Dr. Poj Lysouvakon, and Matt Louzon, CPST, give an in depth presentation on child safety seats.
POJ LYSOUVAKON: Hey everybody. Welcome. Thanks for coming today on campus. A special thank you to Doctor Cunningham and the Department of Pediatrics for hosting this exciting and unique event. Today I'm going to talk about car seats. Not sexy, but very important, keeping our kids healthy and safe. As you can see, I run the newborn nursery so I see a lot of the safety issues begin right in the nursery, and making sure our babies go home safely. So globally, accidental deaths are 25 children dying every day. And accidental deaths from unintentional injuries include accidental ingestions, furniture falls, so furniture falling on kids, suffocation, burns, fires. And at 25 kids a day dying from unintentional injuries, it runs to about 9,000 kids annually who die of unintentional injuries. It's the equivalent of 150 busloads, school buses full of kids, dying every year from unintentional injuries. Motor vehicle crashes comprise a large component of unintentional injuries. They are the leading cause of death among children worldwide. In 2010, 33,000 people died in car crashes. 33.9 million were injured in car crashes and 24 million vehicles were damaged in these crashes. What does that cost society? Here in this country, it comes out to about $277 billion, back in 2010. That accounts for about 1.9 percent of our GDP here in this country. Now $277 billion, that's the GDP of many small nations around the world. And that's just here in this country. The $277 billion-- that's money lost in lost productivity, missed days of work, missed school, lawsuits, replacement of damaged goods. And there's medical cost, not to mention the emotional and psychological toll it takes on it's victims. In more realistic terms, that's $277 billion. That comes out to $897 for every man, woman, and child in this country. That's how much these car accidents cost us as a society. Now in 2012, more than 1,100 kids died in car crashes. And of the 150 school buses full of kids, that's 14 to 15 school bus loads full of kids who die every year from unintentional injuries due to car crashes. The good news is though, in 2012, an estimated 284 kids were saved by properly used child restraints in cars. And we know that car seats are very effective. Car seats reduce the risk of death in infants under one year of age by 71 percent. And in kids between one and four years of age by 54 percent. Booster seats are also very effective. They've been shown to reduce the risk of serious injury by 45 percent in kids between four and eight years of age. Between 1975 and 2012, it's been estimated that properly used child restraint systems have saved an estimated 10,000 lives in this country alone. So a third of kids who died in car crashes were unrestrained. The CDC actually did a study that said every year up to 618,000 kids in this country alone ride unrestrained in a car sometime during that year. Some studies show that kids who are African American or Latino are more likely to ride unrestrained in a moving car compared to their white friends. Safe Kids Global, which is an internationally recognized and respected organization-- it's a nonprofit-- that it's main goal is to basically increase education and awareness, and decrease instances of deaths due to unintentional injuries-- did a cool survey back in 2013. I found some interesting things. One in three parents who made over $100,00 a year said it was OK for the kids to ride unrestrained in a car if they're just going short distances. That's despite knowing the fact that 60 percent of all car crashes happen within ten minutes of their houses. 23 percent of young parents thought it was OK for kids to ride unrestrained in the car if you're traveling overnight, because the kids sleep easier out of the car seat. And I don't know about you, but I'm driving late at night, I'm always worried if the guy next to me is driving impaired because he's drunk, or because she's tired. Roads are not well lit. You may have the random deer coming out in the road. I know my reflexes are nowhere near as sharp at night compared to the daytime, so that just intuitively makes sense, that it's not safe for kids to ride unrestrained in a car travelling at night or overnight. Parents with graduate degrees, smart people, are twice as likely to say it's OK for the kids to travel without a seat belt if the parents are in a rush. And I just have no explanation for that. That just makes no sense to me whatsoever on it's face. These respondents, one in four of them, admitted that sometime during the year the kids have ridden unrestrained in a moving vehicle. So it's a lot of work we need to do as health care providers, , to bring the message home that every parent must buckle up every kid for every ride. Now Doctor Steven Levitt, who is a professor of Economics here at the University of Chicago, and also the author of Freakonomics. He actually did a study looking at the efficacy of car seats versus seat belts in reducing the incidence of morbidity and mortality in kids. And the study actually quoted a survey, the 1997 census for manufacturers-- kind of a weird name-- that said that consumers in this country alone spend roughly $300 million on four million car seats a year. That comes out to about $80 a pop, and we know now, in 2015, you can find car seats for $200 to $300 each easily. But even the cheapest car seats may be beyond the reach of our families who are in need. And so that's one of the things we have to work with our communities, to try to get these families in need car seats, so their kids can travel safely in their cars. And these car seats, you've seen them all. We've all worked with them. They're these tiny engineering marvels of plastic and metal. But unfortunately, they're not very intuitive. They're hard to use. I don't know how many times I've got friends, families, patients, asking me-- Hey Poj, where do these car seats go. Are they rear facing, are they forward facing. Where in the car are they best suited. Or I have a dad come in with a