Pediatric Continuity Clinic Curriculum - PowerPoint Presentation

Slide1

Pediatric Continuity Clinic CurriculumCreated by: Safia Ilyas, PGY-2

Car SeatsSlide2

ObjectivesReview AAP car seat guidelines and incorporate into appropriate guidance for familiesLearn how to properly place a car seat in a car

Describe the types of car seats availableSlide3

Case #1You are doing a meet and greet with a family expecting their first child in a few weeks. At the end of the visit you provide anticipatory guidance about car seat use.

What are the current car seat guidelines regarding rear facing car seats?

When can a child be transitioned to forward facing car seats?

At what age is a booster seat appropriate?Slide4

Discussion question 1-1?Infants

and toddlers should ride in a 

rear-facing car seat

 (infant-only rear facing car seat or rear-facing convertible car seat)

until they

are at least

two years old or until they have reached the weight and height limits of their car seat

.

If a child continues to fit in their car seat in the rear-facing position beyond two years of age, then it is advised

that they continue to remain rear-facing until they grow out of the seat.

Although

this means that some larger infants and toddlers might have to graduate to a rear-facing convertible car

seat

All car seats are different as for weight limits, and is important to familiarize yourself with your child’s car seat specifications. Slide5

Discussion question 1-2?Once

they are

two years old

(or, regardless of age, have outgrown their rear-facing car seat) toddlers should sit in a 

forward-facing car seat

 with harness straps as long as possible and until they reach the weight and height limits of their car seat.

Keep

in mind that many convertible car seats and combination car seats have forward-facing weight limits of 65 to 80 pounds when used with harness straps

.Slide6

Discussion question 1-3?Kids

can next move to a

belt-positioning

booster

seat

 when they reach the weight and height harness strap limits of their forward-facing car seat. 

The move to 

regular seat belts

 should not occur until kids

are

4 feet 9 inches tall (57 inches) and are between 8 and 12 years old. 

All kids under 13 years of age should sit in the back seat, using an age-appropriate restraint. Slide7

Additional InformationSlide8

Case #2A new parents comes to your office for their daughter’s newborn exam. You ask to make sure she is being transported in a rear-facing car seat and that is appropriately sized for her.

What is the proper way to install a car seat?

How can you confirm that a car seat is properly installed?

What about placing a car seat in a pickup truck?Slide9

Discussion question 2-1?Car safety seats may be installed with either the vehicle’s seat belt or the LATCH (Lower Anchors and Tethers for Children) system.

LATCH system

Lower

anchors can be used instead of the seat belt to install the

seat

The

top tether improves the safety provided by the seat and is important to use for all forward-facing seats, even those installed using  the vehicle seat belt.

All

lower anchors are rated for a maximum weight  of 65 pounds(total weight of car safety seat plus the child).

New

car seats have the maximum weight of the child allowed for use of the lower anchors printed on the label.                                                

Vehicles

with the LATCH system have lower anchors located in the back seat, where the seat cushions

meet.

Tether

anchors are located behind the seat, either on the panel behind the seat (in sedans) or on the back of the seat, ceiling, or floor (in most minivans, SUVs, and hatchbacks).

Nearly

all passenger vehicles and all car safety seats made on or after September 1, 2002, are equipped to use LATCH. Slide10

Discussion question 2-1?Seat belts:

Check

the vehicle owner’s manual to see if you need a locking clip to keep the belt locked into position.

Locking

clips are not needed in most newer vehicles, but you may need to fully extend the seat belt first and then allow it to retract in order to keep the seat belt tight around the car safety seat. Slide11

Discussion questions 2-2 and 2-3?Tight is Right

 - make sure your car seat is installed tightly using a seat belt,

or LATCH

i

f

it is available.

I

I

f

, when holding the bottom of the car seat, you can move the seat more than 1 inch, then it may not be installed tightly enough. 

Pickup Trucks

:

children

should never be allowed to ride in the cargo area of a pickup truck

Smaller

rear seats of some compact extended-car pickup trucks may not be as safe as other cars and trucks with larger back seats. Slide12

Case #3You are seeing a 24-month old toddler for his WCC in your office. At the end of the visit, his mother asks when he should transition to another car seat.

What types of car seats are available?

What ages and weights are they appropriate for?Slide13

Rear facing seats3 types:

rear-facing only seats, convertible seats, and 3-in-1

seats

Rear-Facing Only

: For

newborns and small

babies; small

, portable

seat; for infants up to 22-40 pounds

Babies

usually outgrow their infant car seats by eight or nine months.

