Traffic Inj Prev. 2010 Dec; 11(6): 573-7
Brixey SN, Guse CE, Gorelick M

To compare the accuracy of trained community observers for direct observation of child passenger restraint use to certified child passenger safety technicians who are either professional observers or community-based technicians, and to compare these three groups with a gold standard.This is a cross-sectional study of interobserver agreement and accuracy in which 75 photos of children depicted in different child passenger restraint systems were rated by 9 observers total, with 3 representing professional observers, 3 representing certified child passenger safety technicians, and 3 representing trained community observers. For each photo, observers indicated type of restraint; the appropriateness of the harness, if applicable; and overall appropriateness of the restraint. A gold standard was established by consensus agreement of 2 certified car seat technician instructors.The sensitivity and specificity for trained community observers in identifying broad groupings of restraint types was good (78-100% sensitivity; 93-99% specificity), but they had low agreement with the gold standard for overall appropriateness of the child passenger restraints (kappa = 0.28). The community observer group was 42 percent less likely to code the photo depiction of appropriate restraint use as appropriate.Community trained observers do show good sensitivity and specificity for identifying the type of restraint but have a trend toward poorer judgment when determining harness appropriateness and overall appropriateness. They may be a cost-effective option for limited restraint identification.

Pediatr Emerg Care. 2011 Feb; 27(2): 102-5
Cease AT, King WD, Monroe KW

The objectives of the study were to determine the number of children properly restrained during transit to a pediatric emergency department for care and to ascertain parental knowledge of Alabama laws and American Academy of Pediatrics (AAP) guidelines and where they obtain this information.An emergency department (patient care rooms) waiting area, convenience sample of Alabama parents who have children younger than or 13 years of age were surveyed over a 5-week period. Appropriate use of child passenger safety (CPS) restraints was determined using Alabama law and AAP recommendations. Use of Car Seat Checks provided by Children's Hospital and Safe Kids, knowledge of Alabama laws and CPS guidelines, and the source of information used by parents were ascertained.Among 525 patients identified, 520 (99.0%) participated. Appropriate use per Alabama law and AAP guidelines was 72.3% and 60.6%, respectively; 5.0% were unrestrained. Booster seats were the most commonly misused restraint. Car seats were reportedly used correctly by 81.9%. Parents who had used the Car Seat Checks program had correct booster seat and car seat use rates of 95.8% and 61.5%, respectively. Unfortunately, only 31.2% of patients had knowledge of the Car Seat Checks program, and only 40.6% knew the current law. Most often, parents stated that the hospital where their child was born was the primary (and sometimes only) source of CPS information.This study illustrates the need for improving parental knowledge of appropriate child passenger restraint use (especially booster seats) and Car Seat Checks programs. Car seat program assistance is associated with high levels of appropriate use.

Appl Ergon. 2012 Mar; 43(2): 329-35
Kamp I

Producing higher efficiency cars with less and lighter materials but without compromising safety, comfort and driving pleasure might give a competitive advantage. In this light, at BMW a new light weight car-seat concept was developed based on the human body contour. A possibility to increase the comfort is using a seat which elicits positive tactile experiences. However, limited information is available on seat characteristics and tactile experiences. Therefore, this study describes the contour of three different car-seat designs, including a light weight seat, and the recorded corresponding emotion and tactile experience of 21 persons sitting in the seats. Results show that the new light weight car-seat concept rated well on experienced relaxedness, even with the lack of a side support. The most important findings are that hard seats with rather high side supports are rated sporty and seats that are softer are rated more luxurious.

