Search

OBJECTIVE. The popularity of sport utility vehicles (SUVs) is growing, and they are increasingly being used as family vehicles. Because of the large size of SUVs, relative to passenger cars, parents may perceive that they are safer family vehicles. However, little is known about the safety of children in SUVs, compared with passenger cars. The objective of this study was to determine the relative risk of injury to children involved in crashes in SUVs, compared with those in passenger cars. DESIGN. From an on-going motor vehicle crash surveillance system, a probability sample of 3922 child occupants 0 to 15 years of age, representing 72 396 children in crashes of either SUVs or passenger cars (model year 1998 or newer), from 3 large US regions, was identified between March 1, 2000, and December 31, 2003. Injuries were defined as concussions and other brain injuries, spinal cord injuries, facial fractures and lacerations, internal organ injuries, extremity fractures, and scalp lacerations. Logistic regression modeling was used to compute the odds ratio (OR) of injury for children in SUVs versus passenger cars, both unadjusted and adjusted for several potential confounders, including differences in child seating position, restraint use, vehicle weight, exposure of the child to a passenger airbag, and whether the vehicle rolled over. RESULTS. A total of 38.2% of children were in SUVs and 61.8% were in passenger cars. The average weight of SUVs was 1317 lb greater than the average weight of passenger cars. Among all children in the study, those restrained appropriately were less likely to be injured (OR: 0.25; 95% confidence interval [CI]: 0.15-0.45) and those in the front seat were more likely to be injured (OR: 2.06; 95% CI: 1.33-3.21). In both vehicle types, children exposed to a passenger airbag were more likely to be injured than were those who were not (OR: 4.70; 95% CI: 2.36-9.37). Rollover crashes increased the risk of injury in both vehicle types (OR: 3.29; 95% CI: 1.88-5.76) and occurred more than twice as frequently with SUVs (2.9%, compared with 1.2% with passenger cars). There was a trend for increasing vehicle weight being a protective factor with both vehicle types (OR: 0.86; 95% CI: 0.73-1.01). After adjustment for all of the aforementioned factors, the risk of injury was not significantly different for children in SUVs versus passenger cars (adjusted OR: 1.50; 95% CI: 0.88-2.57). Especially detrimental for children in SUVs was being unrestrained versus restrained in a rollover crash (OR: 24.99; 95% CI: 6.68-93.53). CONCLUSIONS. Despite the greater vehicle weight of SUVs, the risk of injury for children in SUVs is similar to that for children in passenger cars. The potential advantage offered by heavier SUVs seems to be offset by other factors, including an increased tendency to roll over. Age-appropriate child restraint and rear seat positioning are important, particularly for children in SUVs, given the very high risk of injury for children restrained inappropriately in rollover crashes. www.pediatrics.org/cgi/doi/10.1542/ peds.2004-1364 doi:10.1542/peds.2004-1364 Key Words sport utility vehicles, accidents, motor vehicle safety Abbreviations SUV--sport utility vehicle OR--odds ratio CI--confidence interval PAB--passenger airbag AIS--Abbreviated Injury Scale, SPORT UTILITY VEHICLES (SUVs) are growing in popularity in the United States and increasingly are being used as family vehicles. (1) The number of SUV registrations rose 250% between 1995 [...]