Should be used only for travel

Convertible seat

:

 As a child grows,

can be changed

from a rear-facing seat to a forward-facing seat with a harness and tether

. For infants up to 40-50 poundsInclude 5-point harness that attaches at shoulders, hips, and between legsShould be used only for travelAll in One Seat: Can be used rear-facing, forward-facing, or as belt-positioning boosterH

igher rear-facing weight and height limitSlide14

Rear facing seatsPlace the harnesses in your rear-facing seat in slots that are at or below your baby's shoulders.

Ensure that the harness is

snug. Harness

clip

should be positioned at

the center of the chest and at the level of the child’s armpits.

Never

place a rear-facing car seat in the front seat of a

vehicle

If you are using a convertible or 3-in-1 seat in the rear-facing position, make sure the seat belt or lower anchor and tether is routed through the correct belt path. Check the instructions that came with the car seat to be sure.

Check

the instruction manual to find out the correct angle for your seat and how to adjust the seat angle if

needed.

All

rear facing seats have built-in angle indicators or adjusters.

Check the car seat instructions and the vehicle owner’s manual about whether the car seat may contact the back of the vehicle seat.Slide15

Forward facing seatsAny child who has outgrown the rear-facing weight or height limit for their convertible car seat should use a forward-facing car seat with a harness for as long as possible, up to the highest weight or height allowed by their car seat manufacturer.

It

is best for children to ride in a seat with a harness

until at

least to 4 years of age.

If

your child out-grows

out of his or her

seat before reaching 4 years of age, consider using a seat with a harness approved for higher weights and heights

.Slide16

Forward facing seatsThere are 5 types of car safety restraints that can be used forward-facing.

Convertible

seats:

Can

"convert" from rear-facing to forward-facing. These include 3-in-1 seats.

Forward-facing-only

seats:

Can

be used forward-facing with a harness for children

up

to

40-80

pounds

Combination seat with harness

—Seats can be used forward-facing with a harness for children who weigh up to

40-90

pounds (depending on the model) or without the harness as a booster (up to 80-120 pounds, depending on the model).Built-in seats: Some vehicles come with built-in forward-facing seats. Do

not use built-in seats until your child  is at least 2 years of age.

Travel

vests:

Can

be worn by children between 20 and 168

pounds.

Useful

for when a vehicle has lap-only seat belts in the rear or for children whose weight has exceeded that allowed by car seats

.Slide17

Forward facing seatsTo switch a convertible or 3-in-1 seat from rear-facing to forward-facing:

Move the shoulder straps to the slots that are at or above your child's shoulders

.

You may have to adjust the recline angle of the seat so that it sits more upright in your vehicle.

If using a seat belt, make sure the seat belt runs through the forward-facing belt path

If

using the lower anchors, follow car seat and vehicle owner's manual instructions.

Always use the top tether when you can.

A

tether is a strap that is attached to the top part of a car seat and holds the seat tightly by connecting to an anchor point in your vehicle 

(often on the seat back or rear

shelf)

.Slide18

booster seatsBooster

seats:

Are for

older children who have outgrown their forward-facing car seats.

For children

whose weight or height is above the forward-facing limit for their car seat should use a belt-positioning booster seat until the vehicle seat belt fits

properly (typically

when

height at least 4

feet 9 inches

and

are between 8 and 12 years of

age).

As

a general guideline, a child has outgrown his forward-facing seat when any one of the following is true:

Child reaches

the top weight or height allowed for his seat with a harness. 

These limits are listed on the seat and also included in the instruction bookletChild’s shoulders are above the top harness slots.Child’s ears have reached the top of the seat. Slide19

Booster seatsThere are 2 types of booster seats: high-back booster seats

and

backless booster seats

.

Do

not come with harness straps but are used with the lap and shoulder seat belts in your vehicle, the same way an adult rides.

Raise

the child up so that the lap and shoulder seat belts fit properly over strong bones

.

Simply

rest on the vehicle seat and are held in place once the seat belt is fastened over the child.

Some

models of booster seats can be secured to the vehicle seat and kept in place using the lower anchors or top tether.

Booster seats should be used until

child

can correctly fit in the adult lap and shoulder seat belts,

4

feet 9 inches in height and 8 to 12 years old.Installation Tips for Booster SeatsO

ften

have a plastic clip or guide to correctly position the vehicle lap and shoulder belts.

Booster seats must be used with a lap and shoulder belt.

When

using a booster seat, make sure:

The lap belt lies low and snug across your child's upper thighs.

The shoulder belt crosses the middle of your child's chest and shoulder, and is off of the neck.

If your booster seat has lower anchors or top tether attachments, check the booster seat manual for installation instructions.Slide20

References and Future Readinghttp://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

http://www.safercar.gov/parents/Car-Seat-Types.htm

http://pediatrics.about.com/od/carseats/a/car-seat.htm

http://www.wesh.com/news/florida-booster-seat-laws-for-children-to-change-in-january/25741288