Spinal Cord. 2011 May; 49(5): 672
Rakowski KR, Sivathasan N, Sivathasan N

Pediatr Int. 2011 Dec; 53(6): 939-43
Sugimura T, Suzue J, Kamada M, Ozaki Y, Tananari Y, Maeno Y, Ito S, Nishino H, Kakimoto N, Yamakawa R

A guideline for the safe use of child car seats (CS) was published by the Japan Pediatric Society in 2008. There have been few studies of the increase of temperature of a CS in parked cars. The aim of this study was to determine the change in the temperature of the CS in cars parked in full sun.The temperature of CS was measured during summer (July and August) in 2006, 2007, and 2008. The CS used in this study (n= 50) were for children (≤ 6 years old) who were taken by car to Sugimura Children's Medical Clinic. Temperatures were only measured on sunny days. Measurements were performed from 09.00 to 17.00 hours. Thermochron (Thermochron i-Button: G type, Maxim Integrated Products, CA, USA) was used to measure the temperatures. The maximum temperatures of CS were compared in time at the clinic, taking into consideration seat colors, and car colors.Of the 50 cars, three cars were excluded due to being in the shade while the temperature was measured. A total of 47 cars were used for this study. The temperature of the CS ranged from 38.0 to 65.5°C (47.8 ± 5.8°C). Eighteen CS (38.3%) reached a temperature of 50°C or above. The maximum temperature of the 13.00-15.00-hours group was significantly higher than that of the 09.00-11.00-hours group (P= 0.035). The CS temperatures in the black car group were significantly higher than those of the white car group (P= 0.013).CS may become very hot while a car is parked in sun, especially if the car and the CS are black, so the CS should be cooled before a young child is placed in it. Guardians of small children should be aware of this risk.

J Dev Behav Pediatr. 2011 Oct; 32(8): 616-8
Reddy A, Graves C, Augustyn M

Sam is a 27-month-old boy who you have followed since birth. He lives with his parents in a small resort town approximately 90 miles outside a major city. Both his parents are professionals in their late 30s and have been highly involved in his care since birth. At the 12-month visit, they were concerned about his difficulty regulating. He was not sleeping through the night and had significant difficulty with baths. His physical examination and growth were normal. His eye contact was good, although it was difficult to see him smile. He had 1 or 2 words and was beginning to walk independently.At the 15-month checkup, they continued to be concerned about his poor regulation. He napped sporadically, and he was very difficult to take out on errands as he did not like his car seat. He now had approximately 10 single words, was using his fingers to point, and very clearly waved "bye bye" as soon as you entered the room.At the 18-month checkup, they state that he has not yet learned the word "no." He will follow a 1-step command when he wants to but now has 15 single words without any combinations. He points for his needs and to show them something. He has become increasingly "shy" around strangers and prefers to play with one other child as opposed to a larger group. He does not like loud noises and prefers to go barefoot constantly. His physical examination was again normal as was his growth. He is referred for a full hearing evaluation, which is also normal. The family was referred to early intervention, and he began receiving speech and language therapy and occupational therapy for his sensory challenges as well as a play group.At the 24-month checkup, his language continued to consist of single words-now approximately 30. When the parents do not understand what he wants, he will often tantrum and has started banging his head on the floor when frustrated. He has no repetitive behaviors and is starting to demonstrate imaginative play. Bath time has becoming increasingly challenging because he does not like the sensation of soap and the water temperature must be "just right." You refer the child to a Developmental and Behavioral Pediatrician for evaluation and at 28 months he is seen. During his testing visit, he had decreased eye contact and followed his own agenda but improved significantly as testing progressed. As he got more comfortable, he began making good eye contact, social referenced, and exhibited joint attention with his parents and the examiner. He did not meet criteria for an autism spectrum disorder or specifically pervasive developmental disorder-not otherwise specified (PDD-NOS). He was given a diagnosis of mixed receptive and expressive language delay and disruptive behavior disorder with sensory processing problems.The parents come to you a month after their evaluation visit asking you to give him a "listed diagnosis of PDD-NOS" that could be removed when he turns 3 years so that he may qualify for increased hours of services-up to 15 hours per week-as well as applied behavioral analysis therapy. A behavioral therapist through early intervention has told the family that he would benefit from this increased intervention, specifically applied behavioral analysis but the only way he can receive it is with a "medical diagnosis" on the autism spectrum. What do you do next?

