Health Administration Services

 Improving Child Safety Seat Education in Utah Hospital Newborn Units

  A baccalaureate thesis prepared by

Michael Tate
for
HIM 4990

Patricia Shaw,

 Weber State University

Table of Contents

Introduction............................................................................................................................................................ 3

Literature Review................................................................................................................................................. 4

Table 1: 1999 – 2001 Utah Unintentional Injuries..................................................................................... 4

Methodology........................................................................................................................................................... 8

Findings and Data................................................................................................................................................ 12

Table 2: Utah Hospital Newborn Unit Survey Results....................................................................... 14

Recommendations............................................................................................................................................... 14

Appendix 1: Safe Transportation of Newborns at Hospital Discharge...................................... 17

Appendix 2: Telephone Survey Script......................................................................................................... 20

References............................................................................................................................................................... 21

Introduction

                Proper child passenger safety seat use is an important parental responsibility.  However, installing a safety seat correctly is complicated enough that parents often seek expert advice.  When safety seat questions arise, parents often go to a handful of professionals with questions: police, fire fighters, health promoters and medical providers.  Newborn units are a particularly important place for parental education, simply due to the enormous number of first-time safety seat users that pass through its doors. As one Utah newborn nurse stated, “I don’t know how you could possibly have a hospital and not teach child seat installation.” 

                Although the American Academy of Pediatrics (AAP) has issued a recommendation to newborn units on safety seat education[i] (see Appendix 1), Utah has not yet proposed nor passed a law requiring newborn units to promote safety seat use nor educate parents on proper installation.  The responsibility, if assumed at all, lies with the hospitals.  Some Utah hospitals have not chosen to assume this responsibility.

The aim of this paper is to determine how effectively one Utah medical sector – hospital newborn units – is teaching and encouraging parents to use child safety seats.  Such data has not been studied, to date, on a statewide level in Utah.  This data will assist health educators in planning and implementing effective newborn unit education methods.  This report will be made available to the National Safe Kids Campaign, Utah hospital child advocacy staff, county and state health departments and other similar safety organizations.

Literature Review

                Unintentional injury is the leading cause of death for children ages one through fourteen in Utah, and motor vehicle crashes are the leading cause of unintentional deaths for that age group[ii] (see Table 1). 

Table 1: 1999 – 2001 Utah Unintentional Injuries

                Since motor vehicle crashes are largely affected by the stringency of traffic laws, the National Safe Kids Campaign has created a system to evaluate child passenger safety laws throughout the United States.  The laws were graded using the following criteria:

·         Restraint use required through age fifteen

·         Appropriate child restraint requirement by age

·         Proper child safety seat adjustment

·         Public education/public fund

·         Penalty provisions

·         Driver/circumstance exemptions

·         Other provisions

                At the conclusion of the study, twenty-four of the states received an “F” grade and eighteen states and the District of Columbia received a “D” (including Utah)[iii].  Since the release of this study, states have worked together to increase child passenger safety laws, with hopes to reduce child fatalities. 

                Currently, Utah law requires all youth sixteen years and younger be restrained in a seat belt and that all children under the age of five be restrained in an approved child safety seat.  Violation of this law is considered a primary offense – that is, a police officer needs no other cause to justify pulling a vehicle over and issuing a warning or ticket.[iv]

                The use of child passenger safety seats and the enforcement of child passenger safety laws have been well established to save children’s lives.  Research shows that safety seats reduce child deaths (infants are 71% less likely to die in a vehicle crash when properly restrained)[v].  The American Academy of Pediatrics asserts that, “With 100% correct use, about 53,000 injuries and 500 deaths could be prevented each year in the United States among children from birth to four years of age” (Appendix 1).  Incorrect use of child safety seats is all too common.  Although 96 percent of parents believe they install and use their child safety seats correctly, it is estimated that 82 percent of child safety seats are not installed correctly[vi].

                To understand a need for proper education, it is also necessary to determine just how complicated infant seat installation can become.                 There are some basic considerations that a parent should know, such as:

·         Seats should be positioned rear-facing until infant is both at least one year old and weighs at least 20 pounds.^[vii]

·         Blankets/jackets should not go between infant and harness.

·         A foam noodle can be used to assist with proper angle of seat.

