Child Car Seat Inspection Stations: Who Attends and What is the Benefit?

INTRODUCTION

Child Car Seat Inspection Stations (CCSIS) are facilities, funded through a combination of federal, state, and local dollars, and staffed by Certified Child Passenger Safety Technicians where drivers may have their child occupant restraint system evaluated for proper fit and installation. The driver can receive current information on choice and proper use of Child Safety Seats (CSS). To date no evaluation has been published on the population served by CCSIS. This study shares CCSIS client demographics and observed CSS misuses.

METHODOLOGY

Data for this study consisted of self-referred drivers with children or expecting a child to one of the state’s 124 CCSIS between October 1, 2011 and September 30, 2012. Drivers were evaluated by appointment at CCSIS and their demographic data was collected, as well as the weight and age of the child passengers. An observation on the CSS used upon arrival was conducted and CSS misuses recorded on a standardized check-up form. Data from the inspection check-up forms were entered into and analyzed using REDCap. REDCap is a software tool developed by Vanderbilt University, with collaboration from a consortium of institutional partners. In all cases recommendations were made to improve the transportation safety of the child, and if needed, a CSS was provided. Data were analyzed for quality control purposes. The study was reviewed and approved by Indiana University IRB (1306011613).

RESULTS

Client profile

During the study period, 7,738 drivers visited and 9,046 children ages newborn through 15 years were evaluated in their vehicle occupant restraint system at a CCSIS. Approximately, 22% were prenatal visits. The majority of the drivers were female (75%), mean age 30.3 years (SD 9.9 y), white (78%), with an annual income less than $50,000 (58%); however, 34% reported income levels of less than $20,000 annually. Fifty-one percent of drivers reported participating in a public assistance program, such as WIC or Medicaid. Education was: less than high school (10%), completed high school (25%), attended some college (21%), or college graduates (31%). The leading referral source was friends or family.

Child profile

The largest proportion of visits was for parents transporting infants birth to <1 year (44%) and the second largest proportion of visits was by prenatal families (22%). The next largest proportion was children age 1 who accounted for 11% of the inspections.

Observed misuse

Not using a CSS properly can compromise the protection provided by the CSS.1 In general, harnesses should be positioned at or below a rear-facing child’s shoulders and at or above a forward-facing child’s shoulders. Harness straps should be adjusted to a snug fit so that fingers slide off the harness when pinching the webbing at the shoulder. Chest clips should be positioned mid-chest or armpit level.2 Of the CSS observed 18% had harnesses positioned incorrectly, 52% had harnesses that were too loose and 48% had chest clips positioned incorrectly.

According to the National Child Passenger Safety Certification Training Curriculum2, CSS should be installed tightly enough so that the CSS does not move more than one inch front to back and side to side at the seat belt path. Installation with a vehicle seat belt requires that the seat belt be “locked” according to vehicle specifications. Rear-facing CSS are installed so that the child is sitting semi-reclined and forward-facing CSS are typically installed so that the child is sitting upright.2 Of those CSS installed upon arrival at the inspection stations, 59% could be moved more than one inch at the seat belt path; 36% of seat belts systems were not locked; and 22% of CSS were not positioned appropriately, either semi-reclined rear-facing or upright forward-facing. Research shows that use of top tethers with forward-facing CSS can decrease head excursion in frontal impacts.3 Of those forward facing CSS in seating positions with top tether anchors, only 14% were installed using the top tether.

Interventions

Education is the primary intervention emphasized at permanent fitting stations. During the appointments, families had the opportunity to demonstrate understanding by restraining their child passengers and/or installing their CSS. Best practice recommendations were emphasized, including the benefits of keeping children rear-facing as long as possible. Of those children who arrived with a CSS installed and who were under 1 year of age, 95% arrived rear-facing and 98% departed rear-facing. For unknown reasons, there were no improvements in moving children ages 12–23 months from forward to rear-facing.

Upon arrival at the inspection station, too many children ages 4 up to 8 years were riding either unrestrained (18%) or using a lap/shoulder belt (19%). Not only were these children riding bereft of optimal protection but also they were riding in violation of the law. Upon departure, the children in this age group left their appointment in a restraint system that provided appropriate protection.

At the permanent fitting station appointments, 39% of inspections resulted in a different car seat. The majority of the CSS were provided by the CPST (84%) at no cost to the family.

CONCLUSIONS

CCSIS appear to provide a valuable service to community members wanting to enhance the transportation safety of their children. Correct usage was significantly improved in this self-selected population of patients. Review of the inspection station data can help shape outreach initiatives by revealing best practice recommendations that need to be emphasized, such as top tether use and prolonged rear-facing for children during the second year of life. An additional benefit that cannot be measured is potential influence provided by treated families on friends and relatives with the ultimate goal of societal change. An unmeasurable number of children are transported more safely because of CCSIS.