Prepared%20by:

1
Basics of Child Passenger Safetyin North
Carolina

• Prepared by
• Highway Safety Research Center
• University of North Carolina
• November 2005

2
Basics of Child Passenger Safety
The Need for Child Restraints and NC Occupant
Restraint Laws
3
The Need for Child Restraints

• Children are not miniature adults
• Need special restraints
• Infant's head larger and heavier - Legs are
  shorter
• Newborn's shoulders are narrow and flexible
• Child's pelvis is small, rounded and not fully
  developed until puberty.

4
The Need for Child Restraints

• Child restraints (CRs) work with belts to
• Prevent ejection
• Distribute and load crash forces to the strongest
  parts of the body.
• CR must be properly used to be able to do this
• Occupant restraint systems can not promise
  complete crash protection, but
• CRs about 70 effective in reducing fatalities
  and serious injuries
• Lap shoulder belts plus frontal air bags about
  50 - 60 effective

5
NC Has 3 Occupant Restraint Laws

1. CPS Law
2. Seat Belt Law
3. Children in Back of Pickup Trucks

6
NC CPS Law

• G.S. 20-137.1 - Effective January 1, 2005
• Requirements
• Covers children lt age 16 in any seating position
• Properly used CR/Booster required if less than
  age 8 AND less than 80 pounds
• Properly used seat belt allowed at age 8 OR 80
  lbs., whichever comes first
• If no lap and shoulder belt is available for a
  booster, a child weighing at least 40 pounds may
  be restrained by a properly fitted lap belt only.

7
NC CPS Law

• Requirements (continued)
• Must be in rear seat if
• Child is less than age 5 and less than 40 lbs.
• Vehicle has active passenger side front air bag
• Vehicle has a rear seat
• Front allowed if the CR is air bag compatible

8
NC CPS Law

• Exemptions
• Ambulances other emergency vehicles
• Tending to personal needs
• More kids than available belts
• Vehicles not required to have belts
• Were included in earliest version of the law
• Helped get a law
• Not considered to be safe or recommended practices

9
NC CPS Law

• Penalties
• Driver is responsible (even if not parent)
• Maximum 25 fine
• Full court costs (110)
• 2 driver license points
• No insurance points
• Charges to be dropped if
• Child lt 8 and lt 80 lbs. and
• CR has been acquired for vehicle child is
  routinely transported in

10
NC CPS Law

• No organizations are exempt from the NC CPS Law,
  only types of vehicles
• Includes public and private schools, child care
  centers, churches, camps. etc
• If vehicle is covered
• CPS law applies
• May be subject to additional regulations
• If vehicle is exempt
• NC CPS law does not apply
• May be subject to additional regulations

11
NC Seat Belt Law

• G.S. 20-135.2A
• Requirements
• Covers driver and front passengers older than age
  15 (16)
• Properly used seat belt
• Passenger motor vehicle in forward motion on
  street or highway

12
NC Seat Belt Law

• Exemptions (generally not considered to be safe)
• Medical, physical, mental conditions
• Rural letter newspaper carriers
• Door to door deliveries
• Commercial/farm plates when being used for
  business
• Vehicles not required to have belts
• Penalties
• 25.00 fine
• 75.00 court costs (not subject to full cost of
  court)
• No driver's license points
• No insurance points

13
NC Children in PickupTrucks Law

• G.S. 20-135.2B
• Requirements
• Covers children less than age 12
• Prohibited from riding in an open bed or open
  cargo area without permanent overhead restraining
  construction
• No definition for permanent overhead restraining
  construction

14
NC Children in PickupTrucks Law

• Exemptions (generally not considered
  to be safe)
• Adult present and supervising the child
• Child restrained by a seat belt
• An emergency situation exists
• In a parade pursuant to a valid permit
• Agricultural enterprise
• The vehicle is being operated in a county that
  has no incorporated area with a population in
  excess of 3,500

