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Daily Dose

Parents Ignore New Car Seat Recomendations

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I have been surprised at the number of parents I have seen lately, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.I have been surprised at the number of parents I have seen, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.

I try to discuss car seat safety at each check-up appointment, and have always been especially mindful of doing this at the one-year check up. A new policy (April 2011) by colleagues at the American Academy of Pediatrics recommends what I have been discussing for a while now: children up to age two should remain in rear-facing safety seats. The new policy is supported by research that shows children younger than 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing. So how did we get here? Original recommendations (established in 2009), I had followed with my own patients. I discussed turning the car seat to a forward facing position if the child had reached 12 months and 20 pounds. Then in April, an article was published (Inj Prev. 2007;13:398-402), which was the first U.S. data to substantiate the benefits of toddlers riding rear facing until they are two years of age. This study showed that children under the age of two are 75 percent less likely to die or experience a serious injury when they are riding in a rear-facing. That is a fairly compelling statistic to keep that car seat rear-facing for another year! Studies have shown that rear-facing seats are more likely to support the back, neck, head and pelvis because the force of a crash is distributed evenly over the entire body. Toddlers between the ages of 12 and 23 months who ride rear facing are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat. There has also been concern that rear-facing toddlers whose feet reach the back of the seat are more likely to suffer injuries to the lower extremities in a car accident. But a commentary written by Dr. Marilyn Bull in Pediatrics (2008;121:619-620) dispelled the myth with documentation that lower extremity injuries were rare with rear-facing seats. So, it has now been over two years since this data was published and recommended, and parents continue to say, “I just turned the seat around any way” or “I didn’t know.” I did go look at car-seats the other day and I noted that the labeling on the boxes had all been changed to recommend rear facing until two years or until a toddler reaches the maximum height and weight recommendations for the model. I take this to mean that some “small” toddlers could even rear face longer as they do in some European countries. For safety sake, rather than convenience, keep that car seat in the rear facing position. I wonder if they will begin putting DVD players and cup holders facing toward these toddlers, as that seemed to be a concern of many parents. Maybe this will make it “okay” to listen to music or talk while in the car rather than watching TV, at least until a child is older!! If you need references on car seats go to http://www.nhtsa.dot.gov or http://www.seatcheck.org Send your question or comment to Dr. Sue!

Leaving Children in a Hot Car

16 deaths have been attributed to children left in a hot car. What every parent needs to know. It is SO HOT in many areas of the country and summer is just beginning. With extreme heat comes the concern for vehicular heatstroke among children who may inadvertently be left inside of a car.

One wonders how that could possibly happen, but in 2010 there were 49 deaths of children who were found inside of cars, and already in 2011 there are 16 deaths being reported. We have a long summer still ahead, and I am hoping that this tragedy can be averted. As busy as parents are these days, it is still hard to fathom how a child can be left (usually in the back seat) inside of a parked car. With a sleeping child in a car seat, and a busy parent heading to work,  a meeting or even the grocery store, a parent may just “forget” that their child is with them. No noise, no reminder and the car is locked and left for minutes, hours or even the day, before someone returns to find the child who has succumbed to heat stroke. Horrific but true. A child’s thermoregulatory system is different than adults and their body temperatures may warm at a rate 3-5 times faster than that of an adult. This means that even several minutes inside of a hot car (even with the windows cracked) may cause heatstroke and ultimately death. Remember that these deaths are due to hyperthermia and this different than 104 degree fever in a child with a viral illness. Fever and hyperthermia are NOT synonymous terms. Heatstroke is a medical emergency.  If you ever come upon a child who has been left inside of a car, not only should you try to locate the driver of the car, but at the same time call 911. Minutes may matter when trying to resuscitate a victim of heatstroke. If the child is unresponsive begin CPR while waiting for the paramedics. How can a parent be reminded that they have left a child in the car?  When routines change it seems accidents may happen. A different parent dropping off at day care, or taking a different route to work may be to blame as 51% of these deaths occurred when a child was forgotten in the car. Make sure to leave yourself a reminder that you have your child in the back seat. Put the child’s toy or stuffed animal in the front seat to remind you that your child is there. At the same time leave your purse, car keys, cell phone, or briefcase in the back seat. By doing this you will immediately look in the back seat before locking and leaving the car. A rear facing car seat (now recommended until age 2 years), may not allow you to visualize your child when glancing in the rear seat. Checking the back seat before locking the door should become a habit for every parent. Lastly, 30% of vehicular heat strokes occurred when a child had been playing inside of an unattended vehicle. Make sure that your car is always locked after parking it in the driveway etc. Do not leave the windows down where a child might be able to climb in the car and then is not noticed. There are also reports of children dying after climbing into a car with an unlocked trunk. Lock all doors and trunks each time you leave the car! Remember the adage “beat the heat, check the backseat”. These are tragic, yet preventable deaths. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Safety Seat Debate Continues

With the recent comments by the AAP on the current research that children under the age of two years remain in rear-facing car seats, I have noted a lot of confusion.With the recent comments by the AAP on the current research that children under the age of two years remain in rear-facing car seats, I have noted a lot of confusion and parental commentary surrounding this recommendation. Although this is currently a recommendation, rather than a law, the studies are showing that the rear facing position is safer, and is especially protective of serious head and neck injuries. Recommendations still vary on a state-to-state basis, and would probably be easier to follow if there were national mandates and a consistent policy. For information on your state go to www.usa.safekids.org.

Many parents with toddlers have already turned their children’s car seats to forward face after their first birthday. Parents have been concerned about the weight limits for rear facing car seats. Most of the convertible car seats (which can rear or forward face) have weight limits of 30

Daily Dose

Importance of Booster Seats

The Texas Legislature is sending a bill to Governor Rick Perry that will change booster seat laws. The current law requires that children under five years of age and 3 feet 9 inches tall be in a car seat. The new law will require that children under the age of eight years or 4 feet 9 inches tall be restrained in a car seat. Car accidents are the leading cause of death for children in this age group and experts testified that changing the booster seat law would reduce the risk of life threatening injury by up to 60%.

The extra height provided by a booster seat allows the seat belt to be positioned correctly, across the child's pelvis. Without the booster the seat belt is often placed across the child's abdomen or neck, or even behind the shoulders and neck and puts them at risk for head, neck and abdominal injuries. Correct positioning of the belt is essential for maximum protection. Forty other states have similar laws requiring booster seat use. This bill will not go into effect in Texas until 2010, but don't wait until then to get your child a booster seat. Many parents already have their children in booster seats, but if not, put this at the top of your "to do list". If your children balk at the idea, tell them that it is for their protection and it is now a law! That's your daily dose, we'll chat again tomorrow.

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