Objective. Selective nonoperative management of pediatric blunt splenic injury became the standard of care in the late 1980s. The extent to which this practice has been adopted in both trauma centers and nontrauma hospitals has been investigated sporadically. Several studies have demonstrated significant variations in practice patterns; however, most published studies capture only a selective population over a relatively short time interval, often without simultaneous adjustment for confounding variables. The objective of this study was to characterize the variation in operative versus nonoperative management of blunt splenic injury in children in nontrauma hospitals and in trauma centers with varying resources for pediatric care within a regionalized trauma system in the past decade. Methods. The study population included all children who were younger than 19 years and had a diagnosis of blunt injury to the spleen (International Classification of Diseases code 865.00-865.09) and were admitted to each of the 175 acute care hospitals in Pennsylvania between 1991 and 2000. The proportion of patients who were treated operatively was stratified by trauma-level certification and adjusted for age and splenic injury severity. Multivariable logistic regression models were used to generate probabilities of splenectomy by age, injury severity, and hospital type. Results. From 1991 through 2000 in Pennsylvania, 3245 children sustained blunt splenic injury that required hospitalization; 752 (23.2%) were treated operatively. Generally, as age and splenic injury severity increased, the proportion of patients who were treated operatively increased. Compared with pediatric trauma centers, the relative risk (with associated 95% confidence interval) of splenectomy was 4.4 (3.0-6.3) for level 1 trauma centers with additional qualifications in pediatrics; 6.2 (4.4-8.7) for level 1 trauma centers, 6.3 (5.3-7.4) for level 2 trauma centers, and 5.0 (4.2-5.9) for nontrauma centers. Significant variation in practice pattern was seen among hospital types and over time even after adjustment for age and injury severity. Conclusions. The operative management of splenic injury in children varied significantly by hospital trauma status and over time during the past decade in Pennsylvania. Given the relative benefits of nonoperative treatment for children with blunt splenic injury, these results highlight the need for more widespread and standardized adoption of this treatment, particularly in hospitals without a large volume of pediatric trauma patients. Pediatrics 2005;115:89-94; trauma systems, pediatric trauma care, splenic injury, blunt abdominal injury., ABBREVIATIONS. ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; PHC4, Pennsylvania Health Care Cost Containment Council; PTC, pediatric trauma center; AQTC, level 1 trauma center with additional qualifications in [...]

Objective. To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety. Methods. We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home. After completing a structured home safety questionnaire via face-to-face interview, caregivers were randomly assigned to receive either comprehensive home safety education and free safety devices or focused, injury-specific ED discharge instructions. Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety questionnaire. The pretest and posttest questionnaires were scored such that the accrual of points correlated with reporting of safer practices. Scores were then normalized to a 100-point scale. The overall safety score reflected performance on the entire questionnaire, and the 8 category safety scores reflected performance in single areas of home injury prevention (fire, burn, poison, near-drowning, aspiration, cuts/piercings, falls, and safety device use). The main outcome was degree of improvement in safety practices as assessed by improvement in safety scores. Results. The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group (73.3% [+ or -] 8.4% vs 66.8% [+ or -] 11.1) and significant improvements in poison, cut/ piercing, and burns category scores. Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices. Conclusions. This educational and device disbursement intervention was effective in improving the home safety practices of caregivers of young children. Moreover, the ED was used effectively to disseminate home injury prevention information. Pediatrics 2004;113: 1603-1608; injury, prevention, safety counseling, anticipatory guidance, emergency department., ABBREVIATIONS. ED, emergency department; OSS, overall safety score; CSS, category safety score. Each year, millions of US children are injured in their own homes. (1) Injuries from falls, poisonings, fires, [...]