handful of straps like-- I put my car seat in what do these extra straps do. And I'm like, I have no idea. But luckily for me I have Matt Louzan here, who's my co-pilot at the University of Chicago. He is the only full-time, dedicated, hospital based, certified child passenger safety technician on the south side of Chicago. I know it's a big title. Woohoo. But he's been a tremendous resource for the university, and a great resource for our families in the community, and a great resource for me. And I'd like to take this opportunity to actually announce that the University of Chicago, through the generous grant from Doctor Cunningham and the Department of Pediatrics, we are resurrecting the Safe Kids chapter here at the University of Chicago. To help bring the messaging out to our communities, and to our providers, on how to instruct our parents, and our friends and families, how to have their kids travel safely in a car. And one of the other goals is to actually bring out educational programming to the community, And hopefully offer these families in need car seats, so that they can take their kids home safely from the hospital, or between doctor's visits, or to the mall. And we plan on, initially, to be on the south of Chicago. And with future success, we plan on rolling out these programs out to our near southern and western suburbs. And without further ado, here is Matt Louzon, who will talk to you abut the nitty-gritty of car seats. MATT LOUZON: Hello. So this is going to be really quick. The actual training for car seats is actually 32 hours. So we're going to try to fit it in twenty minutes. All right. So why do we use car seats? It's because cars are designed for adults. Kids don't buy cars, so car engineers do not really cater to kids so much. So the seat belts in a car are designed to protect an adult's body. So little kids, if they wear a seat belt or an adult restraint, basically fly out of the car. So the number one thing car seats protect are preventing ejections. They also provide pre-crash positioning for the child. And what that means is, when you're driving down the street, and you see a little kid like smacking his mom in the back of the head, that kid is not in the right position for a crash to happen. If he's in the right position and a crash happens, the car seat's going to do its job and protect the child. If he's out of that, it's not going to do anything. And plus, it gets less distraction for the driver. So they can drive better and not get in a wreck. So preventing ejections. So the law in Illinois, The Illinois Child Passenger Protection Act states, and parents always get this wrong, that children eight years or less have to be secured in an appropriate child restraint. So the appropriate part means if it's the wrong car seat, they're in violation of the law. If it's not installed correctly it's a violation of law. So up until their eighth birthday, there is no weight or height limit in the law, which always parents think there is. They took it out because they didn't want cops measuring kids on the side of the road. So there's no weight or height limit. Children over 40 pounds can be secured in just a seat belt, because that's an artifact of old cars that don't have shoulder belts. OK. So if the car has a shoulder belt available they have to ride in that spot. The parent's responsible to give the driver of the car a car seat. The driver's the one that gets the ticket though. So it's kind of a joint thing. And children over the age of eight must be secured properly in a seat belt or appropriate child restraint, if they still fit. The first violation is $75. They can come see somebody like me, a certified child passenger safety technician, to get that fee waved. The second violation is $200. They cannot get that one waved. It's also not applicable for negligence or admissible evidence. And there are medical exemptions, usually for medically intense kids or incredibly large, obese children. All right. Now that you know the Illinois law, the American Academy of Pediatrics has some different ideas. So according to the AAP, all children under the age of two should be riding rear facing. Or until they reach the maximum weight and height of their rear facing car seat. That's really important, as you'll see hopefully in a minute, if the video works. Because rear facing prevents neck and head injuries by keeping the child's head, neck, and spine aligned. Basically, 100 percent mostly, prevent whiplash. Children over the age of two, or those who have outgrown their car seat, should ride forward facing in a car seat with the harness. one with those five point straps. All Children whose height and weight is above the forward facing car limit should wear a belt positioning booster. Now belt positioning boosters are just those little booster seats that are like sitting on a phone book. Now the law says you have to ride in one till they're eight. But the AAP, and most cars are designed for the seat belt to fit them when they're four foot nine, which is like right here, so I almost need one. Now four foot nine, at 50th percentile I think, is like 11 years old. So there's a three-year-old gap. If you have an eight-year-old who's four foot nine, he's going to the NBA, that's Shaq's size. OK. And they should always ride in a lap and shoulder belt for optimal protection. The lap belt can cause some serious damage by causing seat belt syndrome, where the child folds in half like a sandwich. And it can lacerate their liver and all sorts of nasty stuff. So never a lap belt by itself if you can avoid it. And all children under the age of 13 need to be in the backseat. Because the airbag is designed to stop a large man, not a small 13-year-old. All right. Now the hard part. Choosing the correct seat for a child. Which seat should the parents use? Now this little graph on the right side, this little flow chart, you can get through the AAP policy statement on car seats. It's in there. It's really easy to use. Basically just watch it through. All the different criteria for kids and which car seat they should use. So it's