What to tell parents about car restraints
What to tell parents about car restraints
Next time a child comes in with an injury, ask the parents specific questions about car safety, urges Barbara Foley, RN, executive director of Emergency Nurses Care (EN CARE), the Alexandria, VA-based injury prevention affiliate of the Emergency Nurses Association.
"ED nurses are the perfect candidates to help prevent these injuries," she says. "We are teachers by profession, and we need to educate our patients about child passenger safety. Car crashes are still the No. 1 killer of children in this country, and we need to know how to prevent those injuries and deaths."
First, educate yourself about car restraints, urges Foley.
"We’ll ask parents if children are up-to-date on shots, but ED nurses usually don’t ask questions they don’t know the answer to. We won’t ask parents about where they place their child’s car seat if we don’t know ourselves," she says. (See Resource Box for how to obtain educational materials, right.)
Look for teachable moments’
There are often "teachable moments" when caregivers are likely to listen to advice about car seats. "Even if the child comes to the ED for a broken arm or some other reason, it’s a good time to talk about car seats," says Susan Pollock, MD, program manager of pediatric and adolescent injury prevention at the Kentucky Injury Prevention and Research Center in Lexington. "Unlike some things, we have a technological answer that does work for prevention. People just have to use it correctly."
Here are questions and answers to share with parents:
• Question: Do car seats need to be replaced after a minor accident?
Answer: Yes. "There are minor crashes where kids are OK because they were in car seats, but parents need to know the car seats should be replaced," says Pollock. California has just passed a law making it mandatory for insurance companies to pay for that replacement, she reports.
Question: How long do car seats need to face the rear?
Answer: Until a child is both over 1-year old and 20 pounds.
A lot of people are not getting the correct message, Pollock says. "The reason is not just because the child doesn’t have strong neck muscles yet," she says. "That’s a misconception that it’s OK to turn the seat around, because the child can hold their head up."
At 40 pounds, use booster seat
Question: When can a child be moved to a booster seat?
Answer: Once a child reaches 40 pounds, it’s safe to move them to a booster seat. "People often move kids to booster seats too early," she explains.
The purpose of a booster seat is to position the child so the seatbelt fits properly.
"Belts improperly positioned can cause injury too," says Pollock. "When children are restrained at the waist, they can get paralysis and thoracic spine injuries. We continue to see kids paralyzed because the shoulder part of the seatbelt is behind their back because it doesn’t fit properly."
Booster seats are a missing link in car safety for many parents, notes Foley. "Most state laws say that children need to be in a car seat until 4 or 5 years of age, so parents think the child can go into an adult belt after that," she explains. "But they actually need go into a booster seat until the adult belt fits them properly."
Question: Should children ever be positioned in front of an air bag?
Answer: No. "If you have an air bag, don’t put a child in the front because in pre-crash braking, they are thrown into the air bag as it deploys and can’t reach the floor with their legs," Pollock advises. "Air bags are excellent for protecting large adults, but kids shouldn’t be sitting in front of an air bag."
Back seat is safest
All children in car seats 12 and under will be safest in the back seat because of air bags, says Foley.
"It’s supposedly well-known, but most of the air bag injuries and deaths we’re seeing are still caused by kids improperly positioned," she notes. "Had the children been in the back seat, there would have been no problem." (See information on air bag safety, p. 138.)
Question: How do you know an adult seat belt fits your child?
Answer: If child is all the way back in the seat and their legs are out straight, he or she needs to be in a booster seat.
"They tend to scoot down to bend their legs so the seatbelt will go into their abdomen," says Foley. "If the shoulder harness touches their neck, they need a booster seat instead."
Question: Which car seat should I buy?
Answer: There are 400 types, which is extremely confusing to parents, says Foley.
"The best one is to fit your child and the auto you drive. Some car seats don’t fit some automobiles, and some car seats don’t fit infants." (For tips on car seats, see box, above.)
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