Avoid the Unintended Consequences of CR Cleanliness

In 2014, the University of Birmingham (United Kingdom) studied how germ types and levels in cars compared to those in people’s homes.  While they found plenty of germs in people’s vehicles, it was in car seats that the results really stood out. Researchers found that, on average, every square centimeter of a car seat contained at least 100 bacteria and fungi—twice as many as on a toilet seat.

Naturally, this report was widely circulated in the media that year, and people were understandably grossed out.  It is certainly a reminder for CPSTs to stock their tool kit with hand sanitizer and use it routinely while working in cars.

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Updated Study on RF vs. FF Effectiveness

Published: SRN November/December, 2017. Updates will be posted here as they become available.

Update: August 31, 2018. The American Academy of Pediatrics (AAP) has revised their policy on child passenger safety.

As anticipated, the journal Injury Prevention in November published a new study by University of Virginia and other researchers titled “Rear-facing versus forward-facing child restraints: an updated assessment.”  This reexamination of field data was spurred by recent concerns about the accuracy of an earlier study by Henary, et al. (See SRN’s July/August and Sept/Oct 2017 issues.) That 2007 study strongly favored the safety benefits of riding rear facing (and supported subsequent policy updates by the AAP and NHTSA). The new study could not confirm the earlier study’s findings, nor did it result in new, statistically significant outcomes.
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Car Seat Orientation and Safety

Update on Latest Developments As of mid-November 2017

Articles in the last issue of SRN (July/August 2017) covered the major CPS news story that a key, real-life study on the benefits of riding rear facing up to age 2 had been discredited and the status of updated research that will potentially replace it.   Since the journal Injury Prevention issued an Expression of Concern about the 2007 Henary, et al, study—essentially voiding its validity—the CPS community has eagerly awaited a valid study that will replace it in order to guide future policy.

At press time, at least two studies have been completed to reanalyze this data. Neither, however, has completed the peer-review and publication process that is necessary before any scientific research can be relied upon.  Therefore, this is an ongoing and evolving situation; this article aims to summarize new developments since the last SRN issue went to press in late August.

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Start Brainstorming: Ideas to Improve Tether Use in Your Community

Every community could do more to promote the use of tethers.  The following observations are offered as suggestions to help CPSTs get the brainstorming started.

Light BulbConsistently include tethering when describing the transition from rear to forward facing.  I appreciated the National Transportation Safety Board’s CPS Week blog post, which said “When children outgrow a rear-facing car seat, they should use a forward-facing car seat with an internal harness and tether.” This promotes the tether as part of the transition process and keeps it from being linked only to the LATCH system.  On the word “tether,” the NTSB even provided a hot link to the SKBU tether report.

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Bridgespan Report: CPS Movement Recognized Among Standout Initiatives of the Past Century

In the September/October issue of Harvard Business Review, car seats were recognized among 15 movements of the past century that made significant improvements to society.  The article, “Audacious Philanthropy: Lessons from 15 World-Changing Initiatives,” highlighted these top initiatives to help philanthropists identify common behaviors and characteristics that form the framework of movements that successfully create real social change.   CPSTs working to update state laws might also find this article to be helpful in promoting bills.

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Safe Kids Finds Tether Usage Still Low

A recent study found only 36% of FF CRs are tethered—the same low rate as in 2012.

A new study from Safe Kids Buckle Up (SKBU), Car Seat Tethers:  Essential for Safety But Consistently Overlooked, revisits the topic of tether use and misuse, comparing information from recent checkup forms to similar studies from past years.  The results show that not only does tether use continue to be very low but also shows no improvement over the past several years.  Also, among tethers that are used, misuse rates continue to be high.

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NHTSA Policy Reaffirmation of September 2017

The following statement is from NHTSA.

NHTSA LogoAs you know, there have been communications and on-going technical reviews regarding the validity of the 2007 study comparing the injury risk between rear- and forward-facing car seats for children less than 2 years of age in the United States (Henary et al, 2007).  Some of these communications may have caused uncertainty regarding child passenger safety and educational messages given to caregivers.

It is important to note that all the studies in question demonstrate the value and effectiveness that car seats play in keeping children safe while traveling.

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Re-evaluating Car Seat Orientation and Safety

Published: SRN July/August, 2017. Updates will be posted here as they become available.

Update: August 31, 2018. The American Academy of Pediatrics (AAP) has revised their policy on child passenger safety.
Update December 2017:
Updated Study on RF vs. FF Effectiveness.”
Update mid-November 2017:Car Sear Orientation and Safety.”
Update September 2017:NHTSA Policy Reaffirmation.”

Over the past year, certain developments have caused some CPS advocates to be concerned and/or confused about the relative safety of children riding rear facing versus forward facing.  Testimony in a recent lawsuit that questioned the benefits of extended RF, changes to RF and FF requirements in CR instructions, and updated state laws have all contributed to the confusion.  Most recently, an expression of concern published by Injury Prevention and an online statement posted by the CR manufacturer Dorel have understandably raised many questions among CPSTs.  The following describes these developments and gives additional context to help CPSTs make sense of recent news.

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Injury Prevention’s “Expression of Concern”

The following is reprinted from Injury Prevention online, July 3, 2017

“The manuscript ‘Car safety seats for children: rear facing for best protection’ was published in Injury Prevention in 2007, after peer review. The paper used U.S. data from the National Automotive Sampling System Crashworthiness Data System to conclude that children 0–23 months were less likely to be severely injured when using a rear-facing car seat than a front-facing car seat. This result, along with similar data from Swedish experience and biomechanical studies, has been used as the basis for public education and policy recommendations that favor a rear-facing position for children under age two in car seats.

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