CHILD PASSENGER SAFETY Vanessa Salcedo & Rebecca Turcotte Legislative Advocacy January 3, 2012 OUTLINE Background Current Recommendations Research Legislation NYC-Specific concerns Resources for providers and caregivers EPIDEMIOLOGY Motor vehicle crashes are the leading cause of death in children 4 years of age and older. 15% of people killed in motor vehicle crashes in the US are under 21. About 1500 children under 16 years old die in motor vehicle crashes in the US yearly; nearly half of them are unrestrained. Many more are improperly restrained. For every death, 18 children are hospitalized and 500 receive medical attention. Child safety seats reduce the risk of injury by 71-82%, and risk of death by 28% as compared to seat belts. Booster seats reduce risk on nonfatal injury by 45% in children 4-8 years old. Significant racial disparities exist, with highest mortality rates for black and American Indian/Alaskan Native children. CURRENT AAP RECOMMENDATIONS o Infants and toddlers under 2 yo should ride in rear-facing seats. o Children 2 and older should use a forward-facing seat for as long as possible (generally until 65-80 lbs.). o Children who have outgrown a forward-facing seat should use a booster seat until the lap-and-shoulder belt fits properly (generally 4 ft 9 in and between 8 and 12 yo). o Children should always use lap-and-shoulder belts once they’ve outgrown booster seats. o Children should ride in the back seat until age 13 yo. HOW DO I KNOW WHEN TO TRANSITION? In general, try to delay progression from one step to another, as there is always slightly less safety. For test of selt belt fit, ask three questions: Is the child tall enough to sit against the seat back with his or her knees belt at the edge of the seat without slouching? Does the shoulder belt lie across the middle of the chest and should, not against the face or neck? Is the lap belt low and snug across upper thighs, not the abdomen? www.seatcheck.org RESEARCH BEHIND RECOMMENDATIONS Restraint systems are designed to: Reduce risk of ejection during a crash Better distribute the energy load to bones rather than soft tissue Limit the forces experienced by the occupant by prolonging deceleration time and Limit contact of the occupant with interior structures. In 2008, restraint use was 99% among infants less than 1 yo, 92% among 1-3 yo, and 89% among 4-7 yo. 21% of children are not compliant with recommendations. WHY? Rear-facing Support posterior torso, neck, head, and pelvis, and distribute forces over entire body. Babies’ incomplete vertebral ossification, horizontally oriented spinal facet joints, and ligamentous laxity, as well as large heads, put them at risk for movement of the head relative to the small neck. Swedish research has found a 90% decrease in significant injuries relative to unrestrained passengers, and they require rear-facing seats until 4 yo. Forward-facing Spread crash forces over shoulders and hips, and control head excursion. 54% reduction in death for children 1-4 yo compared to unrestrained. WHY? Booster seats and lap-and-shoulder systems. Prevention of “seat belt syndrome.” Use of shoulder belt reduces risk of injury by 81%. Back seat Particularly back rear. VIDEOS http://www.iihs.org/research/topics/child_restrain ts/default.html TYPES OF SEAT BELT LAWS Primary (standard) safety belt laws allow law enforcement officers to stop a vehicle and issue a citation for simply observing an unbelted driver or passenger. Secondary safety belt laws allow law enforcement officers to only issue a citation for not wearing a seat belt only when the driver is stopped for another infraction. CHILD RESTRAINT LAW Require children to travel in approved child restraint devices and some permit or require older children to use adult safety belts Most restraints were put into place to protect adults without regard for children or infants First State was Tennessee in 1978 Robert Sander, Pediatrician By 1985 all 50 states and DC had passed laws requiring child restraints for young children CHILD RESTRAINT LAW Laws were inconsistent, several gaps The age at which belts can be used differ among states Young children usually are covered by child restraint laws Older children and Adults are covered by Safety belt law Enforcement and fines differ among states Poor compliance In the 1990s, protection for older children would take a leap forward. Automakers were finally required to install three-point belts in rear LOWER ANCHOR AND TETHERS FOR CHILDREN (LATCH) ANTON’S LAW December 2002, the federal government passed legislation called "Anton's Law." Its goal was to improve federal standards for child restraint systems for kids weighing more than 50 pounds, typically children ages 4 to 8 The law is named for Anton Skeen, a Washington state four-year-old who was ejected from his seat belt and killed in a rollover crash. His mother, Autumn Alexander Skeen, succeeded in helping to get Washington's belt-positioning booster seat bill passed in 2000, the first ever in the U.S Anton's mother worked for better federal standards for kids in the 4 to 8 age who may have outgrown their child safety seats but are too small for regular seat belts NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION (NHTSA) Develop federal regulation and strategies for reducing the number of children killed and injured in motor vehicle crashes Conducts national campaigns to educate the public about the importance of buckling children into child restraint systems. To improve existing requirements for the performance and testing of child restraint system Federal Motor Vehicle Safety Standards (FMVSS) and Regulations to which manufacturers of motor vehicle and equipment items must conform and certify compliance CAMPAIGNS NEW YORK STATE LAW On April 1, 1982 New York State's first child passenger restraint law went into effect The law requires children under the age of 4 to be restrained in a federally approved car seat when riding in a motor vehicle Section 1229-c(1) If the weight of a child under the age of 4 exceeds 40 pounds, the child may be restrained in an appropriate child restraint system, allowing the child to use a booster seat Children ages 4 -8 yr must be properly secured in an appropriate child restraint system, one for which your child meets the weight and height recommendations of the child restraint manufacturer. Section 1229-c(1) NEW YORK STATE LAW Children < 4 y.o. must be restrained while riding on a school bus Section 1229-c(11) It is highly recommended that all children age 12 and under ride properly restrained in the back seat but NO LAW against children riding in the front WHAT ABOUT TAXIS? Driver and passengers in NYC yellow cabs are exempt from car seat and seatbelt laws. Everyone is “encouraged” to buckle up in a taxi. Passengers with children are encouraged to bring their own car seats, and drivers must allow them to install their seats. RESOURCES NHTSA – Standardized child passenger safety training and certification program in 1998 Community-base child safety clinics Source of info installation of all types of CSS and booster seats Formal Inspection Stations: www.seatcheck.org National Child Passenger Safety Certification Web site http://cert.safekids.org NHTSA child safety seat inspection station locator www.nhtsa.dot.gov/cps/cpsfitting/index.cfm Car seat checkup events or updates www.safekidsweb.org Guide for Families: Healthychildren.org INSPECTION STATIONS New York City DOT Safety Programs Harrison Street, between West and Greenwich Streets, New York, NY 10013 Spanish Speaking Technicians are available. NYC Department of Transportation, Access Safety City 672 West 158th Street, New York, NY 10032 Bronx Safety City (NYC DOT) 837 Brush Avenue, Bronx, NY 10465 Appointment required Spanish Speaking Technicians are available. Keeping Generations Safe Lincoln Medical & Mental Health Center 234 East 149th Street, Bronx, NY 10451 REFERENCES New York City Taxi and Limousine Commission (http://www.nyc.gov/html/tlc/html/passenger/faq_p ass.shtml#9) Durbin DR (2011) Pediatrics 127:e1050-e1066. Durbin DR (2011) Pediatrics 127:788-793. Bull MJ (2002) Pediatrics 109:550-553. http://safeny.ny.gov http://www.healthychildren.org http://www.nhtsa.gov http://www.iihs.org/laws/SafetyBeltUse.aspx http://www.research.chop.edu/programs/carseat/ Thanks and Happy New Year!