Child Passenger Safety: Update on Maryland CPS Programs

1. Child Passenger Safety: Update on Maryland CPS Programs AAP Maryland Chapter & Maryland Emergency Medical Services for Children Educational Conference Call February 17, 2005 This conference call is sponsored by the Maryland EMS for Children’s Partnership Grant from the federal EMSC Program USDHHS/HRSA/MCHB

2. Child Passenger Safety and Occupant ProtectionLaws and General Overview Meg Miller Maryland Highway Safety Office at State Highway Administration 410-787-4077 1-888-963-0307, x4077

3. Importance of ChildPassenger Safety Laws • Unintentional injury remains the leading cause of death among children 4-14 years of age • 42% of those injury-related deaths are a result of motor vehicle crashes • In 2003, 33,471 vehicle occupants were killed in traffic crashes; of those nearly 8% were 0-15 YOA (2,570) • 290,000 were injured (28,000 incapacitating injuries) • (National Center for Statistics and Analysis)

4. More Statistics • In 2003, 291 children up to age 4 were seriously injured in motor vehicle crashes in Maryland; 35% were totally or improperly unrestrained. • In Maryland, only 18% of booster-appropriate • children actually are using boosters (according • to a 2003 statewide observational study).

5. Maryland Traffic Law • Title 22-412.2 Child Safety Seats A child safety seat must be used in accordance with the seat and vehicle manufacturers’ instructions for a child • younger than 6 years of age regardless of weight; or • who weighs 40 pounds or less; regardless of age • A person may not transport a child younger than 16 YOA unless the child is secured in a child safety seat or vehicle’s seat belt in all seating positions in all vehicles

6. Things to Remember About Current Law • Applies to vehicles with MD registration class A, M, and E (trucks under 7000 pounds) • Multiple violations in one vehicle at one time are to be considered one violation • A child seat or seat belt may only be used by one person • If there are more occupants required by this section to be restrained than there are positions for them, there is no violation as long as all positions are in use by someone required to use one.

7. Applications of the Law • In other words, if you have 5 children restrained appropriately in a car with 4 seating positions (driver excluded), there is no violation if the four available seating positions are being used by a child in a restraint system. • However, double buckling (two kids in one belt) is a violation. • If a seat is used in the US it must meet all US federal safety standards.

8. CPS Law, Continued • Out of State vehicles – A child being transported in a motor vehicle registered in another state, DC, or another country, shall be in an approved child safety seat used in accordance with both the vehicle and the seat manufacturers’ instructions if the child: • Is under 4 years of age, regardless of weight; or • Weighs 40 pounds or less, regardless of the child’s age

9. Meaning of the Law • Although not specified as a requirement of the law, booster seats are included as one of the child restraint options. • Boosters were not specified in the law because some children might need other types of special needs restraints, and we didn’t want to make those technically illegal by saying boosters were the only choice. • If child falls into the small % of children that are 6 YOA and less than 40 pounds, by law (and recommendation), s/he still needs to be using a child restraint system.

10. Exemptions from the Law • If a seating position does not allow the proper use of a booster seat (i.e., no shoulder belt available) there is no violation. • Also, if only lap belts are available in the back seat, and are being used for children older than 6 and weighing >40 pounds, there is no violation. (It’s not best practice, but it’s not against the law either.) **However, there are restraints available to help in these situations, call KISS for assistance. • Also not covered: • children who have a written medical certificate from their doctor

11. Reminders • This law was not meant to be punitive—if a family goes to court and proves that they have purchased or rented a safety seat, the fine is waived. • Other requirements and applications of the law include: • A person may not transport a child younger than 16 years of age unless the child is secured in: a child safety seat or vehicle’s seat belt in all seating positions in all vehicles. • A child younger than 16 years may not ride in an unenclosed cargo bed of a pickup truck.

