Analysis and Application of a Clinical Practice Guideline: Child Passenger Safety Motor vehicle crashes are identified as the leading cause of death in children under 19 years of age across the United States (Sauber-Schatz, West, & Bergen, 2014). Due to the large number of child deaths that occur each year, education regarding the proper use of child passenger safety seats must be provided to families. According to Basco, Hletko, West, and Darden (2009), although death and injury caused by motor vehicle accidents are deemed accidental, they are preventable. Due to the fact that deaths and injuries that occur are accidental, The American Academy of Pediatrics recognized the need for standardization of recommendations for child passenger safety seats and initiated and funded the development of the Child Passenger Safety clinical practice guideline. Nurses and physicians working in the community and in the inpatient hospital environment have access to multiple resources that can aide in providing education to family members. Scope and Purpose
The purpose of the guideline was to standardized recommendations for pediatricians and parents to follow to optimize the safety of children from birth to adolescence when riding in passenger vehicles (Committee on Injury, Violence, and Poison Prevention, 2011). With the recommendations standardized, pediatricians are able to promote the safety of children through their daily practice in physician offices and hospitals. In addition the recommendations that were developed by the Committee on Injury, Violence, and Poison Prevention (2011), the guideline provided resources for physicians so that anticipatory guidance on passenger vehicle safety could be offered to families and provided direct resources for families to access so that the information was easy to obtain. The guideline aimed to focus on the safety of children from infancy to adolescent age when riding as a passenger in a vehicle. The following were considered during development of the guideline: the use of age appropriate seats, exposure to air bags, and safety considerations of children in vehicles, pick-up trucks, or on commercial airlines (Committee on Injury, Violence, and Poison Prevention, 2011). Stakeholder Involvement
The American Academy of Pediatrics initiated and funded guideline development. Authors of the guideline are physicians who are members of the Committee on Injury, Violence, and Poison Prevention. During guideline development members of the target population were not consulted by guideline authors. Prior to publishing the document conflicts were presented to the Board of Directors and a resolution process was completed. According to the Committee on Injury, Violence, and Poison Prevention (2011), authors of the document were required to file a conflict of interest statement with the American Academy of Pediatrics and commercial involvement was not accepted during guideline development. Rigor of Development
Guideline authors performed an initial search in May of 2009 using Medline through the OVID database. The following terms were utilized in the search: motor vehicle accidents, motor vehicle crashes, child passenger safety, booster seats, child safety seats, car seats, racial disparities, seat belt syndrome, seat belts and children, children and air bags, children, safety, and airplanes, and child restraint laws (Committee on Injury, Violence, and Poison Prevention, 2011). Search results were limited to articles published in the English language in peer-reviewed journals between the years of 1999 and 2009. The original number of articles that were yielded from the search was not identified, but a total of 131 articles were analyzed and utilize in development of the clinical practice guideline. Specific criteria for article inclusion, type of evidence utilized, or level of article evidence was not identified by the authors. Recommendations
Based on results of the guideline there are specific recommendations that should be followed by families and medical personnel regarding child passenger safety practices. Rear-facing car seats should be utilized for infants and toddlers until they are 2 years old, or have reached the maximum weight identified by the car seat manufacturer. Forward facing seats with a harness should be utilized once the child has outgrown the rear-facing seat and should be utilized until the maximum height or weight identified by the car seat manufacturer has been reached by the child. Once the maximum height or weight requirement has been reached, the child should be transitioned into a belt-positioning booster seat. The belt-positioning booster seat should be utilized until the lap-and-shoulder seat belt fits properly, which is usually between 8 and 12 years of age or around the height of 4 feet nine inches. Until children are at least 14 years of age children should travel in rear seats of vehicles to promote optimal protection (Committee on Injury, Violence, and Poison Prevention, 2011).
Whether working as a nurse in the community or on an inpatient hospital unit it is important to continually offer education to families regarding appropriate practice for child passenger safety. Parents often base car seat selection on age of their child, but that is only one of the factors that must be considered in car seat selection. Therefore, it is important for physicians and nurses to provide education regarding recommended car seat selection based on the child’s height and weight (Basco et al., 2009). Communities often offer car seat clinics at local fire departments or health departments, and the clinics are free of charge. According to The Children’s Hospital of Illinois (2014), car seat clinics are held in Peoria, Illinois on the first Wednesday of the month at one of the fire departments, the second Tuesday of the month at Advanced Medical Transport, and the third Thursday of the month at the Tazwell County Highway Department.
Certified car seat technicians run the clinics and are able to ensure that children fit properly in their car seat and that the car seat is installed safely in the car. If the child does not have an appropriate car seat, technicians at the clinic can aide parents in selection of the appropriate car seat and refer families in need to appropriate community resources (Children’s Hospital of Illinois). To promote proper use of car seats and child passenger safety nurses can refer family to community resources and provide information regarding child passenger safety from www.healthychildren.org or www.aap.org (as cited in The Committee on Injury, Violence, and Poison Prevention, 2011). Implementation
Barriers to implementation of the Child Passenger Safety guideline could occur if physicians and nursing staff resist the use of up to date resources provided by the Healthy Children and American Academy of Pediatrics websites. Additionally, barriers could occur if families are unable to afford appropriate safety seats for their children, or families are unable to receive appropriate education regarding the proper fitting of a child in a car seat or the proper fitting of a car seat in a car. Costs for following guideline recommendations would be limited, but time of individuals would be needed. Car seat clinics offered in the community are free, and are run by volunteers. Therefore, although implementation of the clinic would have a low cost, it would require a large number of volunteers to function smoothly. Resources for nursing staff, pediatricians, and families is available free of charge online.
In order to effectively measure outcomes of implementation of the guidelines, the following outcome measures could be monitored: motor vehicle traffic-related injuries and fatalities in infants, children, and adolescents, reported use of child restraint systems, and effectiveness of car safety seats (Committee on Injury, Violence, and Poison Prevention, 2011). For communities that provide car seat clinics, information regarding community participation and need for education could be collected from families who participate within the clinic. Conclusion
Due to the large number of deaths caused by motor vehicle accidents in children across the United States, there is a need for implementation of guidelines regarding the safe use of child passenger safety seats. Therefore, American Academy of Pediatrics initiated and funded the development of a clinical practice guideline to aide in implementation of safe child safety seat practices. Nurses and physicians have the opportunity to provide families with education regarding proper use of child passenger safety seats, direct families to additional informational and educational resources, and direct families to appropriate community resources. Therefore, nurses and physicians must follow the clinical practice guideline developed and remain educated on up to date information and recommendations provided.
Basco, W.J., Hletko, P., West, L., & Darden, P. (2009). Determining the proportion of children too heavy for age-appropriate car seats in practice-based research network. Clinical Pediatrics, 48(1), 37-43. doi:10.1177/00009922808321676 Children’s Hospital of Illinois. (2014) Child Passenger Safety. Retrieved from http://www.childrenshospitalofillinois.org/different/advocacy/child-passenger-safety.html Committee on Injury, Violence, and Poison Prevention. (2011, April). Child passenger safety. Retrieved from http://pediatrics.aappublications.org/content/127/4/e1050.full Sauber-Schatz, E.K., West, B.A., & Bergen, G. (2014). Vital Signs: Restraint use and motor vehicle occupant death rates among children aged 0-12 years – United States, 2002-2011. MMWR Recommendations & Reports, 63(7), 113-118.