Mexico

20. TM FIND EXPERT RESOURCES IN YOUR COMMUNITY! Certified Child Passenger Safety Technicians can be identified by state on the NHTSA website. www.seatcheck.org www.nhtsa.gov 1-866-Seat-Check NHTSA.gov

21. TM SUMMARY Moving from one child restraint mode to the next is not necessarily a good thing o Lose relative protection every step Rear facing to weight/height limit of seat o Rear facing until at least 2 years Forward facing until weight/height limit of seat o Forward facing in a harness until at least age 4 Belt positioning booster seat until seat belt fits correctly o Generally 4 years to 8-12 years Depends on child and vehicle Rear seat until at least 13 years of age

22. TM IT IS UP TO US! Families look to their pediatricians for the best possible advice Follow the algorithm o http://aappolicy.aappublications. org/cgi/content/full/pediatrics; 127/4/788#F1 Access community resources AAP

23. TM For more information…. On this topic and a host of other topics, visit www.pediatriccareonline.org. Pediatric Care Online is a convenient electronic resource for immediate expert help with virtually every pediatric clinical information need. Must-have resources are included in a comprehensive reference library and time-saving clinical tools. www.pediatriccareonline.org Haven't activated your Pediatric Care Online trial subscription yet? It's quick and easy: simply follow the steps on the back of the card you received from your Mead Johnson representative. Haven't received your free trial card? Contact your Mead Johnson representative or call 888/363-2362 today.