J Manipulative Physiol Ther. 2011 Feb; 34(2): 107-13
Franz M, Zenk R, Vink P, Hallbeck S

The objective of this study was to determine the effect of a lightweight low-intensity massage system (LWMAS) in a car seat on the electromyogram (EMG) of the neck and shoulder muscles and on the comfort experience during driving.Two experiments were performed during driving with and without the active LWMAS in the seat. Subjective measurements were taken, in which the comfort experience was recorded for 20 participants driving a prescribed path around Munich for 120 minutes. Then objective (surface EMG above the rhomboideus and trapezius muscles) measurements and subjective measurements of the comfort experience were recorded over 7 laps on a test track for 24 participants.The comfort was higher, and the EMG was significantly lower in the trapezius area while driving with the LWMAS.Despite the fact that the LWMAS system is lightweight, has low intensity, and might have had a smaller effect, similar effects to previous studies with heavier systems were found, indicating that this massage system increases comfort and reduces muscle activity during driving as well.

Arch Argent Pediatr. 2011 Feb; 109(1): 13-6
Pérez Suárez E, Carceller F, García Salido A, Serrano A, Casado J

Bending-disruption fractures of the vertebral body are called Chance fracture. In some cases these fractures may not be noticeable with a CT scan.A 9 years-old boy suffered a frontal collision while traveling in the back seat of a car. The child was secured by the safetybelt, without a child car seat or elevator adapted to his height. He had abdominal skin lesions in the physical exploration compatible with a belt mark. Conventional thoraco- abdominal CT scan did not show any vertebral fracture. As the clinical suspicion persisted, lateral plain radiography of the lumbar column was performed showing a Chance fracture in L2, confirmed by MRI.Chance fracture is typically seen in children under 12 years less than 135 cm height and with injuries associated with the belt after a traffic accident. This type of fractures may go unnoticed in a conventional CT scan so clinical suspicion must lead us to further work-up. The MRI is the gold standard for the diagnosis. This case remarks the importance of the use of homologated elevated seat devices in older children.

J Pediatr Orthop. 2011 Jun; 31(4): 465-8
Herman MJ, Abzug JM, Krynetskiy EE, Guzzardo LV

Federal guidelines and state laws mandate that all children must be appropriately restrained while traveling in motor vehicles to reduce the risk of injury and death secondary to motor vehicle accidents. The purpose of this study is to identify the methods of restraint in motor vehicles for children in hip spica casts.Children placed in hip spica casts between August 1, 2006 and August 1, 2008 were recruited. Demographic data, type of spica cast placed, and reason for cast placement were recorded. Before discharge, all children were evaluated by a physical therapist to determine adequate restraint with the least cost. At each follow-up visit and at the time of cast removal, parents filled out standardized nonvalidated questionnaires to determine the method of restraint, mode of transportation, the approximate number of trips taken per week, and the occurrence of traffic violations or accidents.Thirty-one children, average age of 5 years (range, 1.3 to 13 y), in a total of 35 spica casts were enrolled in the study. After evaluation by the physical therapist, none of the children were recommended to be transported in their personal car seat, 12 children were advised to travel by ambulance and 23 were advised to use a specially manufactured car seat. Overall, 8 of 35 children (23%) followed the initial recommendation of the physical therapist. On the basis of our discharge protocol's recommendations, children in 24 spica casts (69%) were suboptimally transported after discharge, 6 children who should have had ambulance transportation and 18 who should have been transported by a specially manufactured car seat.The majority of children in hip spica casts are not safely restrained when traveling in motor vehicles. Pediatric hospitals must develop better strategies to improve adherence to prescribed safe transportation protocols for patients in hip spica casts. Improved parental education, expansion of insurance coverage for restraints, hospital-based loaner programs and financial assistance to families are potential solutions to explore.

