Motor vehicle occupant injury is a significant source of morbidity and mortality among children. Correctly used child safety seats (CSSs) substantially reduce injury morbidity and mortality. The objective of this study was to describe how parents learn to use and install CSS at newborn discharge.
We prospectively enrolled maternal/newborn infant dyads at discharge from a large urban teaching hospital. Survey data included maternal demographics and parental knowledge on CSS installation. After survey completion, a certified child passenger safety technician observed and recorded CSS information, infant placement in CSS, and CSS placement in vehicle. Nine specific misuse categories were recorded.
A total of 101 mothers were enrolled, with mean age 29.4 years (15–45 years); 52% were white, 18% were black, and 27% were Hispanic; 50% had college degree or higher; and 41% were privately insured. We observed 254 CSS errors (range, 0–7; mean, 2.5). There were 52% infant placement in CSS misuse errors (range 0–4; mean, 1.3), and 48% CSS placement in vehicle misuse errors (range, 0–4; mean, 1.2). The CSS placement misuse included 29% CSS not attached to vehicle. More frequent misuse occurred among non-white, non–college-educated mothers (p < 0.01).There was no difference in misuse related to how, when, and where mothers learned about CSS installation.
Despite national, state, and hospital policies that require newborns to be transported in a CSS, we found a significant number of concerning CSS misuse in our study population. These results highlight the need for improved CSS education starting with the first ride home.
LEVEL OF EVIDENCE
Therapeutic study, level III.