Medical Student McGovern Medical School at the University of Texas Health Science Center at Houston Houston, Texas, United States
Background: Child safety seats reduce fatal injury in cars by 71% for infants (under 1 year old) and by 54% for toddlers (1 to 4 years old). A previous study found that of 291 mother-baby dyads, 95% of car safety seats were misused with regards to child positioning, car seat installation, or both. Objective: To understand baseline child passenger safety knowledge, attitudes, and behaviors among patient parents or guardians. Design/Methods: A questionnaire was developed to assess current usage of car safety seats or restraints, general car seat knowledge, and attitudes around car seat use and points of education. IRB approval was obtained. The survey was administered to healthcare professionals and patient parents or guardians within pediatric inpatient and outpatient clinical settings and was distributed via email to pediatric residents at UTHealth Houston. Descriptive analysis was performed. Results: Of the 256 children accounted for in this survey’s responses, 166 children (62%) report using car seats correctly, while 50 children (19%) do not sit in the car in accordance with current safety guidelines. For 51 children (19%), car seat restraint usage was not reported. Parents of more than one child were significantly more likely to have at least one child improperly restrained in the car compared to parents with only a single child (OR = 0.09 p< 0.0001).
A majority of respondents correctly answered questions about the guidelines for booster seat graduation and how long children should remain rear facing, though these were the second and third most common car seat misuses noted in the study (Figure 1 and Table 1). Of significance, controlling for parents who correctly answered the question regarding which aftermarket products not sold by the car seat manufacturer are safe to use were at 5.27 greater odds (p=0.004) to have all their children properly restrained in the car.
A vast majority of respondents view hospitals as a trusted source of information and support hospital educational interventions to help parents/guardians (Figure 2).
Conclusion(s): Parents who have more than one child are inherently more likely to have a child seated incorrectly, due to increased exposure of more children. Because knowing about aftermarket products is a significant predictor for seating all children safely in the car, there should be continued efforts to emphasize the fact that car seat covers, car seat inserts, and strap covers not produced by the car seat manufacturer are unsafe. This survey data confirms the opportunity for increased education on car seats and reveals the need for future studies to address disparities.
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