J Spinal Cord Med. 2011; 34(3): 332-4
Benjamin C, Gittler M, Lee R

Heated car seats are a common feature in newer automobiles. They are increasingly being recognized as potential hazards as there have been multiple reports of significant burns to its users. The potential for harm is considerably increased in those with impaired sensation with the possibility of a devastating injury.Case report and literature review.A 26-year-old male with a T8 ASIA A paraplegia presented to the outpatient clinic for management of a hip burn. Two weeks prior to his visit he was driving a 2004 Jeep Cherokee for approximately 30 minutes. He was unaware that the driver's side seat warmer was set on high. He denied that his seat belt was in direct contact with the skin of his right hip. He presented to an acute care hospital that evening with a hip burn where he was prescribed silver sulfadiazine cream and instructed to apply it until his scheduled follow-up clinic visit. In clinic, the hip wound was unstageable with approximately 95% eschar. A dressing of bismuth tribromophenate in petrolatum was applied to the wound and he was instructed to change the dressing daily. This was later changed to an antimicrobial alginate dressing. The ulcer eventually healed.This case illustrates the significant risk of car seat heaters in individuals with spinal cord injuries or neurological impairment who have decreased sensation. Additionally, it highlights an atypical area of potential for burn. Furthermore, it emphasizes the need for a heightened awareness for this unique and dangerous situation.

JEMS. 2012 Jan; 37(1): 16
Widmeier K

Hautarzt. 2010 Nov; 61(11): 933-4
Wurpts G, Merk HF

This is a case report of a female patient showing a delayed allergic reaction to epoxy resin. The allergic contact dermatitis occurred after sitting in her new car equipped with artificial leather seats.

Ann Adv Automot Med. 2011; 55: 27-32
O'neil J, Bull MJ, Talty J, Slaven JE

This study reviews trends, rear facing, top tether use, and seating position for children younger than 13y among motor vehicle passengers in Indiana. This is an observational, cross-sectional survey of drivers transporting children 15 years and younger and drivers collected at 25 convenience locations randomly selected in Indiana during summers 2005 through 2010. Observations were conducted by Certified Child Passenger Safety Technicians (CPST). As the driver completed a written survey collecting demographic data on the driver and children, the CPST recorded the vehicle seating location, the type of restraint, direction the car safety seat (CSS) was facing, and use of the CSS harness or safety belt as appropriate. Data was analyzed for infants younger than twelve months, children in forward facing CSS, and children < 13y. Between 2005 and 2010, 514 infants (age < 12m) were observed in motor vehicles. On average 83.5% (SD 4.8%) of the infants were rear facing. The percent of infants rear facing was 75.5% during 2005 and rose to 88.9% during 2010. Of the 442 vehicles observed with a forward facing car seat, 58% (SD 16.5%) had the top tether attached. In our sample, more than 88.7% (SD 0.8%) children < 13y were seated in a rear seat vehicle position. Driver variables affecting occupant protection are discussed. This information can be used by primary care providers and child passenger safety technicians and other child passenger safety advocates to develop counseling points and educational campaigns.

Appl Ergon. 2011 Nov 5;
Clamann M, Zhu B, Beaver L, Taylor K, Kaber D

The rear-facing Infant Car Seat (ICS) is designed to meet federal requirements for transporting children less than 1 year old. Typical use includes transfer in and out of a vehicle, which is shown to be a difficult lift. Despite the frequency of this lift, manufacturers provide little guidance for users. Review of relevant literature suggested an ICS featuring an angled handle, promoting a neutral wrist posture, would increase grip stability and decrease lifting effort. Popular press suggested a foot-in-car stance for the ICS lift would do the same. An experiment was conducted in which wrist deviations from neutral posture were recorded along with lifting muscle activation levels (multiple flexor muscles and biceps brachii) and overall perceived exertion for straight versus a new bent handle design and conventional stance versus foot-in-car. Foot position was examined to test the recommendations in the popular press. Surprisingly, wrist deviation was not significantly affected by the new bent handle design (due to compensatory behavior with the straight handle) but was related to foot placement (p=0.04). Results revealed the bent handle to significantly reduce flexor activation compared with the straight handle (p=0.0003); however, the level of biceps activation increased. Biceps activation also significantly increased for foot-in-car stance (p=0.035) but not flexor activation. In general, the bent handle enabled the user to lift the ICS with a steadier grip and less effort.

