Little fingers, big trouble

It's tough to keep kids safe when you're traveling by car. First, you need to install a car seat, which many parents can attest is no easy feat. Then you have to get the child, who may be writhing and squirming, restrained in the seat. Mission accomplished? Don't count on it.

New research to be presented Sunday, May 1, at the Pediatric Academic Societies (PAS) annual meeting in Denver reveals another potential roadblock to child passenger safety: youngsters unbuckling themselves while the vehicle is moving.

Restraining children inappropriately in a vehicle more than triples their risk for serious injury in a collision. While previous studies have looked at potential obstacles to getting a child restrained safely, none has assessed how frequently youngsters unbuckle themselves, or the age at which children are able to do so.

In this study, researchers led by Lilia B. Reyes, MD, clinical fellow in the Department of Pediatrics at Yale School of Medicine, surveyed parents with children younger than 6 years to find out the age at which children begin to unbuckle themselves from vehicle restraints and how frequently this occurs while the car is moving. Parents at five urban and suburban pediatric offices also were asked to describe what they do if their child unbuckles.

Results from 378 parents showed that 51 percent reported that at least one of their children self-unbuckled. In addition, 75 percent of children who unbuckled themselves were 3 years of age or younger, and unbuckling was reported as early as 12 months of age. More boys unbuckled themselves than girls (59 percent vs. 42 percent, respectively).

Of the children who unbuckled themselves, 43 percent did so when the car was moving. The majority of parents reported that when this happens, they pull the car over, reprimand the child and re-buckle him or her.

"This pilot study elucidates another potential safety hazard in child motor vehicle restraint that needs to be addressed," Dr. Reyes said. "Most importantly, it makes parents aware of the fact that their child may have the motor capability of self-unbuckling without having the full cognitive understanding of the consequences of this behavior."

Future research should look at which restraint devices would be safer, Dr. Reyes concluded. "Keeping precious cargo safe is our duty."

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Co-authors of the study include Melissa Langhan, MD, FAAP, Linda Arnold, MD, FAAP, Lei Chen, MD, FAAP, John Leventhal, MD, FAAP, and Veronika Northrup, MPH.

The Pediatric Academic Societies (PAS) are four individual pediatric organizations who co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well being of children worldwide.