The Utilization of Child Passenger Safety Restraints in Middle Tennessee

By Samuels, A. Dexter; Foxx, Terri et al. | Journal of the National Society of Allied Health, Annual 2009 | Go to article overview

The Utilization of Child Passenger Safety Restraints in Middle Tennessee


Samuels, A. Dexter, Foxx, Terri, Johnson, Owen, Journal of the National Society of Allied Health


Introduction

Injuries are the leading cause of death in children and teenagers in the United States accounting for approximately 16,000 deaths each year. More than 20 million non-fatal injuries are estimated to occur in United States children each year, costing $347 billion and accounting for more than 300,000 hospital admissions. In 1998 alone, 697 children younger than age six died as occupants in motor vehicle crashes (MVCs) and nearly 100,000 children were injured (Schnitzer, 2006). Motor vehicle crashes are not just the leading cause of death, but also a leading cause of acquired disability for children over age one (Winston, Durbin, Kallan, & Moll, 2000). Researchers have found that motor vehicle crashes accounted for a significant cause of childhood morbidity which resulted from non-fatal unintentional injuries (Winston, Chen, Elliot, Arbogast, & Durbin, 2004). "Although considerable achievements have been realized over a short period of time, 62% of children age 4 to 8 remain inappropriately restrained in adult seat belts" (Winston et al., 2004). This paper seeks to highlight the utilization of child passenger safety restraints from fiscal year 2006 and 2007, as well as effective community-based interventions to increase restraint usage.

A corollary of the improper use and underutilization of seat belts results in unintentional injury and death. Studies have found that lap and shoulder belts are designed for adults and do not work well when used with young children because belts cannot be pulled tight; the lap belt hits the child in the abdomen, and the shoulder harness either does not restrain the child at all or crosses the child at the head or neck ("National Highway Traffic..," 1996). When a child is prematurely graduated to a seat belt from a child safety seat (CSS), the lap portion of the belt rides up over the abdomen and the shoulder portion crosses the neck or face. This places the child at risk for submarining or sliding out of the lap belt during a crash. Studies have shown that children age two through five were 3.5 times more likely to suffer significant injury and 4.5 times more likely to suffer head injury when using a seat belt instead of a car seat. Rapid, jack-knife bending about a poorly positioned vehicle seat belt increases the risk of intra-abdominal and spinal cord injuries, also known as seat belt syndrome, and brain injuries result from the impact of the head with the child's knees or the vehicle interior (Winston, et al., 2000).

Although abdominal injuries are uncommon, they typically occur in children wearing seat belts and not those in child restraint systems (CRS). A major benefit of CRS is a reduction in head injuries. However, the risk of injury for children in lap belts and lap/shoulder belts suggests that the addition of a poorly fitting shoulder portion of the belt offered no added protection for young children. The premature graduation of young children from CRS to seat belts puts them at an increased risk of significant injury crashes. Therefore, in order to reduce the risk of injury, children should remain in a CSS until they are at least four years old and weigh 40 pounds. While correct seat belt fit is not usually achieved until a child is nine years old, children should be placed in belt-positioning booster seats and remain in booster seats until they are the appropriate height and weight for seat belts (Winston, et al., 2000).

Restraint Use

Most parents cannot identify specific injury prevention strategies and believe that simply "being careful is adequate protection from injury" (Schnitzer, 2006, p. 1864). "Car seat use has been shown to be effective in reducing injury and death to children under four years of age who are passengers in cars; however, many parents do not use car seats for their children or use them correctly. It has also been found that car seat use decreases as children get older, and toddlers have been found to receive less protection from motor vehicle related injuries than infants" (Louis & Lewis, 1997, p. …

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