Focus On Pediatrics-Graduation to booster seats remains a secret

Parents must be educated on dangers

It has become second nature to restrain infants and toddlers in child safety seats when traveling in an automobile. This safety habit has been formed largely due to laws requiring young children of a certain age, height, and weight to be transported in this manner. Yet, once a child outgrows these seats, many parents assume it is safe to allow him or her to use the lap or shoulder safety belt system found in most cars.

Not so, says Barbara Shoemaker, RN, MSN, clinical nurse specialist pediatric orthopedics at Shriners Hospital for Children Northern California in Sacramento. "In actuality, the safety belt system in our automobiles is made for the adult body. It would be much safer to move the child to a booster seat, which helps position the shoulder and lap belt appropriately on a young child," she says.

The reason is simple. Seat belts can cause intra-abdominal and spinal injuries to children during an automobile collision. Excessive forward movement, or hyperflexion, of the body around a fixed lap belt causes these injuries.

A young child between the ages of 5 and 10 years does not have a body that is mature enough for seat belts to fit properly, explains Shoemaker. The child's pelvis is small and narrow, so the lap belt does not sit low over the hips but has a tendency to ride up into the abdomen.

While the hyperflexion that results in intra-abdominal or spinal injury in children occurs most commonly with lap belts, young children often use shoulder harness belts incorrectly, making them just as dangerous. Because the belt hits them at the neck, causing discomfort, they tuck it underneath their arm, which puts the harness behind their back, essentially creating a lap belt restraint system.

To prevent these injuries, families need to be told that there are safety seats designed for young children, called booster seats or belt positioning boosters. "Many families are not aware that there are booster seats available. They trust that their automobiles' safety systems will secure their child," says Shoemaker.

A good time to teach parents about these seats is during well-child checkups at the pediatrician's office or clinic. Health care providers educate expecting parents about infant seats and the dangers of air bags. As the child gets older, these same providers need to talk to parents about the graduation from a toddler seat to a booster seat. "I think adding this information to the guidance given to families during well-child checks is probably one of the biggest teaching opportunities we have," says Shoemaker.

The seats are not difficult to use and typically work in conjunction with the shoulder lap belt system of the automobile. There are different designs, and parents should select one that best suits the style of seat restraint in their car, says Shoemaker.

Shriners Hospital for Children Northern California has a safety seat loan program for its patients and their families. Infant seats, toddler seats, booster seats, and special-needs automobile restraints are available. To make sure staff can teach parents to use the seats properly, 13 staff members at Shriners were selected to attend an intensive training program in April designed by the National Highway Traffic Safety Administration. (For more information on this training program, see next article in this issue of Focus on Pediatrics.)

Part of the admission assessment at Shriners includes questions about safety practices, such as the use of car seats. This information helps indicate families that would benefit from the loan program. "We also have written materials available in English and Spanish on car seat safety that we share with our families," says Shoemaker.

For more information on booster seat safety, contact:

Barbara Shoemaker, RN, MSN, Clinical Nurse Specialist Pediatric Orthopedics, Shriners Hospital for Children Northern California, 2425 Stockton Blvd., Sacramento, CA 95817. Telephone: (916) 453-2145.