In honor of Child Passenger Safety Week (Sept. 15-20), we asked Cook Children’s Trauma Injury Prevention Coordinator, Sharon Evans, for insights on how to keep your kids safe in the car.

Know the Four Stages of Car Seats

Knowing how to properly restrain your child in the car at every phase of their growth is crucial to their safety. 

1. Rear-facing
Rear-facing car seats are the first stage of restraint for children ranging from newborns to preschoolers. This stage supports their head, neck, and back while riding in a vehicle until they meet the maximum weight OR height of their car seat. According to Evans, it is highly recommended by experts to keep your child in a rear- facing car seat for as long as possible, as it is the safest option available. 

2. Forward-facing 
Forward facing is the second stage of car seats for preschoolers through school-age kids. Children should remain in a forward-facing car seat with a five-point harness until they meet the maximum weight OR height before moving to a booster seat. 

3. Booster
Children must be at least four years old before transitioning into a booster seat. The booster seat stage is crucial for children who have outgrown a harnessed car seat, but do not yet fit safely behind a lap-shoulder belt. Still, booster seats are skipped over all too often. Evans said many kids between the ages of 4 and 8 get seriously injured due to being put in seat belts too soon. 

4. Seat Belt
A seat belt is the final stage of restraint. The safest time to transition to a seat belt is when your child is at least 4’ 9”, or 57 inches tall. Though the law states children can transition to seatbelts at eight years old, Evans cautions that many children won’t reach 57 inches of height—and should therefore remain in a booster seat—until closer to 10 or 12. 

Important Reminders for Car Seat Safety 

These tips will help you do your due diligence for proper car seat and seatbelt usage before hitting the road.

• When selecting a car seat for your child, ensure it fits in your vehicle properly before purchasing it.
• Thoroughly read and closely follow all manufacturer instructions for your car seat to ensure it is installed correctly.
• Infant car seats should always be rear-facing, and never used forward-facing.
• Make sure the harness is tight enough using the pinch test—if you can pinch the harness between your thumb and forefinger, it is too loose.
• Always lock the vehicle's seatbelt.
• Regularly check the maximum height and weight limits of your car seat to ensure your children are transitioned to the next one in a timely manner.
• For older children who are using booster seats or seat belts, ensure the belt is across the pelvic area and the shoulder belt strap is placed across the shoulder. It should never be placed along a child’s neck or abdomen, under the arm, or behind the back, as it could cause severe injury in a crash.
• Always make sure you are wearing your own seatbelt to set an example for your kids.

Stay Vigilant for Counterfeits and Fakes

As you’re shopping for car seats, keep in mind that many popular brands are being knocked off to create counterfeits. These knockoffs are often cheaper than their legitimate counterparts but are significantly less likely to protect your child in the event of a car crash. Below are some red flags to watch out for when shopping, as well as ways to check the authenticity of your seat. 

Red Flags: 

• A great deal on a car seat. If it’s “too good to be true,” it probably is.
• Do not purchase from someone on social media or from a yard sale.
• Do not purchase from e-commerce sites, which allow for third-party sellers and can lead to a counterfeit car seat.
• A safety warning label with symbols and pictograms, but no detailed written information
  
  

Check for Authenticity

• If you haven’t yet purchased your car seat, make sure you buy it directly from the manufacturer or a reputable retail store.
• Call the seat’s manufacturer. They can help you determine if it’s a knockoff and will sometimes ask you to submit photos.
• Take your car seat to be checked by a certified child passenger safety technician. They are trained to help determine if it’s fake. 

Evans strongly recommends anyone with a new car or booster seat does a car seat check with a child passenger safety technician. These professionals, many of whom are also nurses and physical therapists, educate caregivers/patients/families on car seat safety and know what is required for car seats to meet the Federal Motor Vehicle Safety Standard 213. Here are a few ways to schedule a free car seat check:

• Visit freecarseatcheck.org and click “Book your appointment” 
• Find a child passenger safety technician at safekids.org
• Find an inspection station through The National Highway Traffic Safety Administration

For additional information about car seat safety, visit the Texas Department of State Health Services.

With so many people out on the road, it means more opportunity for danger.

From Dec. 20 to Dec. 31, 2018, the Trauma Department at Cook Children's reports 17 children were admitted at the Medical Center for injuries related to motor vehicle crashes and an additional 29 children were treated and released after a visit to the Cook Children's Emergency Department. One wreck during that time frame included a fatality and a total of three children died during the entire month of December.