·         Convertible seats should be bought with specified capacities of 30-35 pounds (to keep them rear-facing as long as possible).

·         A washcloth can be placed in the groin area to close the gap between the body and the strap.

·         There should be at least one inch between the top of the seat and the top of the infant’s head.^[viii]

                Professional assistance is needed, but who provides it and where are they trained to do so?  The National Highway Traffic Safety Administration (NHTSA) fulfills this role by offering a certification in Child Passenger Safety (CPS).

CPS Technicians must attend a rigorous, one-week course designed to provide hands-on and theoretical knowledge at a depth that will allow the professional to educate a parent on proper installation.  NHTSA created this certification course, which is offered through the National Safe Kids Campaign, the only agency that offers certification nationwide to health promotion professionals. 

The course curriculum includes information on:

·         Crash dynamics

·         Effects of airbags on child safety seats

·         Built-in vehicle safety features

·         Size and weight requirements for different types of child safety seats

·         Various seat belt types

·         Proper installation of child safety seats

·         New technology

·         Federal Motor Vehicle Safety Standards (required by NHTSA of all vehicles and child safety seats)

·         Information for children with special needs

These technicians also learn proper documenting techniques to reduce liability.  After an extensive hands-on skills evaluation, students must take a 100-question certification exam.  A score of 85% or higher is required to become a Certified CPS Technician.  Only these technicians are considered credible by the health promotion industry to offer assistance to parents on car seats.[ix]

                Many times, physicians and nurses are the first and possibly the most important contact in promoting proper car seat use.  Newborn units may be the only contact parents have with a professional.  It has become increasingly necessary for a professional organization to provide education in this regard.  A standard should be created in order to determine whether Utah Hospital newborn units are meeting the education needs of newborn parents.  The AAP’s Committee on Injury and Poison Prevention provides one of the only available benchmark guidelines in an article in a 1999 publication of Pediatrics (Appendix 1).  Key elements of policy that the AAP recommends are:

·         “Although the resources of hospitals and patients vary greatly, at discharge every newborn should be properly restrained in a car safety seat.”

·         “Designation” should be made “of an individual responsible for implementing hospital policies and procedures related to discharge of newborns in car safety seats that are used properly.”

·         “Provision for periodic in-service education of staff responsible for parent and guardian education on correct use of car safety seats.”

·         “Those responsible for training other hospital staff and parents and guardians should have successfully completed the NHTSA 4-day course.”

                Utah State hospital rules do not meet these recommendations.  In fact, although there are many Utah rules that regulate hospital procedure, there are no rules regulating safety seat education and promotion for parents of newborns upon discharge from the hospital.[x]  It is unknown how many hospitals have implemented on their own a policy for their units. Consequently, the level of expertise of newborn nurses is not known either.  This is an area of concern for Utah health advocacy groups.

In conclusion, we see that car seat use is both very important for saving lives and largely ignored by many.  Professionals who advise parents on safety matters should continue to encourage safety seat use wherever possible.  However, the complexity of safety seat instruction makes it imperative that health and law enforcement professionals undergo training.  The most comprehensive training available is through NHTSA and the Safe Kids National Campaign.  This course is rigorous and allows for a means to determine the qualification of a professional to train parents.  Unfortunately, Utah law does not include any regulations for safety seat education in newborn units.  Because it is not legislated, Utah hospital newborn units may not have any regulations in place, either.  Therefore, a study is necessary to benchmark these newborn units and identify areas of greatest need for improvement.

Methodology

The thesis of this project resulted from three informal meetings with the Injury Prevention Coordinator of the Salt Lake Valley Health Department (who was previously the Safe Kids Coordinator for Utah State).  The Injury Prevention Coordinator was part of a coalition which had been formed for the purpose of creating an educational video on proper safety seat installation and use.  Other members of this coalition include representatives from the Utah Department of Health, Primary Children’s Medical Center, Salt Lake Valley Health Department, Summit County Health Department, Fox 13 Television and the Utah Highway Safety Office.  The intended audience of the video is any hospital, day care, health department, law enforcement agency, etc. that wishes to use the video as a medium to train employees and parents.  It is hoped that the video will be distributed by fall of 2005. 