12. Related Laws • The District of Columbia requires all children under 8 to be in a properly installed child safety seat (includes boosters). Their law applies to all vehicles operated in DC. $75 fine and 2 points. • Virginia requires use of a child safety seat (including boosters) by children under age 6 with no weight requirements. • PA Children up to age 8 must use approved restraint. Secondary law for kids over 4 years of age. • DE requires children ages 6 and under and weighing less than 60 pounds to be properly restrained in an appropriate child safety seat in all seating positions.

13. Changes in the Child Seat Industry • LATCH (Lower Anchors and Tethers for Children) • Uses a set of bars mounted in the seat bight (where seat cushions meet) to anchor child seat into car • Does not use the seat belt anymore • All passenger cars have at least two locations • Tether anchors are the hooks on the back deck or the back of the seat • The top tether on the child seat hooks to them to reduce head excursion

14. LATCH • In most vehicles the lower anchors are only in the outer seating positions and cannot have the two inner most points used together. • Meaning if you have a sedan you can not use the LATCH system to anchor the child seat to center rear seat of the vehicle. • This system was meant to make the installation of car seats universal and easy. • To someone outside looking in, a LATCH-installed seat may not look installed, since seat belts are not being used!

15. Car Seats with Harnesses for Higher Weight Limits • New Car Seats with higher weight limits are now available • Until recently there were no car seats made for general use that had weight limits above 40 pounds with the harness system • There are several currently available, and more to come! • This is good for the kids that still like to move around a lot after 40 pounds and need more protection (i.e., kids who reach 40 pounds very early and who are not developmentally ready to use Belt Positioning Boosters).

16. Resources • There are many resources for you if you have questions or concerns related to transporting children in your vehicles or enforcement/investigative situations. • Maryland Kids In Safety Seats (KISS) at 410-767-6016 • MHSO: 410-787-4077, MSKC: 410-787-5893 • Various CPS Technicians / Instructors throughout the State

17. Maryland Kids in Safety Seats(KISS)Maryland Department of Health & Mental Hygiene Tracy A. Whitman Coordinator

18. What is Kids in Safety Seats? • Statewide program dedicated exclusively to child passenger safety issues. • KISS: 1. Educates the public (parents and professionals) on all cps issues. 2. Promotes the proper and consistent use of child safety seats. 3. Answers questions/provides technical support/training to the public.

19. KISS Services • Child Safety Seat Loaner Programs • Technical Assistance/Referral Service • Presentations/Trainings • Safety Seat Check-up Events • Referral Service • Child Passenger Safety Clearinghouse

20. Loaner Programs • Available to Maryland residents • Not available in every county • Some service county residents only • Low cost (sometimes no cost) • Education is provided • Special needs programs (5) • Seats vary per site

21. Presentations/Trainings • One and Two-Hour General CPS Overviews • 16-Hour Child Care Providers Training • 16-Hour Special Needs Training* • 16-Hour RN Training • 16-Hour Law Enforcement Training • 32-Hour National Standardized Certification Course

22. Safety Seat Check-up Events • Assistance provided to agencies/ organizations conducting events • Organized by appointment or open to public • SAFE KIDS Van and/or Trailer (fee) • KISS holds regularly scheduled check-ups once a month • No charge but appointments are necessary

23. Referral Service • KISS maintains a current list of Permanent Fitting Stations (PFS) • PFS are sites where child transporters may take their vehicle and seat to have certified child passenger safety technician check the seat for correct use and installation • Most locations are free but appointments are necessary • Many locations run on a wait list

24. Clearinghouse • Requests for materials • Answers “best practice” and other technical inquiries • Presentation/training and health fair display requests

25. Contact KISS Helpline 800-370-SEAT or 410-767-6016 E-mail Kiss@dhmh.state.md.us Web site www.mdkiss.org

26. Child Passenger Safety Donna J. Perlin, MD Allen Walker, MD Jean Ogborn, MD Ann Duggan

27. Statement of Problem • Motor vehicle collisions are the major cause of death for children ages 5-9 years • Ramsey, A • Among 5-9 year olds in fatal crashes, 48% were unrestrained • CDC