“Unfortunately, we've seen children die around the holidays," said Debbie Wheeler, a Child Life specialist for the Emergency Department at Cook Children's. "With other traumas, we’ve seen young kids live by the grace of being properly restrained in the correct car seat. I really want to encourage parents to travel safely this holiday season, especially for everyone in the vehicle to be buckled up appropriately. It is really sad to see a patient hurt and have injuries that could possibly have been prevented if they were in a car seat, a proper car seat, or a seat belt.”

Motor vehicle injuries are the leading cause of death among children in the United States. Many of those deaths could have been avoided if parents took the extra time to make sure their children were properly restrained.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s extremely frustrating because she has seen wrecks where one child who was properly restrained lived and the other child not buckled died.

“Honestly, it’s just so infuriating,” Evans said. “These crashes are preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt."

Holiday Injuries Treated at Cook Children's (Dec. 20-31, 2018)

The Centers for Disease Control and Prevention (CDC) found that in one year more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time. Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention Specialist at Cook Children’s. “These are people who love their kids, and they want to hold their baby. A lot don’t want to hear their baby cry, and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high and can be a deadly mistake.”

Texas law states that “all children younger than 8 years old, unless taller than 4’9”, are required to be in the appropriate child safety seat system wherever they ride in a passenger vehicle. The safety seat MUST be installed according to the manufacturer’s instructions.”

That means that when a child reaches his or her eighth birthday – no matter their height, it is legal for the child to use only the adult safety belt in the passenger vehicle.

However, the Texas Department of Public Safety states on its website that best safety practice is: “if the child is not yet 4’9”, they are better protected if they continue to use the appropriate child safety seat system until they can fit properly in the adult safety belt.”

“From a safety standpoint, I encourage parents to follow the best safety practice guidelines,” Evans said. “Graduating to a seat belt too early does keep children in the car if they crash, but when the seat belt doesn’t fit properly, it can cause serious injuries. That is something else we are seeing right now at Cook Children’s – children in a halo brace for severe neck injuries because they were in seat belts too young and too early.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

Miraculously, the child was safe. The Mankato Department of Public Safety said in a press release that the 2-year-old girl was not injured.

While the incident continues to be investigated for charges of child endangerment by the authorities, three things are known:

1. Car seats are remarkably durable and safe.

2. Parents should make sure their child’s car seats are securely and properly fastened into the car.

3. Make sure the car door is shut and locked.

"National Highway Traffic Safety Administration statistics show that three out of five car seats are not properly installed,” said Dana Walraven, Community Health Outreach Manager at Cook Children’s. “It appears this little girl was properly harnessed into the car seat and that’s why she’s alive and well. However, another crucial step was not taken, making sure the car seat was securely fastened to the back seat of the car.”

Texas law states that “all children younger than 8 years old, unless taller than 4’9”, are required to be in the appropriate child safety seat system, including properly secured in the car, wherever they ride in a passenger vehicle. The safety seat MUST be installed according to the manufacturer’s instructions.”

The Texas Department of Public Safety states on its website that best safety practice is: “if the child is not yet 4’9”, they are better protected if they continue to use the appropriate child safety seat system until they can fit properly in the adult safety belt.”

“We talk a lot about the safety of a child in a car seat, but what happened in Minnesota is a reminder for all parents that there are two important steps: First, install the car seat in the back seat of the car and two, harness the child into the car seat,” Walraven said.

The best way to make sure your child is secure is to have a certified child passenger safety technician teach you how to install the car seat, and how to fit the child in the seat. Cook Children’s offers free car seat checkups to ensure your seat is properly installed. Call 682-885-2634 for more information.

More Information:

• Vehicle/Car Safety
• Choosing The Right Car Seat
• Ultimate Car Seat Guide
• Car seat safety (Newborn to 2 years old)

Three kids have been ejected total, with one child surviving. It probably doesn’t come as a surprise the cause of the tragedies – the children weren’t restrained properly or not at all in their car seat.

Since April 2015, Cook Children’s Trauma team has treated 13 children who were ejected from a car.

Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s, says it’s so frustrating because she has seen wrecks where one child who was properly restrained live and the other child not buckled in dies.

“Honestly, it’s just so infuriating,” Evans said. “These accidents are totally preventable. It’s because the adults in the car aren’t doing something that could save their child’s life. I don’t think people think it can happen to them. But it can happen to anyone. It just breaks my heart because these are deaths that shouldn’t occur if people would just place their kid in the proper car seat and buckle them up with a seat belt.”

Statistics show this is especially a problem for Hispanics in the community. Ninety percent of the ejections that have occurred since April 2015 were Hispanic.

“I think a lot of it has to do with our culture,” said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. “These are people who love their kids and they want to hold their baby. A lot don’t want to hear their baby cry and so it’s easier to hold their baby in the car. They are showing love, but the consequences are too high. This can be a deadly mistake.”