Objective. Head injury is the leading cause of death in abused children under 2 years of age. Evidence for establishing guidelines regarding screening for occult head injury in a neurologically asymptomatic child with other evidence of abuse is lacking. This is particularly important given that many children with acute inflicted head injury have evidence of old injury when they are diagnosed. The primary aim of this study was to estimate the prevalence of occult head injury in a high-risk sample of abused children with normal neurologic examinations. The secondary aim was to describe characteristics of this population. Methods. Children under 2 years of age admitted to an urban children's hospital between January 1998 and December 2001 with injuries suspicious for child abuse were eligible for this study if they had a normal neurologic examination on admission. Subjects were selected if they met 1 of the following "high-risk" criteria: rib 1fractures, multiple fractures, facial injury, or age Results. Of the 65 patients who met these criteria, 51 (78.5%) had a head computed tomography or magnetic resonance imaging in addition to skeletal survey. Of these 51 patients, 19 (37.3%, 95% confidence interval 24.2-50.4%) had an occult head injury. Injuries included scalp swelling (74%), skull fracture (74%), and intracranial injury (53%). All except 3 of the head-injured patients had at least a skull fracture or intracranial injury. Skeletal survey alone missed 26% (5/19) of the cases. Head-injured children were younger than non-head-injured children (median age 2.5 vs 5.1 months); all but 1 head-injured child was Conclusions. Our results support a recommendation for universal screening in neurologically asymptomatic abused children with any of the high-risk criteria used in this study, particularly if that child is under 1 year of age. Ophthalmologic examination is a poor screening method for occult head injury, and one should proceed directly to computed tomography or magnetic resonance imaging. Given the high prevalence of occult head injury detected in this study, further study is warranted to estimate the prevalence of occult head injury in lower risk populations of abused children. Pediatrics 2003;111:1382-1386; child abuse, head injury., ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; CI, confidence interval. Head injury is the leading cause of death in abused children under 2 years of age, (1,2) and early [...]

Objective. To determine the risk of significant injury associated with premature graduation of young (2- to 5-year-old) children to seat belts from child restraint systems (CRS). Background. Advocates recommend use of child safety seats for children younger than age 4 and booster seats for children age 4 and older. Despite these recommendations, many children are prematurely taken out of these child restraints and placed in seat belts. Although data exist to support the use of child restraints over nonrestraint, no real-world data exist to evaluate the risk of significant injury associated with premature use of seat belts. Design/Methods. Partners for Child Passenger Safety includes a child-focused crash surveillance system based on a representative sample of children ages 0 to 15 years in crashes involving 1990 and newer vehicles reported to State Farm Insurance Companies in 15 states and the District of Columbia. Driver reports of crash circumstances and parent reports of child occupant injury were collected via telephone interview using validated surveys. Results were weighted based on sampling frequencies to represent the entire population. Results. Between December 1, 1998, and November 30, 1999, 2077 children aged 2 to 5 years were included and were weighted to represent 13 853 children. Among these young children, 98% were restrained, but nearly 40% of these children were restrained in seat belts. Compared with children in CRS, children in seat belts were more likely to suffer a significant injury (relative risk: 3.5; 95% confidence interval: [2.4, 5.2]). Children in seat belts were at particular risk of significant head injuries (relative risk: 4.2; 95% confidence interval: [2.6, 6.7]) when compared with children in CRS. Conclusions. Premature graduation of young children from CRS to seat belts puts them at greatly increased risk of injury in crashes. A major benefit of CRS is a reduction in head injuries, potentially attributable to a reduction in the amount of head excursion in a crash. Pediatrics 2000;105:1179-1183; motor vehicle safety, child safety seat, seat belt, booster seat., ABBREVIATIONS. MVC, motor vehicle crash; CRS, child restraint systems; CSS, child safety seats; PCPS, Partners for Child Passenger Safety; CHOP/Penn, The Children's Hospital of Philadelphia/ University of Pennsylvania; RAC, Response [...]

