Review of Recent Medical Publications

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Review of Recent Medical Publications
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Children with Special Health Care Needs Patterns
of Safety Restraint Use, Seating Position, and
Risk of Injury in Motor Vehicle Crashes

• Pediatrics 2009 123 518-523. Huang et el.
  www.pediatrics.org/cgi/content/full/123/2/518

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OBJECTIVES

• Hypothesis Special health care needs associated
  with behavioral conditions may influence a
  childs safety in MVC.
• Aim of study To describe and compare restraint
  use, seating position, and injury risk in
  children with and without behavioral needs.

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METHODS

• Telephone survey of parents for 1-15yo in MVC in
  vehicle insured by State Farm
• SNLAB special needs likely to affect behavior
• AAP and NHTSA standards used for restraint use
  rules
• Experts helped evaluate and sort SNLAB

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RESULTS

• Data collected for 14,654 children 4-15yo
• 1.1 or 152 children SNLAB
• Drivers of SNLAB more likely to be restrained
• No difference in injury or restraint pattern in
  children with/without SNLAB

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How Children With Special Health Care Needs
Travel With Their Parents Observed Versus
Reported Use of Vehicle Restraints

• Pediatrics 2007 119 e637-e642. Korn et al.

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OBJECTIVES

• Hypothesis
• Children with special health care needs can be
  difficult to transport.
• Parental interview is often used but never has
  been validated

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METHODS

• 115 children with special health care needs, ages
  0-18yo, observed in parking lot in Jerusalem
• 94 parents of those children were interviewed in
  clinic later that day

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RESULTS

• 50 unrestrained
• 23 child restraint system
• 0 special needs restraints
• 25 seat belt
• 4 wheelchair

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RESULTS

• 70 were observed to be unrestrained or
  essentially unrestrained due to misuse
• The remaining had variety of errors that could
  compromise safety

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RESULTS

• 50 a parent correctly stated the child was
  restrained
• Most of time a parent correctly stated a
  restraint was not used

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CONCLUSIONS

• High percentage of no restraint and high rate of
  misuse puts this group at high risk of injury
• Many cases were parents doing the best they could
  with information or resources they had

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CONCLUSIONS

• If parent states restraint NOT USED- probably
  true
• If parents states restraint USED- 44 not
  accurate
• Therefore, be cautious of information obtained by
  parental report only

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CONCLUSION

• Misuse and nonuse is very high in special needs
  population
• Parental reporting of restraint use should be
  cautiously interpreted

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Car Safety Seats for Children Rear Facing for
Best Protection

• Injury Prevention 2007 13 398-402. Henary et
  al.
• www.injuryprevention.bmj.com

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OBJECTIVE and METHOD

• To compare injury risk of RF and FF car seats for
  children less than 2yo in the USA
• Data from NHTSA database and computer models and
  calculations

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CONCLUSIONS

• RF resulted in lower risk of injury for all
  crashes in all directions
• RF resulted in lower risk for side impact crashes
• Parents should prolong rear facing for greatest
  protection!!

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Effects of a Booster Seat Education and
Distribution Program in Child Care Centers on
Child Restraint Use Among Children Aged 4-8 Years

• Archives of Pediatrics and Adolescent Medicine
  2009 Vol 163. No 3. p261-267. Thoreson et al.

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OBJECTIVE

• To study effect of booster seat education and
  distribution after booster seat legislation.

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METHODS

• 854 parents and 1010 children aged 4-8yo at 39
  urban child care centers
• Child care staff were trained and given education
  designed to increase booster seat use
• Booster seats were given to the child care
  centers to distribute
• RAs were trained to perform the observation in
  child care parking lots

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RESULTS

• More intervention center drivers reported
  receiving information about booster seats than
  control center drivers
• Intervention center drivers were more likely to
  accurately report when to move child from booster
  seat to seat belt
• No difference in booster seat use

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Car Seat or Car Bed for Very Low Birth Weight
Infants at Discharge Home

• Journal of Pediatrics 2007 Volume 150, Issue 3.
  Salhab et al.

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OBJECTIVE

• To compare apnea, bradycardia, or low oxygen
  saturation in a car seat vs. car bed at time of
  discharge

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METHODS

• 151 VLBW infants tested within 72 hrs of
  discharge
• Standard monitoring procedure
• Done in car bed and car seat or visa versa
• Cosco infant car seat with appropriate
  positioning
• Cosco Ultradreamride car bed on back

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RESULTS
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CONCLUSIONS

• VLBW infants still have apnea, bradycardia,
  decreased oxygen saturation at discharge
• The incidence was similar in car seat and car
  bed.
• A brief observation period is not enough.
• VLBW esp those with lung disease should be
  closely observed and travel time limited

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NEW AAP GuidelinesSafe Transportation of
Preterm and Low Birth Weight Infants at Hospital
Discharge

• Pediatrics Vol 123, No 5 May 2009.
• www.pediatrics.org/cgi/doi/10.1542/peds.2009-0559

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Guidelines for Preterm and LBW

• Observation period for 90-120 minutes or duration
  of travel, whichever is longer
• Trained hospital staff should do the observation
• Protocols should be developed for infants lt37 wks
  and those at risk for apnea, bradycardia, or
  desaturation
• Document any events

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Guidelines for Preterm and LBW

• Car bed should have same observation period
• Same observation period to transition from car
  bed to car seat
• Car seat only for transport!
• Child should never be left alone in car seat- in
  or out of car

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Guidelines for Preterm and LBW

• Travel with twice the amount of portable, self
  contained power
• Secure all equipment (no available products at
  this time)

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Guidelines for Preterm and LBW

• Rear facing as long as possible
• 3-pt or 5-pt but 5-pt provide optimal fit
• Use seats with shortest distance from crotch
  strap to seat back
• No aftermarket products (such as head support
  system)
• Child should be observed in car, if possible