Report: Parents don’t use booster seats
You might assume that most parents know about booster seats, but a new survey tells a different story. According to a report from the Washington, DC-based National Highway Traffic Safety Administration (NHTSA), booster seat use is currently below 10%.1 The survey was done with approximately 4,000 parents and caregivers with children younger than age 6, during 1998 and 1999.
Although almost all parents use car safety seats for infants, most are unaware of booster seats, says Janet Lassman, RN, BS, director of program development and training for Emergency Nurses CARE, the Alexandria, VA-based injury prevention arm of the Emergency Nurses Association. "They need to hear about booster seats, and understand how they work to improve the fit of safety belts," she stresses. "The use of age-appropriate restraints, such as booster seats, reduce the risk of injury by 70%-80% compared to the child being unrestrained."
Address parents’ misconceptions
Here are ways to educate parents:
• Tell them not to be guided by state laws. Many parents equate state laws regarding child passenger safety with what is safest for their child, says Laurie Flaherty, RN, MS, an emergency nurse at Suburban Hospital in Bethesda, MD, and traffic safety consultant with NHTSA. "In most states, laws only cover children through age 4," she notes. "At this point, many well-meaning and well-educated parents move their children to adult seat belts."
According to Lassman, many misconceptions are caused by state occupant restraint laws. "The laws vary from state to state, but most have gaps that need to be closed," she says. In a few states, laws have been passed requiring a booster seat for older children, but in some cases, children as young as 2 to 4 years old can be placed in an adult seat belt, she adds.
• Explain that adult belts might not be the safest option. Parents might assume they are doing the right thing by buckling up their children in an adult belt, says Lassman. "Although better than nothing, adult seat belts alone may not be the best option," she adds. "Most of the time, after hearing the safety issues involved, parents soon realize the benefits of booster seats." Most parents who place their children in seat belts assume this will adequately restrain a small child in a crash, says Flaherty. "Research does not bear this out," she warns. She points to a study which found that children between 2 and 5 years old who rode in seat belts alone were 3.5 times more likely to suffer significant injury than children in car seats or booster seats.2
Until children are about 4 feet 7 inches tall and weigh about 80 pounds, they really don’t fit properly in an adult seat belt, says Lassman. "As a result, in an effort to be comfortable in the car, they either move forward or slide down in the seat until they are out of position for the seat belt to work properly in a crash," she explains.
Although some cars have a device that allows you to adjust an adult seat belt for children, most children older than 4 years and 40 pounds still do not fit well in an adult seat belt, says Lassman. "It is not only the issue of the shoulder belt hitting the neck, but also because the child’s legs are too short for his/her knees to bend over the edge of the vehicle seat and for the feet to rest on the floor," she explains. This causes the child to move forward on the seat to get more comfortable and then they are out of position in the event of a crash, says Lassman. "A belt-positioning booster seat solves this problem and helps the shoulder belt fit more correctly," she says.
Lassman notes that children generally like to sit in booster seats because they are more comfortable and "can see out the window." "It’s also important to "graduate" a child to a booster seat with no lapse between seats, so the child will understand that this is the norm and accept sitting in the booster seat," says Lassman.
When you weigh a child
• Take advantage of "teachable moments" to discuss booster seat use. For example, if you weigh a child between 40 and 80 pounds, Flaherty suggests asking if they use a child safety seat at all, and if so, what kind they use. "More than half of the kids killed in car crashes aren’t restrained at all. We want to change that," says Flaherty. "Also, you want to find out if they are using the correct seat for the age/size of their child.
Recommendations could then be made to use booster seats if they are not already being used, she says. "The parents of smaller children could receive anticipatory guidance from ED nurses about the need for booster seats once the child’s weight surpasses 40 pounds," she adds.
Look for opportunities
• Start when children are very young. Talk to new parents about the continuum of child restraints that they will need to keep their child safe through the years, says Lassman. "It takes only a few minutes to discuss this with parents," she notes. (See chart on proper child safety seat use, below.)
