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  1. Housekeeping Details Please put your phones on MUTE in order to minimize background noise, as the presentation is being recorded so that we can archive the slides & audio on our website. Please save questions/comments until the end of the presentation. Complete and mail back the evaluation form and the participant information form. Happy Children in Safe Seats: Not As Easy As It Sounds Webinar: July 17, 2013

  2. Happy Children in Safe Seats… Not as Easy as it Sounds Considerations every safety advocate needs to know to solve car seat challenges Caroline Langrall, CCLS, CPST

  3. Objectives • Identify key phases of a child's psychosocial and cognitive development that may create challenges regarding safe travel in the car. • Identify developmentally appropriate strategies to encourage and enable caregivers to use car seats properly. • Explore ways to address the transport of children with special needs and developmental delays.

  4. What are the challenges? • Crying • Tantrums • Refusal • Unbuckling

  5. Challenging behaviors… leading to dangerous“solutions” • Excessive crying/screaming? • Loosen straps • Front seat • No seat use • Escaping • Altering seat • Compromising • Vomiting/Motion sickness • Early forward facing

  6. First Step: Check the use… • Age/size appropriate? • Straps snug and routed right? • Buckles functional? • Installation correct?

  7. Infant development & interventions • Bonding, attachment, trust. • Sensorimotor & object permanence. • Blanket with familiar smell • Adult in back seat • Rock/sway the seat • Pacifier • Soothing music • Convertible for older infant?

  8. Infant development & interventions, continued… • Physiological Immaturity • Allow an hour for digestion • Different seat with a different angle • Overheated • Swaddle/boundaries

  9. Toddler development (1-3) • Autonomy • Egocentric • Lack of reasoning • Separation Anxiety • Improving dexterity

  10. Toddler challenges • Unbuckling/escaping • 378 caregivers: 50% reported child unbuckled self. Majority = boys < 3 (Yale University, 2011) • Tantrum/screaming • Driver distraction http://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/new-car-seat-safety-study-toddlers-can-unbuckle-seatbelts

  11. Improper harness use injury patterns http://www.youtube.com/watch?NR=1&feature=endscreen&v=akGpsPyhDdk

  12. Interventions for toddlers • Consistent, simple messages from all cg’s • Reinforce good behavior frequently. • Ignore ‘bad’ behavior • Calm voice, empathy, don’t get angry. • Pull over and wait…or time-out • Offer choices • Keep hands busy: Cheerios, cling stickers. • Special rotating bag of soft ‘car toys’ • Divert attention • Music • Coat tricks

  13. Preschooler development (3-6) • Initiative • Want to please others • Literal interpretations • Lack abstract thought • Dramatic play and magical thinking

  14. Interventions for Preschoolers • “Write” a story together • Be clear and consistent with expectations • Dramatic play • Give a “job” or “role” • Sticker chart for behavior • Choose car seat or decorate. • Seek & find books • Game for long car rides

  15. School age development (6-12) • Spelling and language • Development of scientific method • Moral development: good vs. bad • Use feedback to judge their competency • Acceptance by peer group

  16. Interventions for School Age • Be clear with rules • Run an ‘experiment’ • Praise for good behavior • Empathize • Low back booster…choices

  17. Without booster With booster

  18. Adolescent development • Abstract/higher-level thinking • Critical thinking emergence • Independence • Influence of peers • Risk taking behaviors

  19. Adolescent challenges • MVC’s = 40% of deaths • Age 16-24 = lowest seatbelt use (CDC, 2006) • Driving under the influence • Reckless or careless driving • Texting while driving • >50% of teens >16 yrs admitted to TWD • Less likely to wear seatbelt, • More likely to drive while intoxicated or with someone who is intoxicated (Balin et al., 2013) Bailin, A., Adesman, A., & Sunday, S. R. (2013). 134. Texting While Driving Among High School Students in the United States: Analysis of 2011 Data From the National Youth Risk Behavior Survey (YRBS). Journal Of Adolescent Health, 52(s1), S85-6 National Center for Injury Prevention and Control (CDC). Web-based injury statistics query and reporting system (WISQARS). http://www.cdc.gov/ncipc/wisqars/: 2006

  20. Adolescent interventions • Makes rules and consequences clear • Follow-through on consequences • Provide choices when possible • Demonstrate expected behavior • Reward

  21. Dealing with motion sickness • No reading, video games • Middle seat • I Spy games to look outside • Open window • Ice pack to back of neck • Cool washcloth • Saltine crackers or ginger snaps • Peppermint/ginger aromatherapy (Lua,& Zakaria, 2012) • “Sea bands”/acupressure (Hunt, 2011) • Breathing • Frequent stops • Travel at night/naps Hunt, K., & Ernst, E. (2011). The evidence-base for complementary medicine in children: a critical overview of systematic reviews. Archives Of Disease In Childhood, 96(8), 769-776. Lua, P., & Zakaria, N. (2012). A Brief Review of Current Scientific Evidence Involving Aromatherapy Use for Nausea and Vomiting. Journal Of Alternative & Complementary Medicine, 18(6).

  22. Special Needs • PDD/Autism spectrum/Cognitive delay • Seat options decrease with age/size • Difficulty with reasoning • Need for routine & difficulty with change • Sensory processing challenges Be kind; for everyone you meet is fighting a hard battle. –John Watson

  23. Interventions for Children with Special Needs • Anticipatory guidance to prepare for seat change • Consider other seats. • Refer to http://www.preventinjury.org or search Safe Kids website for a CPST trained in Special needs.

  24. Special needs • EZ-On floor mounted vest and tether • Vehicle modification • Seat bight http://www.ezonpro.com/

  25. Special needs • Roosevelt by Merritt Manufacturing • 35-115 lbs& 33.5-62” • Harness cover & EZ Buckle guard • NOT for use with other seats • Not compatible in all vehicles http://eztether.com/index.php/product-info/roosevelt

  26. Thank you for your attention!ANY QUESTIONS?

  27. Thank you for participating today! Final Instructions: Evaluation form is available on our website: http://www.miemss.org/EMSCwww/CPSHome.htm; alternatively, we can email it to call participants. Return your completed evaluation along with the contact info page. The full presentation with audio will be available on our website in a couple of weeks, in case you wish to re-visit it, or refer a colleague to it.

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