Tags: AAP | Car Seats | Safety

While it's time for the AAP to issue a new policy statement on car safety, I think pediatricians have missed the opportunity to effect a bigger and more meaningful change with respect to car seats.  Wading through all the new evidence based studies and algorithms, it felt a little like I might not have enough graduate degrees behind my name to make sense of it all. 

A number of years ago, I heard economics professor, Steven Levitt, of Freakonomics fame, give a lecture about car seats. (Click Here if you want to listen to him for yourself.) The take home message from his lecture was that kids are less likely to die in a crash if they're buckled into a car's lap and shoulder seatbelt than if they are buckled into a car seat. I was stunned! Could this possibly be true? I dove in head first to examine his statistics, to read more about the "tests" he conducted. In the end, I decided that he was only partly correct, and in choosing to tell SOME of the truth, he came too close for my comfort to misleading his audience. Steve...it's time to revisit your data, and together we can get a new lecture together to to tell the "rest of the story." 

There is a reported statistic that HALF of car seats are installed improperly. Couple that assertion with Steve Levitt's shock talk, and you probably see where I'm going with this. I am concerned with how car seats are designed, selected and installed in our cars, and I want to suggest that problem will only be magnified as parents try to adhere to the new AAP recommendations. 

Parents want to do the right thing for our kids. Speaking as someone who's bought a bunch of car seats, they can be really expensive, but I'm willing to spend the big bucks for safety. Where's the data that says $200 buys me more safety than $39.95? As for the ease of installation, the Highway Safety people have compared which car seats are easiest to use, but it still feels like I need a Ph.D. to install some of these car seats with my local firefighter on standby to inspect the results!  It's time to help parents address the safest way to transport a child AND to get a car seat better designed for correct installation. 

The AAP policy statement is provided here. The cliff notes suggest we should be

• keeping babies rear-facing until age 2 or they outgrow the car seat specs,
• using a 5-point car seat, forward facing as long as it's feasible,
• and finally, use a booster seat until children are 4feet 9inches. 

These recommendations are backed by new data to support who should use car seats and in what manner. I'd also like to see parents asked to use their power of observation (along with AAP guidelines) to make good decisions for each child passenger... every time a child rides in the car.  This imperative to add in a visual assessment of the car seat/child combo is missing among all the pages of evidence based data. Parents MUST look at how babies and children appear to be safely restrained... each and every time we "buckle up for safety." 

If a child looks too big or too cramped for the seat, if the shoulder harness doesn't cross that middle school student properly, then look a little closer at the car seat or booster specs coupled with the child's measurements. Don't find yourself among the half of people using a car seat incorrectly. 

It's long passed time to acknowledge that kids deserve seats and belts that are manufactured in the car itself with their safety in mind. They deserve a better rear-facing car seat design for both safety and comfort. The AAP is well positioned as a national advocate for children and should ask all car manufacturers to make built-in car seats for our patients. If I had been in charge, I might have asked for the moon and issued this policy statement as a bridge to the day when I get it.  I don't mind working hard to get things for the children I serve.  A good car seat design seems a worthy cause.