1. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org UAMS Department of Pediatrics An Introduction to Child Passenger Safety [Your Name, Title]

2. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 10 Leading Causes of Death, Arkansas 2011, All Races, Both Sexes WISQARS, Centers for Disease Control and Prevention, 2011 Age Groups Rank<11-45-910-1415-2425-3435-4445-5455-6465+Total 1 Congenital Anomalies 5,013 Unintentional Injury 1,337 Unintentional Injury 761 Unintentional Injury 874 Unintentional Injury 12,330 Unintentional Injury 15,518 Unintentional Injury 15,230 Malignant Neoplasms 48,897 Malignant Neoplasms 112,572 Heart Disease 475,097 Heart Disease 596,577 2 Short Gestation 4,106 Congenital Anomalies 493 Malignant Neoplasms 441 Malignant Neoplasms 419 Suicide 4,822 Suicide 6,100 Malignant Neoplasms 11,717 Heart Disease 36,100 Heart Disease 69,742 Malignant Neoplasms 397,106 Malignant Neoplasms 576,691 3 SIDS 1,910 Homicide 412 Congenital Anomalies 182 Suicide 282 Homicide 4,554 Homicide 4,185 Heart Disease 10,635 Unintentional Injury 20,749 Unintentional Injury 15,158 Chronic Low. Respiratory Disease 121,869 Chronic Low. Respiratory Disease 142,943 4 Maternal Pregnancy Comp. 1.591 Malignant Neoplasms 353 Homicide 129 Congenital Anomalies 176 Malignant Neoplasms 1,611 Malignant Neoplasms 3,499 Suicide 6,599 Liver Disease 8,864 Chronic Low. Respiratory Disease 15,044 Cerebro- vascular 109,323 Cerebro- vascular 128,932 5 Unintentional Injury 1,163 Heart Disease 165 Heart Disease 92 Homicide 154 Heart Disease 998 Heart Disease 3,301 Homicide 2,519 Suicide 8,858 Diabetes Mellitus 12,688 Alzheimer’s Disease 84,032 Unintentional Injury 126,438 6 Placenta Cord. Membranes 1,004 Influenza & Pneumonia 112 Chronic Low. Respiratory Disease 64 Heart Disease 111 Congenital Anomalies 432 Diabetes Mellitus 686 Liver Disease 2,449 Diabetes Mellitus 6,012 Cerebro- vascular 11,205 Diabetes Mellitus 54,402 Alzheimer’s Disease 84,974 7 Bacterial Sepsis 526 Septicemia 61 Influenza & Pneumonia 63 Chronic Low. Respiratory Disease 72 Influenza & Pneumonia 220 HIV 666 Diabetes Mellitus 1,842 Cerebro- vascular 5,705 Liver Disease 10,749 Influenza & Pneumonia 45,386 Diabetes Mellitus 73,831 8 Respiratory Distress 513 Chronic Low. Respiratory Disease 53 Benign Neoplasms 40 Influenza & Pneumonia 55 Cerebro- vascular 186 Cerebro- vascular 530 Cerebro- vascular 1,718 Chronic Low. Respiratory Disease 4,634 Suicide 6,521 Unintentional Injury 43,258 Influenza & Pneumonia 53,826 9 Circulatory System Disease 500 Benign Neoplasms 45 Cerebro- vascular 40 Cerebro- vascular 47 Complicated Pregnancy 172 Influenza & Pneumonia 515 HIV 1,619 HIV 2,781 Septicemia 4,953 Nephritis 37,796 Nephritis 45,591 10 Neonatal Hemorrhage 456 Cerebro- vascular 42 Septicemia 38 Septicemia 31 Chronic Low. Respiratory Disease 170 Liver Disease 505 Influenza & Pneumonia 859 Septicemia 2,461 Nephritis 4,754 Septicemia 26,746 Suicide 39,518

3. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Arkansas Child Passenger Protection Law All children under age 15 must ride in a child passenger restraint system: Child safety seat until child is 6 years old or weighs 60 lbs (best practice is 8 years old, 80-100 pounds or 4’9” tall) Seat belt until age 15 regardless of seating position in vehicle (best practice is seat belt for life) Fine $25-$100 per child No smoking in vehicle with children under the age of 15.

4. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Reality Check: Arkansas Arkansas: Overall seat belt use: 71.9% Child seat use: 86.5% United States: Overall seat belt use: 86% Child seat use: 87% NOTE: Child seat use under age 6 Source: NHTSA, Traffic Safety Facts, July 2013 NOTE: Child seat use under age 8

5. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 5 Crashes are violent Approximate formula: Weight x Speed = Restraining Force 20 lb baby x 30 mph = 600 lbs of restraining force is needed

6. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Three Collisions in a Crash 1st: Vehicle Collision 2nd: Human Collision 3rd: Internal Collision 3 rd 2 nd 1 st

7. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Children at Risk Proper use of child safety seats reduces the rate of fatal injury: – 71% for infants (<1 year old) – 54% for toddlers (1-4 years old)

8. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Children are safest in the BACK seat Children less than 14 years of age are at risk of serious preventable injury when seated in front of a passenger side air bag. Children less than 13 years of age are 40% more likely to be injured if sitting in the front seat than in the rear seat. Check out the Traumalink website at the Children’s Hospital of Philadelphia for an interactive installation demonstration and much more research - www.chop.eduwww.chop.edu

9. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 5 Ways Restraints Prevent Injury: 1.Prevent ejection 2.Contact the strongest parts of the body 3.Spread forces over a wide area of the body 4.Help the body to “ride down” the crash 5.Protect the head and spinal cord

10. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 4 Steps to Car Safety Step 1: Rear-Facing Seat until age 2 or upper height and weight limits are met Step 2: Forward-Facing Seat with Harness until upper height and weight limits are met Infant Carrier (Rear facing only) Convertible seat (Rear & forward facing) Convertible seat (Rear & forward facing) Combination seat (Forward facing only)

11. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 4 Steps to Car Safety Step 3: Belt-Positioning Booster Seat until the seat belt fits (usually around 4’9” and age 8-12) Step 4: Adult Seat Belt for Life! High back boosterBackless booster

12. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Types Of Restraints For Children Rear-facing only restraints Convertible restraints Forward-facing only restraints Vehicle safety belts Special needs CRS 18

13. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Types of Restraints for Children Height/weight limits Age of child Physical limitations Special Needs Hmm…which car seat is best for my child????

14. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Step 1: Rear Facing

15. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Extended Rear Facing Report In December 2007, pediatrician Marilyn Bull from Riley Hospital for Children in Indianapolis, announced groundbreaking research about car seat safety for children.  “Children under the age of two years are 75% less likely to die or sustain serous injury in a crash when rear facing than forward facing.”  “Children in the second year of life are over 5 times less likely to die or have a serious in jury when placed rear facing than forward facing in car safety seats.

16. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org A child should ride rear-facing until age 2 A child should ride rear-facing until age 2 The American Academy of Pediatrics recommends that infants ride rear facing until they reach the upper weight of their rear-facing convertible seat....30-35 pounds. Step 1: Rear-Facing Rear-facing only Seat rear-facing only up to approx. 22-35 pounds Convertible Seat Rear and forward-facing RF up to approx. 35-40 pounds

17. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org A child should ride rear-facing until age 2 A child should ride rear-facing until age 2 The American Academy of Pediatrics recommends that infants ride rear facing until they reach the upper weight of their rear-facing convertible seat....30-35 pounds. Step 1: Rear-Facing Infant Seat rear-facing only up to approx. 22 pounds Convertible Seat Rear and forward-facing RF up to approx. 35 pounds

18. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Here’s Why...

19. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Forward Facing Too Soon is Dangerous!

20. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Seat should be semi-reclined, no more than 45 degrees. Can be more upright for older infant (6-9 months). Recline angle prevents infant’s head from flopping forward and cutting off airway Harness should be at or below shoulders Place harness clip at armpit level Harness straps should be snug – cannot pinch webbing at collarbone Placement of child in rear-facing seat Always read manufacturer’s instructions on installation and weight limit of seat Infant seats – usually 22-35 pound limit; convertible – 35-40 pounds rear facing Child can also outgrow infant seat if head is within 1 inch of top of shell.

21. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org NEVER Never place a rear facing car safety seat in the front passenger seat of any vehicle equipped with an active air bag. Never install an infant seat facing the front of the vehicle. This type of child safety seat must face the rear.

22. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Only use items that come with the car seat. Stay away from after- market add-ons. Secure projectiles. Use soft toys for travel. Window shades, mirrors, toy bars are not recommended. Additional Warnings X X X X X

23. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org When is it SAFE to Turn Child Forward-Facing? BEST time to promote a child to forward facing is when s/he can no longer safely ride rear facing in their convertible seat (35-40 pounds). Same seat, but facing different direction

24. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Step 2: Forward-Facing with a Harness

25. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Convertible Seat Can be used forward facing and rear facing. A forward facing convertible seat can be used until the child weighs anywhere between 40 – 65 lbs. Convertible Seat used forward facing Forward Facing Seat Can only be used forward facing. Harness can be used until child weighs 40 -65 lbs. After harness is removed, seat is used as high back booster until upper weight limit. Forward Facing Only Child Safety Seats used Forward-Facing

26. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Most convertible and forward facing only seats with harness have upper weight limit of 40 pounds Harness straps should be snug – cannot pinch webbing at collarbone Place harness clip at armpit level. Seat should be tightly installed in vehicle. No more than 1” movement side to side or toward front of vehicle at belt path. Harness should be at or above shoulders in reinforced slots Use the forward facing belt path Place kickstand in upright position Placement of child in forward- facing seat

27. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org The harness straps on many convertible seats MUST be in the TOP reinforced slots. Some newer convertibles have 2 or more sets of reinforced slots. Read and follow directions! The children in these seats died because the top slots weren’t used for forward facing use.

28. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Use correct belt path Install as tightly as possible with reasonable force Pull child restraint at belt path to test tightness Child restraint should not move side to side or forward more than 1” Tightly Securing the Child Restraint

29. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Children should remain in harness until child reaches upper height and weight limits of forward facing child safety seat – 40-65 pounds for most convertible and combination seats. Important to read directions for every seat.

30. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Promote child to booster seat (Step 3) when the child can no longer safely ride in a harness (too tall, heavy, etc.) Step 2 Forward facing with harness Step 3 Belt Positioning Booster seat

31. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Step 3: Belt Positioning Booster Seat

32. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org What is a booster seat? A safety seat designed for children who are too big for a convertible or combination seat but too small to fit properly in a vehicle safety belt. Using a booster seat with a lap/shoulder belt instead of a safety belt alone reduces the child’s risk of injury by 59%.

33. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org High back boosters For use in vehicles with no head restraint behind child Types and Styles of Belt Positioning Booster Seats Belt positioning booster seats MUST be used with a lap and shoulder belt – Never a lap belt only. Backless boosters For use in vehicles with head restraint behind child

34. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org A child should ride in a booster seat until she can correctly fit into the adult lap/shoulder belt…when the child is 80-100 lbs and is 4’9” tall.

35. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Step 4: Vehicle Safety Belt

36. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Types of Safety Belts Lap and shoulder belt Lap belt

37. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org 1. Can the child sit all the way back against the vehicle seat? 2. Do the child’s knees bend comfortably at the edge of the vehicle seat? 3. Is the lap belt on the top part of the child’s thighs? 4. Is the shoulder belt centered on the child’s shoulder and chest? 5. Can the child stay seated like this for the entire trip? (SafetyBeltSafe USA) 5-Step Test for Seat Belts Child needs booster seat

38. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Second Hand Seats* (*regardless of what type of seat is used) Make sure Child safety seat: – Is no more than 6 years old. – Has all its parts. – Isn’t damaged. – Not recalled or repaired if recalled. – Hasn’t been in a serious crash. – Has an instruction booklet. A CSS may need to be replaced after a crash. Call the manufacturer.

39. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Child Safety Seat Misuse 90%+ Misuse Rates in Arkansas Why? Caregivers don’t read instructions Incompatibility - Many different child restraints and vehicles available Hand-me down seats missing parts or instructions Misunderstanding about crash dynamics

40. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Misuse

41. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Misuse

42. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Misuse

43. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Misuse

44. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Websites American Academy of Pediatrics www.aap.org Child Passenger Safety www.carseatsAR.org National Highway Traffic Safety Administration (NHTSA) www.nhtsa.dot.gov SAFE KIDS Worldwide www.usa.safekids.org

45. archildrens.org uams.edu arpediatrics.org uams.edu arpediatrics.org Questions