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Not Enough Child Safety Seats for Obese Children

Breaking News - April 2006 - Week 1

(Apr 5, 2006)

Healthcare in  the News

-- There are no longer enough child safety seats to accommodate the increasing number of obese American children, researchers report.

Picture of a child in a car set

The study by researchers from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy found substantial numbers of children who exceed the maximum weight limits set for most child safety seat models currently available.

The study finding were published in the journal Pediatrics.

Child Obesity Rates Increasing

According to information presented in the study, over the past three decades the rates of obesity have doubled for children aged 2 to 5 and for adolescents aged 12 to 19. The rates have also tripled for children 6 to 11 years of age.

One source estimatesthat as many as 10 percent of children aged 2 to 5 are obese. And rates may be higher in low-income populations.

While the health consequences of obesity are clear, there has been little research into the safety implications of obesity.

New Seat Designs Needed

The authors of this study decided to focus on child seats because technicians at the Children's Safety Center (CSC) at Johns Hopkins were noting the number of obese children who exceeded the upper weight limit for car seats. The CSC loans seats and also sells them at low cost to low-income, urban families.

Child seats are required by law. Motor vehicle crashes account for 23 percent of deaths from injury among infants and 30 percent among preschool-aged children.

Each year in the United States, more than 1.5 million children are in motor vehicle crashes. Car seats have been shown to substantially reduce the risk of dying.

“While we await reductions in the childhood obesity epidemic, it is essential to develop child safety seats that can protect children of all shapes and sizes,” says the lead author Lara Trifiletti, Ph.D, a researcher with the Columbus Children’s Research Institute Center for Injury Research and Policy in Ohio.

Dr. Trifiletti conducted her research while Johns Hopkins University's School of Public Health, which also funded the study.

Dr. Trifiletti continues,"We definitely need to see seats that have been designed and tested and approved at higher weights."

"Children who are either large or obese do have a problem finding the appropriate seat," says Dr. Maja Djordjevic, director of pediatrics at Nyack Hospital in Nyack, N.Y.

"It's also a problem with the developmental level because you can't put them in a booster seat because they don't have a five-point harness," she says.

Dr. Djordjevic speaks from experience: Her son is tall, though not obese, and she has had trouble finding the appropriate seat for him.

Few Adequate Seat Models Available

For this study, Dr.Trifiletti and her colleagues assessed child safety seats using theNational Highway Traffic Safety Administration's 2005 Child Safety Seat Ease of Use Ratings. They estimated the numbers of children exceeding the maximum weight for these seats using national data from 1999 and 2000.

As it turned out, about 283,000 children aged 1 to 6 would have difficulty finding a safe child safety seat because of their combined age and weight.

Most of the "problem kids" (182,661) were 3 years old and weighed more than 40 pounds. For this age group, there are only four child safety seat types available, which cost between $240 and $270 (in contrast, some seats for normal-weight children sell for as low as $14).

More than 8,500 children 2 years of age and almost 92,000 children 4 to 6 years of age would also have a difficult - if not impossible - time finding appropriate car seats.

The issue is an especially critical one for low-income families who are not only more at risk for injuries, but also are more likely to be overweight.

"If a child is large or obese, the seats are very expensive, which hits hardest the lower socioeconomic groups and minorities," Dr. Djordjevic says.

"It's just out of their reach. The parents may also get into trouble legally, as states have child occupant protection laws. If the child is not restrained properly, there's a fine," Dr. Djordjevic continues.

The researchers believe these numbers underestimate the problem, since the data is a few years old and obesity rates have increased.

Manufacturers are already reacting to the problem, however.

"Since we did this study, there have been at least two seats that have come on the market that would accommodate these age groups, and they are actually less expensive," Dr. Trifiletti says.

Always consult your child's physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

Using Child Safety Seats

Infant and child safety seats come in many shapes and sizes. Some are not compatible with certain vehicles.

The best child safety seat for a family is the one that is easy to use, fits in the vehicle's seats and seatbelts, and is the proper size for the child.

TheAmerican Academy of Pediatrics (AAP) has specific recommendations for the use of child safety seats:

  • Children should face the rear of the vehicle until they are at least 20 pounds and 1 year of age to reduce the risk of cervical spine injury in the event of a crash. Infants who weigh 20 pounds before 1 year of age should ride rear-facing in a convertible seat or infant seat approved for weights greater than 20 pounds until one year of age.
  • A rear-facing car safety seat must not be placed in the front passenger seat of any vehicle equipped with a passenger-side front air bag. This practice prevents the risk of death or serious injury from impact of the air bag against the safety seat.
  • Premature and small infants should not be placed in car safety seats with shields, abdominal pads, or arm rests that could directly contact an infant's face and neck during an impact.
  • In rear-facing car safety seats for infants, shoulder straps must be in the lowest slots until the infant's shoulders are above the slots. The harness must be snug and the car safety seat's retainer clip should be positioned at the midpoint of the infant's chest, not on the abdomen or in the neck area.
  • The car safety seat should be reclined halfway back, at a 45-degree tilt. A higher angle should be used when the child is over 6 months. Until engineering modifications can be implemented to prevent this problem, a firm roll of cloth or newspaper can be wedged under the car safety seat below the infant's feet to achieve this angle.
  • A convertible safety seat, which is positioned reclined and rear-facing for a child until 1 year of age and 20 pounds and semi-upright and forward-facing for a child older than 1 year of age who weighs 20 to 40 pounds, should be used as long as the child fits well (this includes ears below the top of the back of the seat and shoulders below the seat strap slots).
  • A booster seat should be used when the child has outgrown a convertible safety seat, but is too small to fit properly in a vehicle safety belt.
    A belt-positioning booster seat usesthecombination lap/shoulder belt already in the vehicle.
  • A booster seat with a small shield, which can be used when only a lap belt is available, is not recommended by theNational Highway Traffic Safety Administration (NHTSA).

As many as 85 percent of child safety seats are found to be improperly installed and/or used when vehicles are stopped and checked, according to studies fromNational SAFE KIDS Campaign Car Seat Check Ups.

Some of the most common mistakes in installing or using child safety seats include the following:

  • safety belt not holding the seat in tightly and/or not in locked mode
  • harness straps not snug and/or routed correctly
  • harness retainer clip not at armpit level
  • locking clip not used correctly
  • car seat recalled and not repaired (includes booster seats)
  • infants placed rear-facing in front of an active air bag
  • children turned forward-facing before reaching 1 year of age and 20 pounds

Parents and caregivers should carefully read their vehicle owner's manual and the instructions that come with the child safety seat to ensure proper installation and use of the seat.

Always consult your child's physician for more information.

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