HJBR Jul/Aug 2019

Healthcare Journal of BATON ROUGE  I  JUL / AUG 2019 49 Mindy L. Calandro, MD, FAAP Pediatric Medicine Baton Rouge Clinic young children in rear-facing car seats is nothing new, especially in countries like Sweden, which has been at the forefront of child passenger safety since the 1960s. Decades before any other country, Swedes began having their children ride rear-fac- ing until 4-5 years of age. This is not con- sidered extended rear-facing in Sweden. This is just the norm. The proof is in the pudding when you consider that the rate of children dying in car accidents in Swe- den is virtually zero. Extremely rigorous crash testing for car seats, including a test called the Plus Test, which no forward fac- ing car seat has ever passed in Sweden, as well as other aspects of road safety, includ- ing more roundabouts (and less intersec- tions), much stricter laws for driving under the influence, higher cost of obtaining a driver’s license (close to $1,800), and lower speed limits in pedestrian areas, are all fac- tors that contribute to their astonishingly low rate of car accident fatalities. Let me dispel some of the arguments I hear or read from parents regarding rear-facing until at least two years of age. “What if their legs are bent/feet touch- ing the seat/legs hanging over the side of the seat?” Good news—the risk of leg in- jury in a collision is very minimal, espe- cially when you compare it to the risk of a head or neck injury for a young child who is forward-facing in a collision. I will take a leg injury in a child over paralysis from a neck injury. I always explain to parents that if they are in a collision and a rear-fac- ing child sustains a leg injury, the outcome would have been absolutely devastating if that child had been forward-facing. “My child gets bored or lonely when they are rear-facing.” Well, more good news—your child knows your voice by 9-12 months of age, so simply by talking to them or singing with them, they will know you are there. As kids get older, playing “I Spy” is a great way to engage children while driving. There are also some great mirrors you can buy and mount on the headrest of the rear seat that allow you and your child to see each other through your rearview mirror. Now, there are two aspects of this new law that need some clarification. First, there is no specific age recommendation from the AAP for when children should stop using a belt positioning booster. In- stead, when a child reaches 4 feet 9 inches tall, then they are an appropriate size to ride in a car using just the seat belt. This generally will occur between 9-12 years of age, but when children are removed from a booster too early, they are at increased risk of significant seat belt injuries includ- ing neck and abdominal trauma. Finally, I recommend that families leave children in their forward-facing harnessed car seat until they outgrow it. For me there is no age restriction for this, as the harness will provide far more protection for most younger children, and many forward-fac- ing car seats will go up to at least 50 pounds. Kids have to be able to reliably sit still in order to switch to a booster seat, and I don’t know about your four year old, but mine certainly was not ready (in fact, my five year old is still safely secured in his harnessed car seat). I applaud the Louisiana Senate for get- ting the legislation passed this session, as car accidents remain the leading cause of accidental death in children 1-13 years of age. In 2017, 667 children under 13 years of age died as passengers in car accidents, which is more than a dozen children each and every week. As healthcare providers, we all need to work on getting the message out to our patients about the new laws so we can keep the children of Louisiana as safe as possible on the road. n