Teaching Parents About Car Safety

Flaura K. Winston, MD, PhD


July 19, 2011

Editorial Collaboration

Medscape &

This feature requires the newest version of Flash. You can download it here.

Hello, I'm Dr. Flaura Koplin Winston. I'm a general pediatrician, a biomechanical engineer, and I co-direct The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia. On March 21, 2011, the American Academy of Pediatrics released new guidelines on child passenger safety, based on up-to-date information. In another Medscape video, I reviewed these recommendations. In this video, I'm going to give you practical information on how to relay this information to families and answer their questions. I'm going to focus on 2 controversial recommendations that caused a lot of buzz. The first one is to keep kids rear-facing until at least age 2 years. The other is to keep kids in booster seats longer, past age 8 years, until they reach 4 foot 9 inches, which might be between the ages of 8 and 12 years.

Let's start with the rear-facing recommendation. The evidence is clear. Children who are rear-facing are safer than kids who are forward-facing. For children between the ages of 0 and 2 years, there is a twofold reduction in injury risk. For the second year of life, between ages 1 and 2 years, it's a fivefold reduction in injury risk. When a child is rear-facing, the crash forces are spread over their entire spine and they don't swing forward in the event of a crash, which might allow their heads, arms, and legs to hit the seat in front of them. That can cause injuries. The second question that parents have concerns about is, "Where am I going to find a rear-facing seat for my big child? He's already 40 pounds and he's a year and a half old."

Well, I want to reassure you that there are many seats out there that will meet these recommendations. In fact, there are currently 40 seats on the market that go to more than 40 pounds.

Other questions come up, such as, "Is my child going to be comfortable back there?" The fact is -- yes. Children, many of them, are already rear-facing to age 2 years. This is not something new for a lot of families. Kids find a way to be comfortable. The parents might not be comfortable but the kids are just fine. They just move around and make themselves comfortable. Some actually sleep better because a rear-facing seat is in a semi-reclined position.

Another question that comes from clinicians as well as parents is, "Will these children be at risk for leg fractures?" This is surprising but, in fact, they are at less risk for a leg fracture. We've looked at thousands of crash investigations and what we found is that the children who are forward-facing, who have that chance to fling forward in a crash, are more likely to have their extremities hit something in front of them, like the seat, and have a fracture. There are almost no extremity fractures to children who are rear-facing. In fact, 25% of the serious injuries to children who are forward-facing are leg fractures.

Now, let's look at the booster seat recommendations. Many parents can't imagine their 10- to 12-year-old in a booster seat. The fact of the matter is that the seat belt may not fit these kids right. Remind them that it's not age but actually size that determines when a seat belt will fit well. Usually that is not until the child is at least 4 foot 9 inches tall. A booster seat just helps the seat belt by spreading the crash over the hard bones -- the chest and shoulders -- and not over the soft organs. You are not going to be squeezing those organs and injuring them in the event of a crash. A practical tip: encourage families of older small children to get a backless booster. It is less obvious; other kids won't know the child is in it. The child might actually be a little more comfortable and they will actually look a little taller and be safer. The backless boosters work just fine.

I just want to reassure you: you do not have to be child passenger safety expert. You just need to know these guidelines and then use the resources that are available to you. For example, we have a Website that may be helpful. It is available in English and in Spanish. You might want to have one of the videos from our site playing in the room before you come in and then the parents can interact with it and get their questions ready for you. If a parent does have a question you can't answer, there are other resources. There are car seat technicians all over the place and to find one near you, all you have to do is call 1-888-CAR-CHECK or check their Website.

With that, I hope that I've given you some help to make these guidelines real for families. Feel free to go to the other Medscape Webcast to learn about the recommendations and thank you for listening and for helping us save children's lives. For more safety tips or to ask safety questions that I might cover in a future Medscape video, please just send me a little note via my Twitter account. Thank you very much.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.