good to have it on a little handy handout in the office. In general the safest restraints are rear facing, then forward facing, then a booster seat, then a lap shoulder belt, then a lap belt, and then no restraint, obviously. All right. Keeping a child in each step provides the maximum protection. We see a lot of parents who want to hurry up and get their kids, because they're a big boy, get them out of the baby seat. Get them in to a forward facing seat, and get them into a booster as fast as they can. Each time you move up to a different car seat, the child is less safe. Because they work worse. OK. So try and prevent that. And everybody always gets this question. What's the best car seat I can buy? There is no best car seat to buy. They all passed the exact same crash test. They all passed the exact same criteria. The best one is what works for the child, and for the family. All right. So the cheap one might be better than the $400 one, just because it fits the child better, or it fits the car better. Types of seats. All right. There's infant only. Those are rear facing. Those are the little carriers you always see. They're easily transportable. They don't last very long. And they have variable minimum weights for the newborn. So if you guys deal with brand new neonates at all, there's some, they go home four pounds, and some go higher, five pounds. So there are car seats that will only work for five pound plus babies. So we see this a lot at our hospital. Where a mom comes in with a car seat she bought off the shelf, and it doesn't work because her baby is a little bit too small. And we have to loan them a different one. All right. So that's something to be aware of. Now a convertible car seat is the second car seat. They go backwards and forwards. They're called convertibles. They can work for a newborn, and up to a toddler, so they're really cost efficient. They're really good for parents in financial need. But you can't take them on the bus or anything. They have to stay in the car. All right. Now a booster seat's a little phone book type thing. They're called belt positioning boosters because all they do is make the child fit the seat belt. All right. They come backless and high backed. Parents ask the difference a lot. And basically the high back version is in case you don't have a headrest behind your head. So if you get in a wreck without a head rest your head whips back pretty far. So the high back builds the headrest into the car seat. Where the backless booster, you just sit there and let the car's headrest do it's job. There are very many varieties of these, including a blow up one where the kid blows it up. One that's actually a backpack, and they sit on the backpack. And customizable ones where the kids can pick their own cover, so there will be eight year olds riding in them. Then there's combination seats. It's a combination regular car seat and a booster seat. So of course it has that cost saving benefit. And it allows children to ride in the car seat for a higher harness rate, so they can ride in it longer, Which is really good for high energy kids with autism or ADHD. Because you can keep them strapped in with that vest, and not have them getting out of the booster seat. Then there's seat belts-- like I said, four foot nine-- and special needs car seats, which are a huge other talk. But they are for medically special children-- spina bifida, dwarfism, hydrocephalus. Anything where a regular restraint might not work. We use this a lot at the hospital. They are very expensive for the big, like cerebral palsy car seats. I'm talking $2,000 to $3,000. So Medicaid buys them a lot. All right. Some common questions you might get from the parents. What is the safest car seat, which car seat do you recommend? I already talked about it. There is no, whichever one works the best for you. All right. Won't the car seat fly out the window if I put it in the middle of the backseat? No it will not. The middle of the back seat is safer, because in case you get T-boned, the other car comes in the side door about 18 inches. So if you put it on the side seat, the child is going to get smacked in the shoulder. Put it in the middle and he's furthest away from any impact point. The seat belt's made to hold like a 300-400 pound person in there. A twenty pound kid in a car seat's not going to break it. OK. My child keeps escaping his seat. How can I stop him? If a child's getting out of their car seat, they're not strapped in right. They have a big jacket on, the straps aren't tight enough. You just need to strap that kid in, get him nice and tight, where he can't get out. All right. My car seat was in an accident. Is it OK to use? Lots of people don't realize car seats and seat belts are only good for one car accident. If you get in a car accident you should replace your driver's seat belt too. All right. Because they stretch during an accident. So the second car accident, it won't stretch as much. It might break. Is my child safe in a used car seat? No, because we don't know if it was in a car wreck. All right. When can my child stop using a car seat? When they outgrow it. All right. Can my child ride in the front seat? No, never. Unless it's in that last option The airbag's made to stop a big person. If it explodes in their face, it will do some serious damage. My child looks uncomfortable, what can I do? Don't do anything. Let them be uncomfortable. It's better to be alive and uncomfortable, than dead and uncomfortable. I read that I can't wear big coats in a car seat. How can I keep my baby warm? This is a really complicated answer. It's blankets. Just put blankets on top. All right. Parents in the winter always yell at me because they can't use the little snuggies on their kids. Just buckle them up and put three, four blankets on top. It's OK. All right. And car seats do expire. All right. The plastic in the car seat gets so old and brittle, that if it gets in a wreck after about six years it will snap and break. All right. So this is the majority of the four day class. How to correctly install a car seat. Over 75 percent