Child seat belt guidelines: Examining the 4 feet 9 inches rule as the standard

Evaluating Child Passenger Restraint Use Education

BACKGROUND

Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education.

OBJECTIVE

This project aims to measure the impact of an education initiative on child passenger restraint use.

METHODS

This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5 months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3 weeks later at the same schools to evaluate the education provided.

RESULTS

A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p = < .001). In the primary age group of 4-8 years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p = <.001).

CONCLUSIONS

The study results demonstrate that one-on-one education increases child passenger restraint use.

Analysis of the factors influencing parents' support for child safety seat legislation in Nanjing

OBJECTIVE

Although the use of child safety seats can effectively ensure the safety of children in cars, the utilization rate of such seats in China is still low (<5%, 2021). Therefore, it is urgent to promote the use of child safety seats. The goal of this study was to examine the factors affecting parents' support for child safety seat legislation.

METHODS

Data were collected via 1200 questionnaires distributed in several community hospitals in Nanjing. We used the data to do a multivariate logistic regression analysis to find the influencing factors of parental support for child safety seat legislation.

RESULTS

On the whole, the respondents had low support for legislation mandating the installation of child safety seats. Although only 5.83% of the respondents expressed opposition to the relevant legislation, more than 40% expressed a neutral attitude rather than a supportive attitude. Multinomial logistic regression analyses revealed that gender, monthly household income, educational level, number of children in the family, comprehension of child safety seat-related publicity information, and cognition of children's riding safety significantly affected parents' support for child safety seat legislation. In addition to gender and cognition of children's riding safety, other influential factors had significant positive impacts on legislative support for compulsory installation of child safety seats.

CONCLUSION

These results have implications for making more effective recommendations to advance child safety seat legislation and keep child passengers safe.

Evaluation of an After-Hours Child Passenger Safety Resource Guide

Motor vehicle crashes are a leading cause of unintentional injury deaths for children in the United States. Child safety seats are effective in reducing the rate and severity of injury for children. Families seen in an emergency department (ED) outside of injury prevention (IP) operational hours may not have the same opportunity to obtain a child safety seat due to the unavailability of IP resources. This study evaluated the effectiveness of a resource guide that assists the ED staff to screen and provide the appropriate child safety seat. Two retrospective cohort analyses were conducted to assess the following: (1) patients seen in the ED who were eligible to be screened through the resource guide; and (2) patients who were screened and received a restraint system through the resource guide. Records for both cohorts were reviewed from May 1, 2015, to February 29, 2016. Descriptive statistics were used to describe each cohort. In Cohort 1, 10.6% of the 113 patients meeting criteria were screened for a restraint system. In Cohort 2, 20 patients received a restraint system through the resource guide and 90% of these received the appropriate restraint system for their age and weight. Our results demonstrate the need for an algorithm to increase consistency of the resource guide's utilization. Algorithm development to identify screening candidates, further refinement of the guide's restraint identification process, and staff training may improve this tool to ensure that all patients, despite the availability of IP staff, are screened for the appropriate child safety seat.

Pilot Trial of an Emergency Department-based Intervention to Promote Child Passenger Safety Best Practices

BACKGROUND

Despite demonstrated effectiveness of child restraint systems (CRSs), use remains suboptimal. In this randomized pilot trial, we sought to determine the feasibility, acceptability, and potential efficacy of "Tiny Cargo, Big Deal" an ED-based intervention to promote guideline-concordant size-appropriate CRS use.

METHODS

Parents of children < 11 years old were recruited in two EDs and randomized in a 2 × 2 factorial design to four conditions: 1) generic information sheet, 2) tailored brochure mailed after the ED visit, 3) a single motivational interviewing-based counseling session in the ED, and 4) full intervention (counseling session plus tailored brochure). We assessed feasibility (recruitment, completion, follow-up rates) and acceptability (parent attitudes, uptake of information) in the ED, at 1 month and at 6 months. We obtained preliminary estimates of effect sizes of the intervention components on appropriate CRS use at 6-month follow-up.

RESULTS

Of the 514 parents assessed for eligibility, 456 met inclusion criteria and 347 consented to participate. Enrolled parents were mostly mothers (88.1%); 48.7% were 18 to 29 years old; 52.5% were non-Hispanic, white; and 65.2% reported size-appropriate CRS use. Completion rates were 97.7% for baseline survey, 81.6% for counseling, 51.9% for 1-month follow-up, and 59.3% for 6-month follow-up. In the ED, 70.5% rated thinking about child passenger safety in the ED as very helpful. At 1 month, 70.0% expressed positive attitudes toward the study. Of 132 parents who reported receiving study mailings, 78.9% reviewed the information. Parents randomized to the full intervention demonstrated an increase (+6.12 percentage points) and other groups a decrease (-1.69 to -9.3 percentage points) in the proportion of children reported to use a size-appropriate CRS at 6-month follow-up.

CONCLUSIONS

Suboptimal CRS use can be identified and intervened upon during a child's ED visit. A combined approach with ED-based counseling and mailed tailored brochures shows promise to improve size-appropriate CRS use.