According to the Centers for Disease Control and Prevention, car crashes are a leading cause of death among children ages 3 to 14. From 2002 to 2011, about 9,000 children under the age of 12 died in car accidents, the agency’s statistics show. Correctly using a child safety seat can reduce the risk of death by as much as 71 percent.

“We know that car seats are working,” Evans said. “Research shows that a properly installed rear-facing car seat is five times safer and can dramatically reduce the risk of head, neck and spinal cord injury if your child is involved in a crash.”

Call 682-885-2634 to set up a FREE car seat checkup to ensure your seat is properly installed.

Then, I was blessed to have a beautiful son...

….who decided that I needed to be re-taught a few things about children.

And by a few things, I mean everything.

Don’t get me wrong – you don’t have to be a parent to be an excellent doctor. I still dish out the same advice. The books and studies are spot-on and I’m going to give it to you straight. Breastfeeding does provide the best nutrition for babies. But I understand the pain you’re going through to meet that goal. And I understand the frustration of having a child who just won’t latch on. And I understand now why you look at me, with a crazy twitch in your eye, when I tell you to try an extra pumping session a day to build up your supply, mama. I hated that thing, too. Can anyone say “dairy cow”? And guess what – formula isn’t poisonous. I wasn’t physically able to meet my full breastfeeding goals with my kid – there’s no judgement here if you grab that can. And it’s okay if it makes your relationship with your child happier, healthier and more fulfilling.

Our car seat remains rear-facing at 18 months. It’s been proven to be five times safer than forward-facing. I’m sorry for my lecture during your little one’s checkup. And oh yes, I too want to rip my hair out when I can’t reach over far enough to give my kid that 400^th toy to keep them quiet on the trip to grandma’s.

“Crying it out” was a tough one for me. Pre-child, it was so easy to coach parents - encourage them to drop the constant rocking, the running into the nursery at all hours of the night, the fear of allowing their child to cry in order to learn put themselves to sleep. Then I went through it with my son. Let’s just say I give the same advice now (it really does work) …and recommend a glass of wine for every 15 minutes of crying. I probably cried more than my kid did. Motherhood helped me give this advice with a much softer tone. I get it, mom and dad. And I feel your pain (and exhaustion).

Pacifiers – I missed that thing so much. So, so much. Oh man I missed that thing when it had to go. I think I needed one myself when the time came to get rid of it.

As for the well-rounded, healthy meals I recommend offering your child throughout the day – I now understand why there are food shortages in some parts of the world. It’s because all that food is currently on the floor of my kitchen. Where my son threw it. I get it. And I’m here to help you find tricks to make things better. Tried and tested in my own home.

In all seriousness, motherhood has been the most exhausting, challenging, humbling thing I’ve ever experienced. But I can say without a doubt that it’s made me a better doctor for your child. Because helping you get through those everyday challenges is a huge part of what being a pediatrician is all about.

I recently polled some physician mom colleagues to get their take on how motherhood changed them:

• “I am that much more in awe of the composure, patience, faith, resolve my patients' families have, especially considering how chronically sick the kids are that I see, and how too not-infrequently, limited the treatments are. I see my son in every patient. Everything is different. Every heartache is my heartache. Each illness, each story seems to hit home that much harder. I am so so appreciative.”
• “I am much more empathetic and practical in some advice. I think that I am much more emotionally available post having kids and can understand a variety of stresses parents who go through NICU may encounter.”
• “You come to understand that "by the book" is not always what is possible in real life!”
• “I feel like when the kids have a tougher diagnosis - cancer- it hits closer to home and I hold my kids a bit tighter. Likewise, little pearls and tricks that I used help make it more of a village caring mentality for the family which has been lost over the last 30-40 years.”
• “My medical advice is not too different, but I understand the unspoken worry so much better now. So I try to address the emotional stuff first in ways that would not have occurred to me pre-kids. Now I'll directly say things like "you are a good mother even if you need to use formula," or "this lymphadenitis/rectal bleeding/etc is NOT cancer," or "they are not dangerous, but constant viral illnesses all winter TOTALLY SUCK.” I think it has made me a much better pediatrician.”
• “One of my favorite attendings in peds residency told me, as I was a mess after coming back from maternity leave with my first, that a little part of your heart will always be on the outside, dangling like a vulnerable little wisp in the wind that is parenting- and that little wisp makes you so much stronger and so much softer- all for the good....it's so true.”

Happy Mother’s Day, everyone!

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And by a few things, I mean everything. Click to read more.

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