Happy Children in Safe Seats: Not As Easy As It Sounds
July 17, 2013
Sponsored by The Maryland Institute for Emergency Medical Services Systems
Moderator: Susanne Ogaitis-Jones
Presenter: Caroline Langrall, CCLS, CPST
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and the participant information form!
Available at http://miemss.org/EMSCwww/CPSConference.html
Happy Children in Safe Seats…
Not as Easy as it Sounds
Considerations every safety advocate
needs to know to solve car seat challenges
Caroline Langrall, CCLS, CPST
Objectives
Identify key phases of a child's
psychosocial and cognitive development
that may create challenges regarding safe
travel in the car.
 Identify developmentally appropriate
strategies to encourage and enable
caregivers to use car seats properly.
 Explore ways to address the transport of
children with special needs and
developmental delays.
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What are the challenges?
Crying
 Tantrums
 Refusal
 Unbuckling
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Challenging behaviors… leading to
dangerous “solutions”
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Excessive crying/screaming?
◦ Loosen straps
◦ Front seat
◦ No seat use
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Escaping
◦ Altering seat
◦ Compromising
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Vomiting/Motion sickness
◦ Early forward facing
First Step:
Check the
use…
◦ Age/size
appropriate?
◦ Straps snug and
routed right?
◦ Buckles functional?
◦ Installation correct?
Infant development & interventions
Bonding, attachment, trust.
 Sensorimotor & object permanence.
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Blanket with familiar smell
Adult in back seat
Rock/sway the seat
Pacifier
Soothing music
Convertible for older infant?
Infant development & interventions,
continued…
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Physiological Immaturity
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Allow an hour for digestion
Different seat with a different angle
Overheated
Swaddle/boundaries
Toddler development (1-3)
Autonomy
 Egocentric
 Lack of reasoning
 Separation Anxiety
 Improving dexterity

Toddler challenges
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Unbuckling/escaping
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378 caregivers: 50% reported child unbuckled self.
Majority = boys < 3 (Yale University, 2011)
Tantrum/screaming
◦ Driver distraction
http://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/new-car-seat-safety-study-toddlers-can-unbuckle-seatbelts
Improper harness use injury
patterns
http://www.youtube.com/watch?NR=1&feature=endscreen&v=akGpsPyhDdk
Interventions for toddlers
Consistent, simple messages from all cgs
 Reinforce good behavior frequently.
 Ignore ‘bad’ behavior
 Calm voice, empathy, don’t get angry.
 Pull over and wait…or time-out
 Offer choices
 Keep hands busy: Cheerios, cling stickers.
 Special rotating bag of soft ‘car toys’
 Divert attention
 Music
 Coat tricks
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Preschooler development (3-6)
Initiative
 Want to please others
 Literal interpretations
 Lack abstract thought
 Dramatic play and magical thinking
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Interventions for Preschoolers
“Write” a story together
 Be clear and consistent
with expectations
 Dramatic play
 Give a “job” or “role”
 Sticker chart for behavior
 Choose car seat or
decorate.
 Seek & find books
 Game for long car rides
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School age development (6-12)
Spelling and language
 Development of scientific method
 Moral development: good vs. bad
 Use feedback to judge their competency
 Acceptance by peer group
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Interventions for School Age
Be clear with rules
 Run an ‘experiment’
 Praise for good behavior
 Empathize
 Low back booster…choices

Without booster
With booster
Adolescent development
Abstract/higher-level thinking
 Critical thinking emergence
 Independence
 Influence of peers
 Risk taking behaviors
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Adolescent challenges

MVC’s = 40% of deaths
◦ Age 16-24 = lowest seatbelt use
(CDC, 2006)
Driving under the influence
 Reckless or careless driving
 Texting while driving
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◦ >50% of teens >16 yrs admitted to TWD
◦ Less likely to wear seatbelt,
◦ More likely to drive while intoxicated or
with someone who is intoxicated
(Balin et al., 2013)
Bailin, A., Adesman, A., & Sunday, S. R. (2013). 134. Texting While Driving Among High School Students in the United States: Analysis of 2011 Data
From the National Youth Risk Behavior Survey (YRBS). Journal Of Adolescent Health, 52(s1), S85-6
National Center for Injury Prevention and Control (CDC). Web-based injury statistics query and reporting system (WISQARS).
http://www.cdc.gov/ncipc/wisqars/: 2006
Adolescent interventions
Makes rules and consequences clear
 Follow-through on consequences
 Provide choices when possible
 Demonstrate expected behavior
 Reward
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Dealing with motion sickness
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No reading, video games
Middle seat
I Spy games to look outside
Open window
Ice pack to back of neck
Cool washcloth
Saltine crackers or ginger snaps
Peppermint/ginger aromatherapy
“Sea bands”/acupressure
Breathing
Frequent stops
Travel at night/naps
(Lua,& Zakaria, 2012)
(Hunt, 2011)
Hunt, K., & Ernst, E. (2011). The evidence-base for complementary medicine in children: a critical overview of systematic reviews. Archives Of Disease In Childhood, 96(8), 769-776.
Lua, P., & Zakaria, N. (2012). A Brief Review of Current Scientific Evidence Involving Aromatherapy Use for Nausea and Vomiting. Journal Of Alternative & Complementary Medicine,
18(6).
Special Needs
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PDD/Autism spectrum/Cognitive delay
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Seat options decrease with age/size
Difficulty with reasoning
Need for routine & difficulty with change
Sensory processing challenges
Be kind; for everyone you meet is fighting a hard
battle. –John Watson
Interventions for Children with
Special Needs
◦ Anticipatory guidance to prepare for seat
change
◦ Consider other seats.
◦ Refer to http://www.preventinjury.org or
search Safe Kids website for a CPST trained in
Special needs.
Special needs

EZ-On floor mounted vest and tether
◦ Vehicle modification
◦ Seat bight
http://www.ezonpro.com/
Special needs

Roosevelt by Merritt Manufacturing
◦ 35-115 lbs & 33.5-62”
◦ Harness cover & EZ Buckle guard
 NOT for use with other seats
◦ Not compatible in all vehicles
http://eztether.com/index.php/product-info/roosevelt
Thank you for your attention!
Q & A SESSION
Thank you for participating!
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
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
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