A 30-month-old is brought to the office by his parents for a well-child visit. The parents are divorced and share custody. They disagree about car safety and ask for advice about his car seat. He currently sits in a rear-facing car seat. His mother says that the car seat manual states that the boy's height and weight are acceptable to remain in this position. His father says that the boy's legs are bent against the back seat while he is rear-facing and that other children in the preschool face forward in their car seats. The parents also have a 10-year-old daughter who was a similar size and had transitioned out of rear-facing by this age. The boy is 95th percentile for height and weight. Which of the following is the most appropriate advice for this patient?

Question

A 30-month-old is brought to the office by his parents for a well-child visit.  The parents are divorced and share custody.  They disagree about car safety and ask for advice about his car seat.  He currently sits in a rear-facing car seat.  His mother says that the car seat manual states that the boy's height and weight are acceptable to remain in this position.  His father says that the boy's legs are bent against the back seat while he is rear-facing and that other children in the preschool face forward in their car seats.  The parents also have a 10-year-old daughter who was a similar size and had transitioned out of rear-facing by this age.  The boy is 95th percentile for height and weight.  Which of the following is the most appropriate advice for this patient?

Quizplus · Accepted Answer

11ec25c8_d5fb_f98f_bc81_2bc85b39c078_MD0003_00 Motor vehicle collisions are a leading cause of death in children, and proper use of motor vehicle restraints should be discussed at every well-child visit. Beginning at birth, a child should be placed in a rear-facing car seat in a back-passenger row of the car. Young children are at increased risk of serious head and spinal cord injury from motor vehicle collisions due to incomplete vertebral ossification, disproportionately large heads, and increased ligamentous laxity. The hard shell of the back of the car seat prevents rapid neck flexion during abrupt stops and absorbs force in the case of a collision. Car seats should never be placed in a front seat with an active airbag because the airbag's force can cause head injury or death upon deployment. Current guidelines set by the American Academy of Pediatrics and the Centers for Disease Control and Prevention state that children should remain rear-facing until they surpass the maximum height or weight limit set by the manufacturer of their specific car seat, which typically occurs between age 2-4. Although some state laws permit any child age ≥2 to be forward-facing (eg, forward-facing car seat age ~2-8; booster seat age ~5-12), there is no absolute height, weight, or age that determines the transition; rear-facing is safest in young children and should be maintained for as long as possible (Choices B, C, and D). Reassurance should be provided to parents who are concerned about leg positioning in a tall child who is in a rear-facing car seat. Legs bent against the back seat are typically not dangerous or uncomfortable to the child, and protecting the brain and spine is the priority. (Choice A) A belt-positioning booster should be used once a child reaches the height or weight limit of a forward-facing car seat, as determined by the manufacturer. This transition typically occurs between age 5-8 but may occur later (eg, age 5-12). Once a child outgrows a belt-positioning booster (eg, age 9+), a standard lap and shoulder seat belt can be used. seat belt Educational objective: Children should remain in a rear-facing car seat as long as possible and transition to a forward-facing car seat only once they surpass the height or weight limit of their specific car seat, as determined by the manufacturer. There is no absolute height, weight, or age that determines the transition. References: Child passenger safety. (http://www.ncbi.nlm.nih.gov/pubmed/30166368)

A 30-Month-Old Is Brought to the Office by His Parents