The Injury Prevention Coordinator suggested that a needs assessment be conducted in order to determine how often this video would be used.  Realizing that there may be other methods of education, both the Coordinator and researcher discussed other possible issues to research, such as:

·         Level of knowledge of Utah parents on car seat use.  It was suggested that the results from this project might establish a need for the video’s creation.  However, it was found that some data already existed regarding parent expertise.  Also, it seemed that a more important approach would be whether the educators know what to teach (this would then help to determine whether the parents were being taught the correct safety seat principles)

·         Assessment of Utah hospital policy compared to other states regarding safety seat education.  Because each hospital creates its own policy, it seemed likely that considering out-of-state hospitals different than in-state hospitals was unnecessary.  The real issue seemed to be whether Utah hospitals had policies at all.

·         Level of knowledge of Utah newborn unit staff.  This idea was given by the Injury Coordinator.  It seemed appealing because it seemed focused in scope.  However, a survey would not be sufficient to determine that level of expertise.  It was decided that a survey could be used to ask whether any or all of the staff were Certified Child Passenger Safety Technicians.  This would give some indication of newborn staff training.  Also, newborn unit staff could be asked whether a new video would be useful.  Other related questions surfaced, which could be included with the survey:

·         Do the hospitals feel responsible for safety seat education?

·         If so, how do parents get educated?

This was of particular interest to the Injury Coordinator because the Coordinator knew of an incident in 1995 where a newborn unit used an old safety seat video that did not address airbag issues.  The parent installed the infant seat in front of an airbag and the hospital did not make any recommendations, later that day, the infant died in a crash due to this oversight.  The Coordinator’s hope was to find ways to avoid this sort of mistake in Utah hospitals.[xi]

As more literature was reviewed, it became apparent that Utah newborn unit’s safety seat procedures had not been researched. The Salt Lake Valley Health Department and Utah State Health Department (Injury Prevention Division) both indicated that there were presently no such data.  The Coordinator and researcher agreed that newborn units would be the focus of the project.  A question about video usability would be “thrown in” because the Coordinator would find this information useful. 

Because this was a new area of research, it would be necessary to contact the hospitals and ask staff of the newborn units how the units viewed safety seat use (in order to maintain anonymity, the names of these individuals and organizations will not be used in this report).  The data were so scarce that it was unknown whether any hospitals had policies at all.  A little more information was needed about Utah hospitals before the survey could be created.  The researcher determined that Primary Children’s Medical Center, which is a partner of the Safe Kids Coalition of Utah, would serve well as a “good example” benchmark.  In order to conduct a pre-survey benchmark, the researcher contacted the newborn unit of Primary Children’s and asked whether a safety seat policy was in place and, if so, to please describe the policy.  The newborn unit employee indicated that this issue is of key importance to the newborn unit staff, for regular and intensive care newborns alike.  A Safety Squad member (each of whom is or was trained by a Certified Child Passenger Safety Technician) is on hand for parent assistance one hour in the morning and one in the afternoon, Monday through Friday.  The employee indicated that parents were not forced – only encouraged and educated.  Prenatal classes also included some mention of and training on safety seats.

The above information served as a catalyst for the survey’s creation.  The following questions were formulated for phone survey (each question was open-ended):

Questions regarding hospitals attitude toward roles and responsibilities in implementation:

·         Does your hospital enforce child safety seat use?  Only law enforcement can enforce car seat safety use through ticketing.  It does not fall under the hospital’s jurisdiction.  Instead, the hospital can encourage use.  This question will determine whether hospitals understand their role in encouraging safety seat use.

·         Do your nurses install car seats directly or do you ask the parents to install them? This question is important because Child Passenger Safety Technicians are taught to insist that the parents do the final installation of a seat during training (following an instructor demonstration).

Questions about parent education at the hospital:

·         Do you refer parents to agencies that would be able to give educate on car seat installation?  To health agencies, this is preferable to hospital employees attempting to teach without proper training.  This is encouraged, especially when hospitals do not have certified technicians on staff.

·         Does your staff provide personal car seat education to parents/patients?  This is asked in coordination with questions on certification.  Ideally, any employee providing training should be certified.

·         Do you have prenatal classes that provide education on child safety seats?  This question was chosen for a similar reason to that of the previous question. 

·         Are there any other way that you educate parents on safety seat use?  This would allow the employee to name any other method used by the hospital.