of car seats are installed incorrectly. I've been doing this about 13 years and I've seen two correct in 13 years. I'm kind of a nit picker though. But two correct in 13 years. And one was a 15-year-old mom, and one was a former car seat tech. None of the doctors at our hospitals got it completely right. All right. So the first step you can do is encourage the parents to read the car seat instructions, and the car's owner's manual. Both of them have to agree on what you do in the car. All right. Most dads especially, think it's like a VCR, and they just try it and figure it out. They're not intuitive. You will guess wrong. Even I can't do it, and I've dealt with them for 13 years. All right. If the instructions are missing, because they always are, the stickers on the side of the seat have basic instructions. They will walk you through most of it. All right. Only use the seat belt or the latch system. Now the latch system is the little black hook thing that you might have seen on car seats, and it's designed to take the place of the seat belt. Congress messed up the law regarding them, and you can't use them in the middle of the back seat in a lot of cars. So a lot of parents double up, because they think it's safer. But due do that stretching issue that's supposed to happen, you use both together and they don't stretch, and it puts more force on the car seat. So just use one or the other. I just generally use the seat belt. Make sure the angle's correct for the child. Make sure everything's tight. The car seat and the kid. Use the middle of the backseat. All right. The child's incorrectly restrained. Bulky clothes, don't use those. Tighten shoulder straps so you can pinch. You cannot pinch just a little bit. Ah! Chest clip across the sternum. And shoulder straps at or above or at or below for rear facing. Out or above for forward facing. At or below for rear facing. And don't use add-ons. Mirrors, coats, seat protectors, or head supports. All right. Now this is a new article that came out. I forget the lady's name, but it's "Car Seats Are Only For Travel." They looked at a lot of SIDS and suffocation deaths in car seats, or seated angle devices like strollers, swings, slings. And what they found is, there were only two deaths of the ones they looked at that were in the car. Almost all of them were in the house, where the parents had brought in the car seat, and were using it as a portable crib. OK. So the angle position of a positioning device, where the baby's sitting at like a 45 degree angle, puts a lot of strain on the baby's neck. And what happens is, after about an hour or so, they lose the strength in the neck and their heads flex down like this. And when they do that, they can actually pinch their airway shut. So if a parent's not watching the baby and that happens, it's very easy for the baby to stop breathing. All right. And we do a test on the babies in the hospital called the car seat tolerance test. Where we look at this, and we hook them up to [INAUDIBLE], and that's the next slide. So remind parents that they're only for travel, not for the home. And encourage parents to keep the children secure in the car seat, if they're pushing a stroller, or they're carrying them around. We do see a lot of falls out of the car seat, where the parent's trip, or fall over the curb, and the babies fall out and hit their heads. Really quick. The car seat challenge. We just test for apnea, bradycardia, tachycardia, and pulse oxygen desaturation. We test babies five and a half pounds and less, and less than 37 weeks gestation age. It's a 90-100 minute test, where I sit there and watch them sleep in the car seat. Sounds very boring. I have had babies turn blue on me in the car seat in about five minutes. Very rare, I'd say about 10 percent of kids fail. There is no AAP guideline for failure. So it's up to a NICU or [INAUDIBLE] to come up with the criteria for what constitutes a failure in that particular hospital. We generally assign them a car bed, which is a special needs car seat that doesn't have the angle, they lay down flat in. And the neck flexion has been noted to be a predictor of decreased minute ventilation. So if you see the chin going to the chest, that's a bad sign. I always warn parents about that now. And all angle positioning devices have that risk. The bouncer, the swing, the car seat, the slings. OK. Children with special medical needs. Car seats designed for children with a vast array of medical issues. Big list there. They're extremely specialized. Each car seat generally works for one or two diagnoses. And Illinois has a short term loan program through Children's Hospital Illinois in Peoria, where parents can get one of these car seats if they need it for short term. Because sometimes Medicaid takes a few months to get one of the more expensive seats. Like this blue one we use at the hospital, for kids with broken legs, OK. Where parents can get help. So if you have a parent that has a really hard time, they just can't figure it out, and no one in your office can help them. Call the local CPD. They're required to have two officers trained to be a car seat technician. They're usually the CAPS officers. Give them a call. If they say they can't, call the other closest one. Or you can go to seatcheck.org, and they have a whole list [INAUDIBLE] of every car seat tech that was ever made, so sometimes they're out of date. For help with children with special needs. If you have one of those medically intense kids come through, contact the Children's Hospital Illinois special needs car seat passenger safety resource center at that number. The north side person is at La Rabida, and he comes over, and he'll drive to anywhere on the north side of Illinois. And if parents come in and they don't have a car seat, Cook County Stroger Hospital has a low cost car seat program for anybody in the state with a medical card. You go there, it's through the gift shop I believe, and it's $20 to $35, they can get a car seat. That would normally cost them $65 to $75 at the store. Questions? Sorry, I ran through that real quick.