| Proper Child Safety Seat Use Chart: Buckle Everyone. Children Age 12 and Under in Back | |||
| Infants | Toddlers | Preschoolers | |
| Weight | Birth to 1 year up to 20-22 lbs. | Over 1 year and over 20 lbs.-40 lbs. | Over 40 lbs. up to 80 lbs. |
| Type of Seat | Infant only on rear-facing convertible | Convertible/forward facing | Belt positioning booster seat |
| Seat Position | Rear-facing only | Forward-facing | Forward-facing |
| Always Make Sure | Children to one year and at least 20 lbs. rear-facing seats | Harness straps should be at or above shoulders. | Belt positioning booster seats must be used with both lap and shoulder belt. |
| Harness straps should be at or below shoulder level | Most seats require top slot for forward-facing. | Make sure the lap belt fits low and tight across the lap/upper thigh area and the shoulder belt fits snug crossing the chest and shoulder to avoid abdominal injuries. | |
| Warning | All children age 12 and under should ride in the back seat. | All children age 12 and under should ride in the back seat. | All children age 12 and under should ride in the back seat. |
| Source: National Highway Traffic Safety Administration, Washington, DC. | |||
Discharge information also can provide guidelines to reinforce the discussion, Lassman adds. She recommends displaying free materials in ED waiting rooms and clinical areas. (See "Resources," at the end of this article, for ordering information.)
• Volunteer as a guest speaker. Lassman recommends becoming a certified technician in child passenger safety and speaking to community groups. (For more information about certification courses, see "Resources.") As an ED nurse, you are a credible spokesperson because you see the sad, often preventable results of noncompliance, she says. "Nurses can get out in the community and speak to parenting, school, and church groups to provide the latest information available," she recommends.
References
1. National Highway Traffic Safety Administration. Children in car seats and in the backseat. Ann Emerg Med 2001; 37:406-407.
2. Berg MD, Cook L, Corneli HM, et al. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000; 105:831-835.
Sources
For more information about educating parents on booster seat use, contact:
• Laurie Flaherty, RN, MS, Traffic Safety Consultant Office of Communications and Outreach, US DOT/NHTSA, 400 Seventh St. S.W., NTS-22, Room 5119, Washington, DC 20590. Telephone: (202) 366-2705. Fax: (202) 366-6916. E-mail: [email protected].
• Janet Lassman, EN CARE, 205 S. Whiting St., Suite 403, Alexandria, VA 22304. Telephone: (703) 370-4050. Fax: (703) 370-4005. E-mail: [email protected].
Resources
A complete copy of the 1998 Motor Vehicle Occupant Safety: Child Safety Seat Report — Volume 3 can be accessed at no charge from the National Highway Traffic Safety Administration (NHTSA) web site at www.nhtsa.dot.gov/people/injury/research. Click on "Occupant Protection." NHTSA offers a variety of materials on child passenger safety, including Buckle Up America — Boost ’Em Before You Buckle ’Em: Don’t Skip a Step (Item No. 1P1123), Child Passenger Safety Training Programs (Item No. 1P1050), Are You Using it Right? (Item No. 1P0040) and Child Transportation Safety Tips (Item No. 1P1045). Single copies of these materials can be ordered at no cost on the NHTSA web site: www.nhtsa.dot.gov. (Click on "Safety Materials Catalog" and under topic, select "Child Passenger Safety.") Or you can contact NHTSA to order copies of the materials or the report: National Highway Traffic Safety Administration, 400 Seventh St. S.W., Washington, DC 20590.Telephone: (800) 424-9393 or (202) 366-0123. Fax: (301) 386-2194. E-mail: [email protected].
The NHTSA Standardized Child Passenger Safety Training Program is a four-day course with lectures, role-playing, and hands-on practice. Certification is available for the Technician and Technician Instructor levels. For more information, click on "Child Passenger Safety" on the NHTSA home page, then click on "Child Passenger Safety Programs." Next, click on "Summary Chart Showing Available NHTSA Training Programs." Or contact the NHTSA Regional Office in your area.
The American Academy of Pediatrics (AAP) has resources pertaining to car safety that can be ordered from the web site (www.aap.org). A checklist for users of infant, convertible, or booster car seats, One-Minute Car Seat Safety Check-up is sold in pads of 100. The cost is $19.95 or $14.95 for AAP members. To order, under "BookStore" heading, click on "AAP BookStore," then under "Parenting & Health Education," click on "Safety & Injury Prevention." The AAP’s Car Seat Shopping Guide for Children with Special Needs addresses various conditions including premature infants and children with tracheostomies. The guide costs $34.95 or $29.95 for AAP members. To order, under "Parenting & Health Education, click on "New & Most Requested Topics." Or to order either publication by mail, contact: American Academy of Pediatrics, 141 N.W. Point Blvd., Elk Grove Village, IL 60009-1098. Telephone: (888) 227-1770 or (847) 434-4000. Fax: (847) 228-1281. E-mail: [email protected].
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