Question regarding expertise of staff:

·         Is there an available Certified Child Passenger Safety Technician on staff at your location?  This is asked because personal training should not take place without the certification.

Question about usability of a new training video:

·         Would your hospital and staff be interested in an educational video on Child Passenger Safety?  This question is designed specifically for the aforementioned coalition producing the video.

The Coordinator and researcher needed to determine sample size.  There are many hospitals in Utah, but only approximately 30 which have newborn units that deliver babies.  It was decided that all 30 could be reached without undue time commitment.  Because mail surveys have a low response rate, a survey by phone was chosen, since it seemed to be the most efficient method of contacting each hospital.

In order to avoid undue repetition, the possibility was explored that perhaps groups of hospitals were using the same policy.  Because many hospitals belong to larger companies, the first phone call was to the corporate office of one chain of Utah hospitals.  The researcher was told that each hospital is allowed to create its own policy regarding safety seats.

Of Utah hospitals surveyed, twenty-five newborn units were successfully contacted.  (See Appendix 2 for the complete survey script.)  The manager/spokesperson from each newborn unit was contacted.  After answering the above-mentioned questions, the hospitals were invited to simply describe their methods, policy and training levels.

The results of this survey have been reviewed by the researcher’s contact at the Salt Lake Valley Health Department, which was satisfied that the data collected during this survey will be useful for future implementation of safety seat education initiatives.  The section that follows (“Findings and Data”) describes the data.  The section following “Findings and Data” analyzes the meaning of those findings.

Findings and Data

The results of the survey are summarized in Table 2.  Each question on the X-axis is discussed here:

Rural vs. Metropolitan

One of the most significant general findings was that Utah newborn unit policy varies widely throughout the state.  Also of significance was the variation between rural and metropolitan policy.  Of the twenty-five hospitals polled, five might be considered rural hospitals (i.e. not within forty-five minutes of Ogden, Salt Lake City, Provo or St. George) and twenty might be considered metropolitan hospitals (non-rural). 

Does your hospital enforce child safety seat use?

40% of the rural hospitals and 60% of metropolitan hospitals stated that they don’t allow parents to leave without a safety seat.   Each of those hospitals stated that they would not allow the child to be discharged from the unit if the parent did not have a child safety seat.  Many of these hospitals mentioned that there has never been a need to enforce.  One enforcing hospital’s employee mentioned that it had a loaner program to allow the parent to borrow a safety seat to be used just during the initial ride home.  Two enforcer hospitals said that they would call the police if a parent would leave without having a child safety seat.

Do your nurses install car seats directly or do you ask the parents to install them?

The eleven non-enforcer hospitals didn’t enforce safety seat use because they wanted to avoid the liability issues that would be involved or the interviewee and/or hospital simply didn’t feel it was the hospital’s jurisdiction. The majority of those surveyed did, however, give direction on how to properly install the seat.  They did not install the seat themselves because they either recognized that they were not qualified to do so or, again, did not want to create a liability.  A few of the hospitals would help to put the child into the car seat, but not to put the car seat into the car (for these same reasons).

Do you refer parents to agencies that would be able to provide education on car seat installation?

Eleven of the twenty-five (55%) of the metropolitan hospital newborn units did know of a resource available outside of the hospital that they could refer the patient/parent to if they had a question about child safety seats.  Many of them mentioned local health departments or nearby fire departments that would have certified staff that would be able to help out.   A few of the hospitals gave answers such as, “maybe I would refer them to a car dealership.”  Rural hospitals were much less likely to refer to other agencies (only one of five referred to other agencies) and instead gave personal instruction.

Does your staff provide personal car seat education to parents/patients?

                Though only one unit has a team of certified staff dedicated to car seat training, 85% of metropolitan units give personal training of some sort.  Only 40% of rural units give personal training.  Many of the trainers in both rural and metropolitan areas are self-taught or have received some short, informal training.

Do you have prenatal classes that provide education on child safety seats?

Most of the newborn staff nurses did not teach the prenatal classes and were therefore unable to determine if child safety seat information was included in the classes.  However, five of the hospitals surveyed did know that child safety seat education was taught in the prenatal classes. 

Is there an available Certified Child Passenger Safety Technician on staff at your location?

