Last summer when I was working as the trauma room RN in an ED in Colorado, the paramedics brought in a family of four who were injured in a car crash. My patient was a seven-year-old girl in trauma arrest. She had been restrained in the backseat with the customary adult lap-shoulder belt, as many children are once they outgrow their car seats. Her family's vehicle was broadsided at an intersection during a rainstorm. The girl died of a high cervical fracture, which probably occurred when her head snapped forward or hit the seat in front of her, as is often the case when adult restraints are used on children. Her mom and younger sister were in adjacent trauma rooms, and it broke my heart to hear the three-year-old (who was most likely saved by her car seat) crying for her older sister.
Motor vehicle crashes are the leading cause of death in children, according to the National Safety Council, despite the public's awareness of the importance of child safety seats. The issue is complicated by the fact that while many parents recognize the need for child restraints and indeed use them, most don't use them correctly. In a recent study from the National Highway Traffic Safety Administration (NHTSA), researchers found that "nearly 73% of all child restraints are improperly used." While it's clear, given the general level of compliance, that the broad message concerning child safety in vehicles has been sent and received, care-givers still lack important information on ways to keep children safe in motor vehicles, especially their "big" boys and girls.
All 50 states and the District of Columbia have child passenger safety laws, but there are significant gaps and exemptions in coverage that diminish the safety of our children. For instance, the concept of child passenger restraint for four-to-eight-year-olds is newer and not enforced in all states. Parents and caregivers need to know that when children outgrow forward-facing seats, they must be restrained in booster seats. Children are usually ready for booster seats at the age of four (when they're about 40 lbs.). To ensure proper restraint during a motor vehicle crash, children should use booster seats until they're at least 4' 9" tall, regardless of age. The American Academy of Pediatrics, the NHTSA, and the National SAFE KIDS Campaign suggest that a child's height is the best predictor of the proper restraint. According to the SAFE KIDS Web site, "sitting height is more important to crash protection than overall height," so parents must do some shopping to find the best seat for a child. An appropriate booster seat can be easily purchased for $20 to $40. The American Academy of Pediatrics has a guide to car seats at http://www.aap.org/family/carseatguide.htm.
Nurses are the frontline workers caring for the small victims of motor vehicle crashes. We place IV and intraosseous lines for lifesaving blood administration. We squeeze the Ambu bags to force oxygenated air into their tiny lungs. We are also on the front line with the survivors who find no solace when a child has died despite the best resuscitation efforts. We hold their hands and listen to their cries, knowing that some of these premature deaths can be prevented if children are properly restrained. Because we are on the front line, we can make a huge difference.
Nurses have contact with children and their adult drivers in a variety of settings, from clinics and health fairs to schools and day care centers, and can increase the use of booster seats by talking about it. Tell grandparents, who are often the chauffeurs for their busy families, about the right restraints and how to use them.
I can't tell you the number of times I've had to informally educate the parents of my five-year-old's friends who no longer use car seats because "the children are in school and are big kids." I have two friends who have put their five- and six-year-olds back in booster seats because of this informal education. Information on how you can help can be found at http://www.nhtsa.gov and http://www.safekids.org. The NHTSA and the Ad Council have declared 2004 the year of the booster seat. Let's join in celebrating it-for life.