UAMS Department of Pediatrics

1. UAMS Department of Pediatrics An Introduction to Child Passenger Safety [Your Name, Title]

2. 10 Leading Causes of Death, Arkansas 2011, All Races, Both Sexes WISQARS, Centers for Disease Control and Prevention, 2011

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

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. 1st 2nd 3rd Three Collisions in a Crash 1st: Vehicle Collision 2nd: Human Collision 3rd: Internal Collision

7. 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. Children are safest in the BACK seat 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. Children less than 14 years of age are at risk of serious preventable injury when seated in front of a passenger side air bag. Check out the Traumalink website at the Children’s Hospital of Philadelphia for an interactive installation demonstration and much more research - www.chop.edu

9. 5 Ways Restraints Prevent Injury: • 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. 4 Steps to Car Safety Step 1: Rear-Facing Seat until age 2 or upper height and weight limits are met Infant Carrier (Rear facing only) Convertible seat (Rear & forward facing) Step 2: Forward-Facing Seat with Harness until upper height and weight limits are met Combination seat (Forward facing only) Convertible seat (Rear & forward facing)

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

12. Types Of Restraints For Children • Rear-facing only restraints • Convertible restraints • Forward-facing only restraints • Vehicle safety belts • Special needs CRS 18

13. 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. Step 1: Rear Facing

15. 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. Step 1: Rear-Facing A child should ride rear-facing until age 2 • Convertible Seat • Rear and forward-facing • RF up to approx. 35-40 pounds • Rear-facing only Seat • rear-facing only • up to approx. 22-35 pounds 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.

17. Step 1: Rear-Facing A child should ride rear-facing until age 2 • Convertible Seat • Rear and forward-facing • RF up to approx. 35 pounds • Infant Seat • rear-facing only • up to approx. 22 pounds 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.

18. Here’s Why...

19. Forward Facing Too Soon is Dangerous!

20. 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. 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 belowshoulders Harness straps should be snug – cannot pinch webbing at collarbone Place harness clip at armpit level

21. 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. Additional Warnings • 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. X X X X X

23. When is it SAFE to Turn Child Forward-Facing? Same seat, but facing different direction • 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).

24. Step 2: Forward-Facing with a Harness

25. Child Safety Seats 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. 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. Forward Facing Only Convertible Seat used forward facing

26. Placement of child in forward-facing seat Harness should be at or above shoulders in reinforced slots 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 Seat should be tightly installed in vehicle. No more than 1” movement side to side or toward front of vehicle at belt path. Place harness clip at armpit level. Use the forward facing belt path Place kickstand in upright position

27. 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. Tightly Securing the Child Restraint • 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”

29. 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. 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. Step 3: Belt Positioning Booster Seat

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

34. 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. Step 4: Vehicle Safety Belt

36. Types of Safety Belts Lap belt Lap and shoulder belt

37. 5-Step Test for Seat Belts 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) Child needs booster seat

38. 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. 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. Misuse

41. Misuse

42. Misuse

43. Misuse

44. 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. Questions