60% of the rural hospitals staffed a Certified Child Passenger Safety Technician, and the technician helped to education parents.  Only 15% of the metropolitan hospitals staffed a Certified Child Passenger Safety Technician.  None of the rural hospitals installed car seats for parents.  A follow-up question (which was not asked every time) was asked regarding any training (even up to one-half hour) at all in the arena of child safety seats and few (2-3) of those that were not Certified CPS Technicians did not have any training at all.

Would your hospital and staff be interested in an educational video on Child Passenger Safety?

The majority of those surveyed were very interested in receiving a video that would be focused towards parents and staff to educate on the basics of child safety seat installation.  Some already owned a video that they stated was outdated, with old information.  These hospitals already were using the video to train the parents and were happy to hear that they may be able to receive an updated version.

Table 2: Utah Hospital Newborn Unit Survey Results

Recommendations

If an expanded policy was implemented to require staff to become Certified Child Passenger Safety Technicians, it would benefit the community in a number of ways.  First, hospital staff would become a credible source to patients and would be able to answer questions correctly.  Second, the liability level of the hospital would be decreased since the staff would be giving correct information.  Third, policy would improve as decision-making newborn unit staff learned about proper training methods (e.g. deciding whether to enforce, impact of enforcing, ability to recognize which educational materials are current, etc.) Fourth (and most important), there may be a decrease in the number of child deaths due to a decrease in incorrect use.

For example, a policy on a corporate level regarding safety seat use in newborn units might cause education change to occur more rapidly because of a planned, concerted effort.  This might also be accomplished as an initiative of local medical associations.

Hospitals are one of the first contacts for new parents and can be an even better educational resource than they already are.  The education level of newborn unit staff may affect proper use of safety seats and directly reduce Utah infant deaths. 

This survey showed that 48% of Utah newborn units speak with patients about health, fire, and police departments for further training.  In order to boost this percentage, the researcher recommends that these agencies stock informational literature containing contact information at the newborn units.  This may raise community awareness of services already in place.  This may also help hospitals gain a stronger relationship with local health departments – possible leading to training and certification opportunities.

Based on the large discrepancy of statistics in favor of rural hospitals, it is recommended that this effort begin in the four major Utah metropolitan areas (this recommendation is made because rural hospitals were more likely to have Certified Child Passenger Safety Technicians on hand).

Future research can be done in this area for Utah and other states.  It is recommended that researchers proceed by executing one or more of the following steps:

·         Focus on documenting benefits to hospitals by allowing more budget costs to go towards education and Child Passenger Safety Certification (CPS).  Use cost saving data (http://www.utcodes.org) to show the hospital costs involved due to motor vehicle crash deaths.

·         Conduct a similar survey on a national level. Report the results to the National Highway Traffic Safety Administration, National Safe Kids Campaign, American Academy of Pediatrics, etc.

·         Investigate the number of law suits against hospitals caused by misguided newborn parents.

·         Evaluate the feasibility of creating a Utah rule or law mandating hospital CPS certification of Utah newborn units.

·         Research the requirements for newborns in need of special care.   This could include newborns with birth defects, preemies, newborns with disease, etc.  For example, many large Utah hospitals test preemies’ ability to breathe while sitting in a child safety seat.  Oxygen levels are typically monitored for ninety minutes.  Utah law/hospital policy may not be complete without mandating special care for these babies, who might be in more danger of suffocation than completely healthy babies.

Appendix 1: Safe Transportation of Newborns at Hospital Discharge

AMERICAN ACADEMY OF PEDIATRICS

Committee on Injury and Poison Prevention

Safe Transportation of Newborns at Hospital Discharge

ABSTRACT. All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant’s maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.

ABBREVIATIONS. FMVSS, Federal Motor Vehicle Safety Standard;  AAP, American Academy of Pediatrics; NHTSA, National  Highway Traffic Safety Administration. 