Acad Pediatr. 2010 Nov-Dec; 10(6): 389-94
Keenan HT, Leventhal JM

Educational programs designed to inform mothers and other child caretakers about the dangers of infant shaking have been widely adopted; however, only one has been evaluated to ascertain its effect on abusive head trauma (AHT). This project's goal was to evaluate whether an educational video delivered on the postpartum ward decreased AHT occurrence.A case-control study was conducted in which 77 Utah resident mothers of children aged under 2 years who had AHT were drawn from the only pediatric level-one trauma center in Utah and the Medical Examiner's Office from 2001 to 2007. Five control mothers per case matched by birth year were identified through the state's birth certificate registry. Conditional logistic regression was used to calculate the adjusted odds of AHT given maternal exposure to the educational video. An alternate injury and alternate educational exposures were assessed to examine potential confounding.The educational video was associated with nonstatistically significant reductions of both AHT (odds ratio [OR] 0.7, 95% confidence interval [CI], 0.5-1.2) and the alternate injury mechanism, child injury from motor vehicle crash (OR 0.9, 95% CI, 0.6-1.4). Alternate education about car seat use (OR 0.4, 95% CI, 0.2-0.8), back to sleep (OR 0.3, 95% CI, 0.2-0.5), and setting hot water temperature (OR 0.2, 95% CI, 0.1-0.4) were associated with significant reductions in AHT.AHT occurrence was not significantly associated with the educational video but was associated with alternate postpartum education provided to mothers. These results suggest that the shaken baby prevention video is not causal at reducing AHT.

JEMS. 2012 Jan; 37(1): 16
Remsberg T

Appl Ergon. 2012 Jan; 43(1): 27-37
Coelho DA, Dahlman S

This article reports on a pilot experimental study aimed at a first evaluation of the introduction of an articulation in the upper part of the seat backrest. The idea of introducing this articulation sprang from prevention of whiplash injuries and this study tentatively assesses its potential for improvement in comfort. This was done considering a pre-defined articulation height. A height for the articulation of 43.5 cm above the H-point of a reference seat was theoretically deduced based on a population with an average sitting height of 88 cm. Participants evaluated the articulated seat in comparison with the reference seat. Twelve participants were divided into three groups of sitting height. In a laboratory environment subjective comfort evaluations and preferred values of deployment of the articulation and of counter-tilting of the headrest were registered. Driving on the roads completed and validated the laboratory assessments. The reference seat was deemed less comfortable for the participants with short and medium sitting height than for the tall ones. There was a notable improvement in comfort for most of the medium and short sitting height participants when using the articulated seat. The articulation was fully deployed by most participants.

Aggress Behav. 2010 Nov-Dec; 36(6): 351-7
Hay DF, Perra O, Hudson K, Waters CS, Mundy L, Phillips R, Goodyer I, Harold G, Thapar A, van Goozen S,

Our aim was to develop an age-appropriate measure of early manifestations of aggression. We constructed a questionnaire about normative developmental milestones into which a set of items measuring infants' use of physical force against people and expressed anger were included. These items comprise the Cardiff Infant Contentiousness Scale (CICS). Evidence for the reliability and validity of the CICS is provided from analyses of a sample of N=310 British infants, assessed at a mean age of 6 months as part of a larger longitudinal study of the development of aggression. The informants' CICS ratings demonstrated reasonable levels of internal consistency and interrater agreement. Informants' ratings were validated by observations of infants' distress in response to restraint in a car seat. Longitudinal analyses revealed that contentiousness was stable over time and that contentiousness at 6 months predicted infants' later use of force with peers. When used in the company of other methods, the simple four-item CICS scale could serve as a useful screen for early manifestations of aggressiveness in human infants.

JEMS. 2012 Jan; 37(1): 16

J Burn Care Res. 2011 Mar-Apr; 32(2): e33-4; author reply e35-6
Diller KR