28. Statement of Problem • Parents reliably restrain their infants and toddlers in appropriate child safety seats secondary to a public awareness of their significant protective records in motor vehicle crashes

29. Statement of Problem • The prevailing belief among parents of children ages 4-8 years is that a lap/shoulder belt is the appropriate form of restraint once the child has outgrown their toddler seat. Unfortunately, the studies show this belief to be false

30. Booster Seats • Decrease the risk of significant injury in a motor vehicle accident by a factor of 3.5 • Provide a relative risk reduction of 4.2 for significant head injury • Used in only 6-10% of children in the 4-8 year old age range • Decreased the risk of both lumbar and hollow viscus injuries • Winston, FK, Ramsey, A

31. Maryland Statistics • In 2003, motor vehicle crashes involving Maryland children resulted in fatalities and serious injuries to: • 282 children <5 years old • 546 children 5-10 years old • 923 children 11-16 years old • Car safety seat misuse in Maryland, as of May, 2004, is 88%

32. Crash Dynamics • An object in motion remains in motion at the original speed until acted upon by an outside force • Approximate: • Weight X Speed = Restraining Force • Example: 40 lb. Child in a car going 40 mph has 1600 lbs of crash weight

33. Three Collisions 1. Vehicle 2. Human 3. Internal

34. Children in CrashesChildren are more vulnerable to injury in crashes because: Immature musculoskeletal system Cars are designed to protect the ADULTS

35. Child Safety Seats Prevent Injury • Prevent ejection • Spread out crash forces • Contact strongest parts of the child’s body • Allow the child to “ride down” the crash • Protect head, neck, and spinal column

36. Local News Paper Articles

37. Statement of Problem • Various studies have shown that only 6-10% of children who are 4-8 years old are actually being appropriately restrained in booster seats • Ramsey, A • Decina, LA • Karp,H

38. Statement of Problem • Lack of awareness of their need by parents is the most commonly cited barrier to their usage • Ramsey, A • Rivera, FP • Kunkel, NC

39. Statement of Problem • Other barriers to booster seat usage are the cost of the seats, child resistance, peer pressure and the difficulty of fitting multiple seats into the car • Rivera, FP • Ramsey, A

40. Statement of Problem • Many parents are not aware that the seatbelts required by law in most states for their children ages 4-9 are not sufficient protection for their children in a crash • Their perception is that the laws support the current safety recommendations

41. Statement of Problem • “The state law usually ends with three or four year olds. The law of physics lasts a lifetime.” • (Bob Wall, Child-Passenger Safety Instructor)5.

42. Statement of Problem • Many states, including Maryland, have recently or are in the process of enacting legislation mandating booster seat usage for children over age 4

43. Goals of This Study • Our long-term goal is to design an effective intervention to optimize the transportation safety of children ages 4-8 through a multifaceted attack on the previously reported barriers to booster seat usage

44. Goals of This Study • In order to achieve this goal, we must determine the factors that directly influence the most commonly cited barrier to their usage, parental knowledge of their efficacy

45. Hypothesis • Pediatricians can play an important role in advocating their usage by educating families

46. Hypothesis • We hypothesize that the frequency of booster seat counseling is low among primary care pediatricians

47. Hypothesis • In the first part of our study we hope to • assess the frequency of Pediatrician counseling regarding booster seats • to delineate those factors that are associated with a poor rate of booster seat counseling.

48. Hypothesis • In the second part of our study we will evaluate the effectiveness of booster seat legislation on Pediatrician counseling practices by assessing the change counseling practices

49. We acknowledge the role of the pediatrician in the movement towards widespread booster seat utilization

50. This study hoped to delineate those factors that are associated with a poor rate of booster seat counseling.  Our long-term goal is to devise an intervention directed at those predictive variables. Long Term Goal