All newborns discharged from hospitals  should be transported home in car safety  seats that meet Federal Motor Vehicle Safety  Standard (FMVSS) 213 and that are selected to meet  the specific transportation needs of healthy newborns,  premature infants, or infants with special  health care needs.  In 1996, 1780 children (newborns to 14 years of age) were killed, and 305 000 were injured as occupants in motor vehicles.1 Of the fatalities, 60% were unrestrained. The fatality rate for infants was higher than any other age group, 4.4/100 000.2 In 1996, 653 children (newborns through 4 years of age) were killed as occupants in motor vehicles. Of these fatalities, 52% were unrestrained. The American Academy of Pediatrics (AAP) has  made major contributions to child passenger safety,  including contributions to the passage of legislation  in all 50 states that requires the use of car safety seats  or child restraint devices for infants and young children.  Assuring that newborns are restrained properly  when riding for the first time establishes the  pattern for continued compliance with a measure  that can save their lives or prevent serious injury.  Correctly used car safety seats are 71% effective in  preventing fatalities attributable to car crashes and  67% effective in preventing injury that requires hospitalization.  With 100% correct use, about 53 000 injuries  and 500 deaths could be prevented each year in  the United States among children from birth to 4  years of age.3 

RECOMMENDATIONS

1. In conjunction with their medical staff, all hospitals with services for newborns should develop policies for the discharge of newborns in car safety seats that are crash tested and meet the FMVSS 213. These policies should be developed in consultation with a car seat expert who has successfully completed the National Highway Traffic Safety Administration (NHTSA) 4-day course.4 Although the resources of hospitals and patients vary greatly, at discharge every newborn should be properly restrained in a car safety seat.

2. Pediatricians should work with these hospitals in establishing hospital policies that clearly define staff roles for each required task. Also, pediatricians should reinforce the need for compliance with these policies with both hospital staff and parents/guardians. Hospital policies related to newborns should include the following:

·         Methods by which expectant parents will be informed, before delivery, of the importance of using car safety seats and potential problems with vehicle incompatibility. Parents should be advised through prenatal classes, their obstetrical provider, or pediatric prenatal visits to obtain a car safety seat, properly secure it in their vehicle, and resolve compatibility issues before delivery. This is especially important because physicians frequently discharge infants after only a short hospital stay.

·         Designation of an individual responsible for implementing hospital policies and procedures related to discharge of newborns in car safety seats that are used properly. Hospital policy also should include designation of an individual or team specifically trained to assess the needs of infants with special health care needs with regard to the selection of the most appropriate child safety seat.5– 8 Hospitals should develop a policy to ensure provision of a period of observation in a car safety seat before hospital discharge for each infant born at < 37 weeks’ gestation to monitor for possible apnea, bradycardia, or oxygen desaturation. 5  Provision for periodic in-service education of staff responsible for parent and guardian education on correct use of car safety seats. Those responsible for training other hospital staff and parents and guardians should have successfully completed the NHTSA 4-day course.4

·         Provision of regular periodic review by a designated person who has completed the NHTSA 4-day course of all materials distributed to parents and guardians of newborns about proper car safety seat use. Hospitals should ensure that information is current, relevant, and accurate, with date of publication or revision noted.9

·         Provisions to make available an appropriate car safety seat by sale, short-term loan, or donation to parents before discharge if the parents are unable to provide their own. Hospitals should consider giving a low-cost infant car seat, which can also be used for generic instruction, to parents at discharge as a gift.

·         Assessment of the degree of compliance with the policies and procedures on discharge in child safety seats in routine quality assurance surveillance by hospital staff. Hospital staffs should take appropriate actions to correct deficiencies when present.

Admission orders for newborns should include an order written by a physician for parent instruction about use of child safety seats. This should be included as a part of standard admission orders to ensure its completion before discharge. Discharge policies for newborns should include the following:

·         Determination of the most appropriate car safety seat for each newborn according to maturity and medical condition by a designated hospital employee.

·         Provision of information and training for parents and guardians should be presented before discharge on the generic issues related to correct use of car safety seats. Hands-on teaching including “return demonstration” should be a part of this instruction. The installation of a specific car seat in a specific car must be the parent’s responsibility. Resources to address these issues are available from the AAP.10,11

·         A period of observation in a car safety seat before hospital discharge should be provided to each infant born at < 37 weeks’ gestation to monitor for possible apnea, bradycardia, or oxygen desaturation. 5

·         Pediatricians with other child health and safety advocates should work for coverage of appropriate child restraint systems as a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers. Until that time, hospitals are encouraged to have a giveaway or loan program for parents who cannot afford to purchase a car seat.