Background: Barriers exist to the optimal restraint of children in motor vehicles. According to the National Highway Traffic Safety Administration, in 1997, 55% of children ages 0-4 and 45% of children ages 5-9 killed in crashes were restrained. Many of these restrained children were prematurely graduated from child safety seats to vehicle safety belts. The reasons for premature graduation are not well understood. This study involved parents of restrained children to examine optimal restraint for children under age 9. Methods: Focus groups of approximately 10 parents each were held in Pennsylvania and New Jersey. The parents represented a mixture of household size and composition, employment, and income. Participants were recruited using a flyer that was distributed at local child care programs and elementary schools and using lists maintained by the focus group facilities. Three different groups were conducted: parents of children ages 1-4 who had been restrained in vehicle safety belts at least once or twice in the previous 6 months; parents of children ages 5-9 who had been restrained in vehicle safety belts at least once or twice in the previous six months; and parents of children ages 5-9 who had been restrained in booster seats at least once or twice in the previous six months. Topics explored included parents' perceptions of the risk of their child being injured in a motor vehicle crash; parents' awareness of recommended best practices for child restraint in a motor vehicle and the possible consequences of not implementing these practices; and parents' attitudes towards booster seats. Results: Parents who had restrained their children in booster seats differed from the other two groups in several key ways: they were more aware of the child passenger safety laws in their state, they were more likely to have sought out information on child passenger safety, and they perceived a greater risk of their child being injured in a motor vehicle crash. Factors that influenced how children were restrained and where they were seated in a vehicle for parents in all three groups included: (1) the particular circumstances of the trip, such as the number or type of passengers; (2) negative attitudes towards booster seats; and (3) awareness of recommended best practices and the potential consequences of not implementing these practices. Conclusions: This study indicates that parents and caregivers appear to need more information about the optimal restraint of children in motor vehicles, including information about potential consequences of premature graduation to seat belts, the risks of motor vehicle injury, and specific information on proper positioning and the purpose of booster seats. Future research should, therefore, be directed to understanding how parents determine restraint for their children in order to assist in the development of more targeted interventions to promote optimal restraint., Elisa K. Moll, BA, Esha Bhatia, MA, Gwen Miller, MA, Flaura K. Winston, MD, PhD, FAAP, Nancy Kassam-Adams, PhD, Dennis R. Durbin, MD, MS, FAAP. The Children's Hospital of Philadelphia, [...]

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death to children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend the inclusion of child passenger safety anticipatory guidance at every health supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues affecting the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Children with moderate to severe traumatic brain injury (TBI) show early neurobehavioral deficits that can persist several years after injury. Despite the negative impact that TBI can have on a child's physical, cognitive, and psychosocial well-being, only 1 study to date has documented the receipt of health care services after acute care and the needs of children after TBI. The purpose of this study was to document the health care use and needs of children after a TBI and to identify factors that are associated with unmet or unrecognized health care needs during the first year after injury. METHODS. The health care use and needs of children who sustained a TBI were obtained via telephone interview with a primary caregiver at 2 and 12 months after injury. Of the 330 who enrolled in the study, 302 (92%) completed the 3-month and 288 (87%) completed the 12-month follow-up interviews. The health care needs of each child were categorized as no need, met need, unmet need, or unrecognized need on the basis of the child's use of post-acute services, the caregiver's report of unmet need, and the caregiver's report of the child's functioning as measured by the Pediatric Quality of Life Inventory (PedsQL). Regardless of the use of services or level of function, children of caregivers who reported an unmet need for a health care service were defined as having unmet need. Children who were categorized as having no needs were defined as those who did not receive services; whose caregiver did not report unmet need for a service; and the whose physical, socioemotional, and cognitive functioning was reported to be normal by the caregiver. Children with met needs were those who used services in a particular domain and whose caregivers did not report need for additional services. Finally, children with unrecognized needs were those whose caregiver reported cognitive, physical, or socioemotional dysfunction; who were not receiving services to address the dysfunction; and whose caregiver did not report unmet need for services. Polytomous logistic regression was used to model unmet and unrecognized need at 3 and 12 months after injury as a function of child, family, and injury characteristics. RESULTS. At 3 months after injury, 62% of the study sample reported receiving at least 1 outpatient health care service. Most frequently, children visited a doctor (56%) or a physical therapist (27%); however, 37% of caregivers reported that their child did not see a physician at all during the first year after injury. At 3 and 12 months after injury, 26% and 31% of children, respectively, had unmet/unrecognized health care needs. The most frequent type of unmet or unrecognized need was for cognitive services. The top 3 reasons for unmet need at 3 and 12 months were (1) not recommended by doctor (34% and 31%); (2) not recommended/provided by school (16% and 17%); and (3) cost too much (16% and 16%). Factors that were associated with unmet or unrecognized need changed over time. At 3 months after injury, the caregivers of children with a preexisting psychosocial condition were 3 times more likely to report unmet need compared with children who did not have one. Also, female caregivers were significantly more likely to report unmet need compared with male caregivers. Finally, the caregivers of children with Medicaid were almost 2 times more likely to report unmet need compared with children who were covered by commercial insurance. The only factor that was associated with unrecognized need at 3 months after injury was abnormal family functioning. At 12 months after injury, although TBI severity was not significant, children who sustained a major associated injury were 2 times more likely to report unmet need compared with children who did not. Consistent with the 3-month results, the caregivers of children with Medicaid were significantly more likely to report unmet needs at 1 year after injury. In addition to poor family functioning's being associated with unrecognized need, nonwhite children were significantly more likely to have unrecognized needs at 1 year compared with white children. CONCLUSIONS. A substantial proportion of children with TBI had unmet or unrecognized health care needs during the first year after injury. It is recommended that pediatricians be involved in the post-acute care follow-up of children with TBI to ensure that the injured child's needs are being addressed in a timely and appropriate manner. One of the recommendations that trauma center providers should make on hospital discharge is that the parent/primary caregiver schedule a visit with the child's pediatrician regardless of the post-acute services that the child may be receiving. Because unmet and unrecognized need was highest for cognitive services, it is important to screen for cognitive dysfunction in the primary care setting. Finally, because the health care needs of children with TBI change over time, it is important for pediatricians to monitor their recovery to ensure that children with TBI receive the services that they need to restore their health after injury. KEY WORDS. health service utilization, traumatic brain injury.

