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Date: Fri 23-Apr-1999



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Date: Fri 23-Apr-1999

Publication: Hea

Author: CURT

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By Jeff Cersonsky, MD, FAAP

One of the most important parts of my work is counseling parents on keeping

their children safe in different situations. Such counseling can include

advising against the use of infant walkers, locking up poisons, or keeping the

hot water temperature at 120-130§ F (49-54§ C) to minimize the risk of burns.

However, the most important advice I can give is how to restrain children

properly in cars and trucks.

Over 1,400 children die each year in motor vehicle accidents. Of these, 200

die because they are improperly restrained in the car. Another 20,000 children

are injured solely because they were improperly restrained. On the other hand,

in 1994, 300 children age 4 and under were saved as a result of child

restraint use.

For infants under a year old, a backwards-facing infant seat (convertible or

not) is mandatory. The infant's neck is unable to accommodate the stresses in

an accident when he is thrown forward against the restraint. Never place an

infant seat in a car's front seat. For children 12 months or older who weigh

less than 40 pounds, a certified child car seat should be used. These seats

can be the convertible kind, which switch from a backward-facing infant seat

to a forward-facing child seat.

For children 40-60 pounds, an approved booster seat is recommended. The safest

of these have a five-point harness (similar to what airplane pilots wear).

This might be the hardest sell, especially for the smaller child who might not

reach 60 pounds until third or fourth grade. However, these seats provide

tremendous additional protection over the lap belt and eliminate the problem

of how to adjust the shoulder belt without having it lie across the child's

neck. For children 60 pounds and up, a properly secured lap and shoulder belt

is necessary. Yet, when I ask children whether they wear their seat belt all

the time, frequently the answer is, "No." I don't accept "no" for an answer

because there is no acceptable excuse for not wearing a seat belt. My

wonderful nephew, Ben, fresh after getting his license at age 16, lost his

life because he was in a one-vehicle accident while not wearing his seat belt.

Air bags have been in the news a lot lately because of serious injuries and

deaths that have occurred to (mainly) children from the deployment of the air

bags. Yet in 1995 alone, 475 lives were saved by air bags. Contrast this with

the 46 people (as of September 1997) that had ever been killed by air bags.

Also, almost all of those 46 people were unrestrained or improperly restrained

in the car.

It is recommended that no children under 12 (or of small stature) ride in a

seat with an air bag. In addition, even if there is no front seat air bag,

children should sit in the back seat (if there is one). Estimates say that a

child riding in the back seat has a 36 percent less chance of dying in a car

crash than one riding in front.

Eighty-seven percent of car seats are improperly installed and therefore

cannot do the job.

For all car seats (infant, child, and booster), there are several important

recommendations to assure that the child is safe in the seat:

1. Make sure that, if the seat belt or lap belt/shoulder strap combination is

the kind that slides easily through the buckling part, a locking clip is

installed within an inch of the buckle. All car seats come with locking clips

- frequently, they are found in a slot in the back of the seat. They can also

be purchased at some children's product stores such as Toys R' Us.

2. The car seat should fit tightly against the seat of the car-while buckling

or tightening the seat - one can kneel in the car seat to push it tightly in.

3. Any straps over the shoulders should fit tight enough that two fingers

cannot fit between the strap and the shoulder. Readjustment is frequently

necessary as the child's wardrobe (parka vs. jacket vs. shirtsleeves) varies

throughout the year.

4. If the car seat has a slider joining the two shoulder straps together, this

slider should be pushed up to the upper chest about at the level of the


5. Under no circumstances should the child be allowed out of the seat while

the car is in motion. I had a patient who sustained a serious head injury when

a mother took him out of his infant seat for "just a moment to give him a

break." Jim Hall, the chairman of the National Transportation Safety Board

(www.ntsb.gov), is advocating for states, automobile dealers, and child safety

seat manufacturers to create permanent fitting stations which would ensure the

correct use of seats. Currently, the National Safe Kids Coalition sponsors

temporary stations throughout the country to help parents and children. In

Australia, the government has established hundreds of permanent fitting

stations. In this country, such stations would reduce the problem of seats

that are improperly installed.

Keeping your child safe in the car can be relatively easy with today's car

seats and seat belts. There is no excuse not to.

(Note: some information for this column was obtained from www.ccmckids.org,

the website for the Connecticut Childhood Injury Prevention Center, Garry

Lapidus, PA-C, MPH, director. They can be reached by phone at 860/545-9988, or

FAX at 860/545-9975.)

Comments are open. Be civil.

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