New and Improved 2011 Car Seat Recommendations

Given that today is the day that the American Academy of Pediatrics releases its 2011 Policy Statement on Child Passenger Safety, it seems to me a particularly good time to not only review these important car seat recommendations, but also take a quick look back to share just how far we’ve come in our efforts to keep children safe in cars.

Let me start by saying that for as long as I remember, motor vehicle crashes have been, and continue to be the leading cause of death in children. A few years after completing my pediatric training, I was tasked with writing about child passenger safety and car seats for a nationwide public education campaign. Yet despite having only just completed my pediatric training a few years prior, this was not a subject in which I was well-versed. While this may sound surprising to you given the extent to which pediatricians today are responsible for educating parents on car seats, the fact of the matter was that in the late 1990‘s, the science of injury prevention and child passenger safety was only just taking hold. At that time, it still took some convincing to keep kids properly restrained in car seats up until the age of four, while the first U.S. booster seat law (which only required extra protection for children between 40 to 60 pounds) wouldn’t go into effect for several years in Washington State in 2002.

Fast forward less than ten years, and today just about every state in the country, as well as the District of Columbia all have some form of booster seat law in place. Over the same time period, what was initially a relatively small group of trained child passenger safety professionals (I believe there were only approximately 1000 formally certified Child Passenger Safety Technicians when I got my certification ten years ago) now numbers in the tens of thousands. Not only that, but we have far more data and insight into what keeps children of all ages safest when it comes to riding in motor vehicles. Fortunately, we also have many new and improved car seats that offer the features we need to do so.

I continue to be convinced that investing the time and effort in making sure your child is properly restrained each and every time he/she rides in a car is one of the single most important things you can do as a parent to insure your child’s safety. With that in mind, I thought I’d offer you the following quick summary and explanation of the AAP’s new car seat recommendations.

Rear-facing until the age of two.  That’s right, the age of two. Not almost one, not one, but two.  Now to be honest with you, this recommendation isn’t so much a change from what I (and other trained child passenger safety professionals) have been saying since the AAP’s last set of recommendations came out in 2002. For years now we have known that it is safest to keep children facing rear-facing as long as possible within the limits of their seat – a recommendation that for many children isn’t so different from saying up to the age of two.

However, in the past the recommendation also stated that children should ride rear-facing a minimum of at least one year and 20 pounds. Instead of taking this to mean a bare minimum, parents understandably focused on the part of the sentence that said one year and twenty pounds. Given that children between the ages of one and two are at five times less risk of death or serious injury when riding rear facing, the difference between emphasizing age one and age two (and making sure you have a car seat that has higher rear-facing height and weight limits) is potentially life-saving.

Forward-facing facts. After recommending that children be turned face-forward as late as possible, the new AAP Policy also adds much needed emphasis on the fact that using a forward-facing seat with 5-point harness straps is not only the safest option for newly forward-facing children, but for as long as possible until they reach the maximum height and/or weight limits for the harness straps. While there was a time when most forward-facing seats only allowed for harness strap use up to 40 pounds, there are now seats available with harness straps that accommodate children all the way up to 65 or even 80 pounds, making the switch to a belt-positioning booster seat unnecessary (and ill-advised) until far past forty pounds.

Booster Seats until age 12. Okay, technically the policy recommendation is for children to ride in booster seats up until they reach a height of 4 feet 9 inches, but the important emphasis here is that there has long been misleading emphasis on the age of 8, whereas the new policy says somewhere between the ages of 8 and 12 years. This perception problem is understandable, given that the ideal booster seat laws all reference the age of 8.

What you need to understand, however, is that only 1 out of 100 eight-year olds reach the right height to safely use a vehicle’s lap-shoulder belt without a booster seat. The average child doesn’t reach 4 foot 9 inches until somewhere between the age of 10 and 12. Foregoing a booster seat before the vehicle’s lap-shoulder belt fits them correctly puts children at significantly greater risk of severe injuries.

Big Kids in Back. I have long been asked by parents when they can allow their children to ride in the front passenger seat. The straightforward answer is now clearly stated as age 13. But I fear that just telling parents to have their pre-teens relegated to the back seat until age 13 doesn’t quite get across the importance of this recommendation – especially since it’s not likely to be received well by many pre-teens. The somewhat harsher but data-driven answer is “when you love them 40% to 70% less.” This attention-getting answer clearly gets across the fact until the age of 13, riding in the back seat significantly reduces the risk of injury (as well as the severity of injury) in both frontal and side-impact crashes.

With all that said, I am proud to report that literally hundreds of child passenger safety professionals from around the state of Nebraska will be attending tomorrow’s annual two-day conference which includes an update on the latest AAP recommendations. Our state is truly fortunate to have hundreds of dedicated technicians who are ready, willing, and able to serve as valuable and informed resources in helping insure safe travels for all of Nebraska’s children.

I also encourage all of you to visit the AAP’s website, – not only to directly access the new 2011 Policy Report, but also to enter the Safe Ride Sweeps car-seat giveaway. Each day for the rest of the month of March, you can enter to win a Safety 1st car seat that can help you best follow the AAP’s latest safety recommendations, courtesy of Dorel (which, for full disclosure, is the car seat manufacturing company for whom I currently consult).

Originally posted on Omaha World Herald’s Live Well Nebraska

Fighting fever phobia: The facts about fever for parents

This seems like an appropriate time to spend a few minutes focusing  on the subject of fever, in part because it’s one that effects (and therefore interests) just about every parent I know, and also because we happen to be right in the middle of cold and flu season – a time of year during which children inevitably experience far more than their fair share of fevers.  It’s also because fever phobia amongst parents is usually far more pervasive than it is warranted. That’s not to say that fever is inconsequential, but rather that we should all take the time to brush up on exactly what fever is, what it represents, when it does (or doesn’t) need to be treated, and how to do so appropriately. Fortunately,  the American Academy of Pediatrics just pulled together all of the latest expert thinking on the management of fever in children and released it in a clinical report entitled Fever and Antipyretic Use in Children.

Given the importance of the subject,  I figured it would be particularly helpful to review just what these latest fever recommendations tell us about fever.

A healthy respect for fever.  It’s important to understand that fever is not an illness, but rather a common and normal response to infection. While fevers can in some instances signify a more serious underlying infection, they are unlikely to endanger generally healthy children.

It’s a matter of degree – or is it?  According to the AAP’s report, the use of fever-reducing medications should be focused on making children more comfortable, rather than getting rid of fevers altogether. It’s certainly useful to own a thermometer and to know how to accurately measure your child’s temperature. But all too often, parents unnecessarily focus on using fever-reducing medications to fight their child’s temperature back down to normal and keep it there.

The benefits of fever. While I know it may be hard to recognize any benefits when you’re home caring for a sick child, the report reinforces that fever is actually thought to have a  beneficial effect when it comes to the body’s efforts to fight infection.

Fighting fever phobia. The most common fear that parents, caregivers and even health care providers often share is that high fevers, if left untreated, will result in seizures, brain damage, or worse. In fact there is no evidence to support this fever phobia, as there is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.

Treat with care. Acetaminophen products (like Tylenol) and ibuprofen products (such as Motrin or Advil) are considered equally safe and effective for use in the treatment of fever for children 6 months of age and older. That said, it is especially important for these fever-reducing medications to be dosed accurately and given no more often than necessary or recommended (every 4-6 hours for acetaminophen and 6-8 hours for ibuprofen). As for giving them in combination or alternating them, as is often discussed, it may be effective but shouldn’t be done unless absolutely necessary since it increases the risk of making dosing errors.

Originally posted on Omaha World Herald’s Live Well Nebraska