Background. Currently, many states are upgrading their child restraint laws to include provisions for the use of age-appropriate restraints through 6 to 8 years of age, with some also requiring rear seating for children, enabling the laws to be in closer alignment with best-practice recommendations. Objective. To evaluate the relationships of seating position and restraint status to the risk of injury among children in passenger vehicle crashes. Methods. This was a cross-sectional study of children Results. Approximately 62% of the children used seat belts, 35% used child restraints, and 3% used no restraint. Nearly 4 of 5 children sat in the rear seat, with one half of all children being restrained appropriately for their age in the rear, although this varied according to the age of the child. Overall, 1.6% of children suffered serious injuries, 13.5% had minor injuries, and 84.9% did not have any injury. Unrestrained children in the front were at the highest risk of injury and appropriately restrained children in the rear were at the lowest risk, for all age groups. Inappropriately restrained children were at nearly twice the risk of injury, compared with appropriately restrained children (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.4-2.3), whereas unrestrained children were at >3 times the risk (OR: 3.2; 95% CI: 2.5-4.1). The effect of seating row was smaller than the effect of restraint status; children in the front seat were at 40% greater risk of injury, compared with children in the rear seat (OR: 1.4; 95% CI: 1.2-1.7). Had all children in the study population been appropriately restrained in the rear seat, 1014 serious injuries (95% CI: 675-1353 injuries) would have been prevented (with the assumption that restraint effectiveness does not depend on a variety of other driver-related, child-related, crash-related, vehicle-related, and environmental factors). Conclusions. Age-appropriate restraint confers relatively more safety benefit than rear seating, but the 2 work synergistically to provide the best protection for children in crashes. These results support the current focus on age-appropriate restraint in recently upgraded state child restraint laws. However, it is important to note that considerable added benefit would be realized with additional requirements for rear seating. Pediatrics 2005;115:e305-e309. URL: www.pediatrics.org/cgi/doi/ 10.1542/peds.2004-1522; child restraint, seating position, injury, motor vehicle accidents.

