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Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge

Tuesday, December 22, 2015  
Posted by: Kyle Schaller
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More than 3.9 million children were born in the US in 2014.1 Considering that only approximately 36 000 of those births were home deliveries,2 the overwhelming majority of infants born in the US traveled home from a hospital or birthing center. Given that all 50 states have laws mandating car safety seat (CSS) use for young children,3 it follows that virtually all children born in the US travel home in a CSS.


The American Academy of Pediatrics (AAP) policy statement on Safe Transportation of Newborns at Hospital Discharge states that “every newborn should be properly restrained in a car safety seat,”4 a policy echoed by the Children’s Hospital Association.5 Although many hospitals have child passenger safety programs, and many prenatal classes include information about safe transportation of newborns, there is tremendous variability in the content and degree of integration of these programs into hospital perinatal services.6 Constraints on time, staffing needs, financial resources, and risk management concerns are all barriers to the development and implementation of robust child passenger safety programs.7 Research is essential to define the need and identify the essential components of effective child passenger safety programs for newborns and parents.


In 2013, 134 infants aged <1 year died in motor vehicle crashes, and approximately 500 more were hospitalized and >8000 more were treated in emergency departments for injuries sustained in crashes.8 CSSs are very effective at protecting children in crash events, reducing the risk of death by 71% in infants aged <1 year.9 However, research has found that some 73% of all CSS uses involve at least 1 critical misuse.10 Misuse may be even more prevalent for newborns; 2 previous studies examining CSS use at hospital discharge reported misuse rates of 85% and 78%.11,12 The purpose of the present study was to apply standardized criteria to examine the prevalence and types of CSS misuse, and to identify potential risk factors and protective factors, among a random sample of families of well newborns at an academic medical center.


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