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

PEDIATRICS (ISSN 0031 4005). Copyright © 1999 by the American Academy of Pediatrics.

COMMITTEE ON INJURY AND POISON PREVENTION, 1999–2000

Marilyn Bull, MD, Chairperson

Phyllis Agran, MD, MPH

Danielle Laraque, MD

Susan H. Pollack, MD

Gary A. Smith, MD, DrPH

Howard R. Spivak, MD

Milton Tenenbein, MD

Susan B. Tully, MD

Liaison Representatives

Ruth A. Brenner, MD, MPH

National Institute of Child Health and Human Development

Stephanie Bryn, MPH

Maternal and Child Health Bureau

Cheryl Neverman, MS

National Highway Traffic Safety Administration

Richard A. Schieber, MD, MPH

Centers for Disease Control and Prevention

Richard Stanwick, MD

Canadian Paediatric Society

Deborah Tinsworth

US Consumer Product Safety Commission

William P. Tully, MD

Pediatric Orthopaedic Society of North America

Section Liaison

Victor Garcia, MD

Section on Surgery

Consultant

Murray L. Katcher, MD, PhD

REFERENCES

1. US Department of Transportation, National Highway Traffic Safety Administration. Traffic Safety Facts 1996. A Compilation of Motor Vehicle Crash Data From the Fatal Accident Reporting System and the General Estimates System. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 1997

2. Fingerhut LA, Annest JI, Baker SP, et al. Injury mortality among children and teenagers in the United States: 1993. Inj Prev. 1996;2:93–94

3. An Evaluation of Child Passenger Safety: The Effectiveness and Benefits of Safety Seats. Springfield, VA: National Technical Information Service; 1986. DOT report DOT MS 806890

4. National Highway Traffic Safety Administration. Standardized Child Passenger Safety Training Program. Washington, DC: National Highway Traffic Safety Administration; 1998

5. American Academy of Pediatrics, Committee on Injury and Poison Prevention and Committee on Fetus and Newborn. Safe transportation of premature and low birth weight infants. Pediatrics. 1996;97:758–760

6. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics. 1996;97:761–763

7. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Transporting children with special health care needs. 1999; 104:988–992

8. Summerfelt M, Spitzer A, Wallace E, et al. Kars/Special Kars. An Easter Seals’ Model Program Training Manual. Chicago, IL: National Easter Seal Society; 1992

9. National Highway Traffic Safety Administration. Is This Child on the Road to Danger? Washington, DC: National Highway Traffic Safety Administration; 1997. DOT report DOT HS 808672

10. American Academy of Pediatrics. 1999 Family Shopping Guide to Car Seats (brochure). Elk Grove Village, IL: American Academy of Pediatrics; 1999

11. American Academy of Pediatrics. Car Seat Shopping Guide for Children With Speical Needs. (brochure). Elk Grove Village, IL: American Academy of Pediatrics; 1998

AMERICAN ACADEMY OF PEDIATRICS Vol. 104 No. 4 October 1999 (pp. 986-987)

Appendix 2: Telephone Survey Script

(Call is made to hospital main phone number.  Main operator answers and announces hospital name.

Surveyor: “Hello, may I please be transferred to the newborn unit, please?”

(Call is transferred to the newborn unit, then answered by an employee of the newborn unit.)

Surveyor: “Hello, my name is Mike Tate, and I’m writing a research paper on car seat education policies in Utah newborn units.  Would you have three minutes for me to ask a few questions regarding car seat use in your department?”

“Does your hospital enforce child safety seat use?”

“Do you or other employees install car seats directly or do the parents install them?”

“Do you refer out to other agencies that would be able to give educate on car seat installation?”

“Does your staff provide personal car seat education to parents/patients?”

“Do you have prenatal classes that provide education on child safety seats?”

“Are there any other way that you educate parents on safety seat use?”

“Is there an available Certified Child Passenger Safety Technician on staff at your location?”

“I am also calling on behalf of a coalition of Salt Lake and Utah organizations that are considering creating a safety seat instructional video.  Would your hospital and staff be interested in using the video?”

“That is all of my questions.  Thank you for your time and thank you for encouraging the proper use of safety seats.  Goodbye.”

(End of phone call)

References

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