Objective. To assess the success of recent outreach activities to promote appropriate child restraint in motor vehicles by examining trends in restraint types used by children under age 9 in 3 large regions of the United States. Methods. Cross-sectional study was conducted of children who were under age 9 and in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 8730 crashes involving 10 195 children, representing 128 291 crashes involving 149 820 children, was collected between December 1, 1998, and November 30, 2002. Parent report was used to determine restraint type used in the crash. Logistic regression models were used to analyze the secular trend of restraint type use. Results. Overall, for children under age 9, seat belt use decreased significantly from 49% to 36% between 1998 and 2002; for 7-and 8-year-olds, from 97% to 92%; and for 3-to 6-year-olds, from 63% to 34%. Concurrently, gains were achieved in overall child restraint use from 49% to 63%, for 7-and 8-year-olds, from 2% to 5%; and for 3- to 6-year-olds, from 35% to 65%. Child restraint use remains stable for children from birth to 2 years of age (from 97% in 1998 to 98% in 2002). Both the use of child safety seat and belt positioning booster seat increased significantly, whereas shield booster seat use decreased significantly. Conclusion. Although considerable achievements have been realized over a short period of time, substantial inappropriate restraint still remains: 62% of children aged 4 to 8 remain inappropriately restrained in adult seat belts. Parents hear safety messages when they are relevant to their children. As a result, sustained efforts about appropriate restraint must continue to maintain and improve the gains achieved in appropriate child restraint use. The additional benefits realized by recent changes in child restraint laws remain to be evaluated. Pediatrics 2004;113:e458-e464. URL: http://www.pediatrics.orglcgilcontent/full/113/5/e458; motor vehicle safety, child safety seats, seat belts, belt positioning booster seats.

Introduction. Booster seat use in the United States is extremely low among 4- to 8-year-old children, the group targeted for their use. However, more recent attention has been paid to the role of booster seats for children who have outgrown their forward-facing child safety seat. In particular, several states are currently considering upgrades to their child restraint laws to include the use of booster seats for children over 4 years of age. Objective. To examine recent trends in booster seat use among children involved in automobile crashes in 3 large regions of the United States. Design. This study was performed as part of the Partners for Child Passenger Safety project, an ongoing, child-specific crash surveillance system that links insurance claims data to telephone survey and crash investigation data. All crashes occurring between December 1, 1998, and November 30, 2000, involving a child occupant between 2 to 8 years of age riding in a model year 1990 or newer vehicle reported to State Farm Insurance Companies from 15 states and Washington, DC, were eligible for this study. A probability sample of eligible crashes was selected for a telephone survey with the driver of the vehicle using a previously validated instrument. The study sample was weighted according to each subject's probability of selection, with analyses conducted on the weighted sample. Results. The weighted study sample consisted of 53 834 children between 2 to 8 years old, 11.5% of whom were using a booster seat at the time of the crash. Booster seat use peaked at age 3 and dropped dramatically after age 4. Over the period of study, booster seat use among 4to 8-year-olds increased from 4% to 13%. Among 4-year-olds specifically, booster use increased from 14% to 34%. Among children using booster seats, approximately half used shield boosters and half used belt-positioning boosters. Conclusion. Although overall booster seat use among the targeted population of 4- to 8-year-old children remains low, significant increases have been noted among specific age groups of children over the past 2 years. These data may be useful to pediatricians, legislators, and educators in efforts to target interventions designed to increase appropriate booster seat use in these children. Pediatrics 2001;108(6). URL: http://www.pediatrics.org/ cgi/content/full/108/6/e109; booster seat, child passenger safety, automobile crashes.

