Child restraint systems: Understanding confidence in proper use and addressing the need for education.

Objective: To quantify the extent of proper local child restraint system (CRS) use and to better understand changes to the level of self-reported confidence with increased CRS installations. With the goal being to improve safety for children travelling in personal vehicles across London, ON and the region. Methods: Public CRS clinics were initiated by Injury Prevention staff after they obtained the Child Passenger Safety Technician certification. Additionally, an online survey was commissioned targeting Ontario parents who had installed at least one CRS in the last five years. Results: From September 2018 to September 2019, 96 comprehensive CRS checks were performed, with 29% of systems found to be installed correctly. Survey results showed a high level of reported confidence with CRS installation (N = 514, 70% female, 43% one child). Parents who had installed only one CRS reported higher confidence in their first install, compared to parents who had installed two or more systems. Conclusions: The error rate with CRS installation and use seen in London, Ontario and the region, is similar to that reported in previous research. Survey results showed high levels of self-reported confidence in CRS use, especially for parents who have installed only one CRS. There presents a need to better understand the root cause of the discrepancy between level of confidence and proper CRS use and to expand our understanding of CRS knowledge retention and transferability to subsequent systems.

Pediatric cervical spine fracture case report: Best practice to delay transition to rear-facing restraint.

Pediatric physicians and motor vehicle safety experts have been advocating for change in child passenger restraint practices for decades. As professional recommendations evolve to support extended rear-facing restraint, actual practices remain disparate. We report a case of pediatric cervical spine fracture due to motor vehicle collision, an uncommon, yet predictable, pattern of injury for which prevention education is undoubtedly preferable to managing the consequences of premature forward-facing in vulnerable pediatric patients. Currently, 9 kg is a minimum legal standard for forward-facing child restraint system use in Ontario, rather than a recommended transition time. We advise that parents should be counselled on the benefits of rear-facing as long as possible and discuss realistic transition times using their child restraint system manual as a reference, with the goal of approaching, but not exceeding, the maximum weight, height and fit requirements for optimal safety.