Notice to Readers
National Child Passenger Safety Week -- February 14-20, 1999
In 1997, 1791 U.S. children aged less than 15 years were
killed and
282,000 were injured while riding in motor vehicles (1). National
Child
Passenger Safety Week, February 14-20, 1999, will highlight safety
recommendations for children aged greater than 4 years and weighing
greater
than 40 lbs who have outgrown their child safety seats.
Children who are too large for child safety seats often are
restrained
improperly or not at all. A recent observational study in four
states
indicated that, of children weighing 40-60 lbs, 75% were improperly
restrained, and 19% were unrestrained (2). Of passengers aged 5-9
years in
fatal crashes in 1997, 46% were unrestrained (1).
For proper restraint, children who have outgrown child safety
seats
require booster seats used with vehicle lap/shoulder belts.
Lap/shoulder
belts usually do not fit children properly until they are 58 inches
tall,
have a sitting height of 29 inches, and weigh 80 lbs (3).
Therefore,
children aged less than 10 years probably will not be big enough to
use a
lap/shoulder belt without a booster seat. When smaller children
restrained
with only a lap belt or a poorly fitting lap/shoulder belt become
involved
in a crash, the belt tends to ride up onto the abdomen, allowing
the pelvis
to slide under the belt. This places pressure directly on the
abdominal
organs and may lead to the child flexing over the belt above the
hips,
resulting in abdominal and/or spinal injuries (4).
Children should remain in their convertible child safety seats
as long
as they fit well. Convertible seats are the appropriate restraints
for
children until their ears reach the top of the back of the safety
seat and
their shoulders are above the top strap slots, or until they reach
the
upper weight limit of the seat. To help prevent deaths and injuries
among
young passengers who have outgrown their child safety seats, CDC
recommends
the following:
Belt-positioning booster seats should be used until
lap/shoulder belts
fit properly (5). Belt-positioning boosters raise children so
that the
safety belt fits correctly (Figure_1) and should always be
used
with a lap/shoulder belt. Booster seats with high backs are
recommended
for vehicles with seat backs that do not support a child's
head. Shield
boosters, which have a plastic shield in front of the child, do
not
provide as much upper-body protection and are no longer
certified for
children weighing greater than 40 lbs. The American Academy of
Pediatrics recommends that shield boosters not be used for
children
weighing less than 40 lbs, even if they are labeled for use at
a lower
weight (6). Shield boosters should only be used with their
shields
removed so they can function as belt-positioning booster seats
with
lap-shoulder belts.
Lap/shoulder belts should fit properly (Figure_1). A child
cannot
ride comfortably and remain properly restrained until tall
enough for
the knees to bend over the edge of the seat when the child's
back is
resting firmly against the seat back.
Whenever possible, child passengers should be placed in the
back seat.
The National Transportation Safety Board recommends that
states
upgrade their child passenger protection laws to require
age-appropriate
child restraint systems and booster seats for children aged less
than 8
years and has asked automobile manufacturers to redesign the back
seats of
cars to be more accommodating to children (7). Additional
information on
child passenger protection is available on the World-Wide Web from
the
American Academy of Pediatrics at http://www.aap.org, the Society
of
Automotive Engineers at http://www.sae.org, the National Highway
Traffic
Safety Administration at http://www.nhtsa.dot.gov, the National
Transportation Safety Board at http://www.ntsb.gov, and CDC's
National
Center for Injury Prevention and Control at
http://www.cdc.gov/ncipc.
References
US Department of Transportation, National Highway Traffic
Safety
Administration. Children: traffic safety facts 1997.
Washington, DC: US
Department of Transportation, National Highway Traffic Safety
Administration, 1998.
Decina LE, Knoebel KY. Child safety seat misuse patterns in
four
states. Accid Anal Prev 1997;29:125-32.
Klinch KD, Pritz HB, Beebe MS, et al. Study of older child
restraint/booster seat fit and NASS injury analysis.
Washington, DC: US
Department of Transportation, National Highway Traffic Safety
Administration, November 1994; report no. DOT-HS-808-248.
Lane JC. The seat belt syndrome in children. Warrendale,
Pennsylvania:
Society of Automotive Engineers, 1993:159-64. (SAE no. 933098).
American Academy of Pediatrics, Committee on Injury and Poison
Prevention. Selecting and using the most appropriate car safety
seats
for growing children: guidelines for counseling parents.
Pediatrics
1996;97:761-2.
American Academy of Pediatrics. 1998 family shopping guide to
car
seats. Elk Grove Village, Illinois: American Academy of
Pediatrics,
1998.
National Transportation Safety Board. The performance and use
of child
restraints, seatbelts, and air bags for children in passenger
vehicles.
Washington, DC: US Department of Transportation, 1996; document
no.
NTSB/SS-96/01.
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