OBJECTIVES: To compare restraint-use practices and injuries among children in crashes with grandparent versus parent drivers. METHODS: This was a cross-sectional study of motor vehicle crashes that occurred from January 15, 2003, to November 30, 2007, involving children aged 15 years or younger, with cases identified via insurance claims and data collected via follow-up telephone surveys. We calculated the relative risk of significant child-passenger injury for grandparent-driven versus parent-driven vehicles. Logistic regression modeling estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for several child occupant, driver, vehicle, and crash characteristics. RESULTS: Children driven by grandparents comprised 9.5% of the sample but resulted in only 6.6% of the total injuries. Injuries were reported for 1302 children, for an overall injury rate of 1.02 (95% CI: 0.90-1.17) per 100 child occupants. These represented 161 weighted injuries (0.70% injury rate) with grandparent drivers and 2293 injuries (1.05% injury rate) with parent drivers. Although nearly all children were reported to have been restrained, children in crashes with grandparent drivers used optimal restraint slightly less often. Despite this, children in grandparent-driven crashes were at one-half the risk of injuries as those in parent-driven crashes (OR: 0.50 [95% CI: 0.33- 0.75]) after adjustment. CONCLUSIONS: Grandchildren seem to be safer in crashes when driven by grandparents than by their parents, but safety could be enhanced if grandparents followed current child-restraint guidelines. Additional elucidation of safe grandparent driving practices when carrying their grandchildren may inform future child-occupant driving education guidelines for all drivers. [ABSTRACT FROM AUTHOR]

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear- facing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit. [ABSTRACT FROM AUTHOR]

Objective: To determine the residual physical disability after inpatient rehabilitation for children 7 to 18 years old with traumatic injuries., Methods: This was a retrospective cohort study of patients aged 7 to 18 years who underwent inpatient rehabilitation for traumatic injuries from 2002 to 2011. Patients were identified from the Uniform Data System for Medical Rehabilitation. Injuries were captured by using standardized Medicare Inpatient Rehabilitation Facility Patient Assessment Instrument codes. Functional outcome was measured with the Functional Independence Measure (FIM) instrument. A validated, categorical grading system of the FIM motor items was used, consisting of clinically relevant levels of physical achievement from grade 1 (need for total assistance) to grade 7 (completely independent for self-care and mobility)., Results: A total of 13,798 injured children underwent inpatient rehabilitation across 523 facilities during the 10-year period. After a mean 3-week length of stay, functional limitations were reduced, but children still tended to have residual physical disabilities (median admission grade: 1; median discharge grade: 4). Children with spinal cord injuries, either alone or in combination with other injuries, had lower functional grade at discharge, longer lengths of stay, and more comorbidities at discharge than those with traumatic brain injuries, burns, and multiple injuries (P < .0001 for all comparisons)., Conclusions: Children had very severe physical disability on admission to inpatient rehabilitation for traumatic injuries, and those with spinal cord injuries had persistent disability at discharge. These traumatic events during critical stages of development may result in a substantial care burden over the child's lifespan.

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit.

Objective: Current guidelines for optimal restraint of children in motor vehicles recommend the center rear seating location for installing a child-restraint system. However, recent research on child occupants in child-restraint system has brought this into question. The objective of this study was to describe seating position patterns among appropriately restrained child occupants aged 0 to 3 years in the rear row of vehicles. In addition, we determined the association between rear row seating location and risk of injury., Methods: We studied data collected on child occupants from December 1, 1998, to December 31, 2006, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 3 years seated in a child-restraint system in the rear row of the vehicle, model year 1990 or newer, involved in a crash in 16 states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of > or = 2., Results: Seating position distribution for child occupants was as follows: left outboard (31%), center (28%), and right outboard (41%). There was an inverse relationship between the center position and increasing child age (39% for occupants < 1 year old versus 18% for occupants 3 years old), independent of the number of additional row occupants. Child occupants seated in the center had an injury risk 43% less than children seated in either of the rear outboard positions., Conclusions: The most common seating position for appropriately restrained child occupants in a child-restraint system is the right rear outboard. The center rear seating position is used less often by children restrained by a child-restraint system as they get older. Children seated in the center rear have a 43% lower risk of injury compared with children in a rear outboard position.