15
NC Children in Pickup Trucks Law Exempt Counties
Alexander, Alleghany, Ashe, Avery, Bertie,
Camden, Caswell, Cherokee, Clay, Currituck,
Duplin, Franklin, Gates, Graham, Green, Hyde,
Jackson, Jones, Macon, Madison, Mitchell,
Montgomery, Northhampton, Pamlico, Pender,
Perquimans, Polk, Swain, Tyrrell, Warren, Yadkin,
and Yancey
Exempt Counties
16
NC Children in PickupTrucks Law

• Penalties
• Maximum 25 fine
• No court costs
• No license points
• No insurance points

17
Legal vs Recommended

• Legal
• Sets minimum standards
• Laws are based mostly on age
• Not required that all occupants be buckled up at
  all times in all positions
• Recommended
• Provides maximum protection
• Best restraints to use also based on weight and
  physical development
• EVERYONE should be properly restrained in all
  seating positions at all times

18
Basics of Child Passenger Safety

• HOW RESTRAINTS PROTECT OCCUPANTS IN CRASHES

19
What Happens in a CrashBasics of Crash Dynamics

• Dealing with laws of physics and motion Object
  in motion will remain in motion...
• Occupant moves toward point of impact until
  stopped by another object
• Could be protective system (safety belts or child
  restraint), or
• Could be hostile object

Courtesy Insurance Institute For Highway Safety
20
Basics of Crash Dynamics

• Weight times speed is an approximation of impact
  force

21
Three Collisions In A Crash

• 1. Vehicle collision
• 2. Human collision
• 3. Internal collision

22
Five Ways Restraints Reduce Injury

• 1. Prevent ejection - If ejected
• 4 times more likely to be killed
• 14 times as likely to sustain cervical spine
  injury
• 2. Load forces on strongest parts of the body
• Older child or adult Hips and shoulders
• Infant and young child Hips, shoulders and back
• 3. Spread forces over wide area
• Belts/Harnesses Over shoulders, chest hips
• Rear-facing CR Over back, neck and head

23
Five Ways Restraints Reduce Injury

• 4. Allow the body to slow down gradually
• Vehicles crush in a controlled manner
• Can take advantage of vehicle ride down only if a
  "part" of the vehicle via safety belt or CR
• 5. Protect the head, neck, and spine
• Shoulder belt/CR harness keeps head/upper body
  away from hostile surfaces of the vehicle
• Rear facing CR supports the head and neck

24
Three-Part Process for Correct Use

• Essential for Maximum Protection
• Restraint selection - Type of restraint, child
  restraint (CR), booster seat or seat belt, used
  must be appropriate for the age and size of the
  child
• 2) Securing the child in the restraint - The
  child must be correctly and snugly secured within
  the restraint itself
• 3) Installing the CR in vehicle CR must be
  correctly and snugly secured in the vehicle by a
  tight and locked seat belt

25
Basics of Child Passenger Safety

• Choosing The "Best" Child Restraint

26
"What is the best car seat for my child?"

• Common question, but no simple answer

27
NHTSAs 4 Steps for Kids

1. Infants Rear-facing
2. Toddlers Forward-Facing with Harness
3. Boosters
4. Safety Belts

28
There Is No "Best Car Seat For A Child

• Best CR
• Fits the child
• Fits the vehicle(s)
• Will be used correctly every ride
• Least expensive meets same standards as most
  expensive

29
Rear Facing Restraints

• Rear-facing Only
• Most convenient
• Fits small infants well
• Rear-facing convertible
• Can be used RF longer
• Rear-facing CR until at least age one and at
  least 20 pounds.
• Development of neck bones and ligaments
• Rear-facing best for any body of any size
• AAP recommendation

30
Front Facing Restraints

• Front-facing convertible
• At least 1 year old AND at least 20 pounds
• Until harness outgrown most at 40 lbs
• Front-facing only CR with harness
• Can Not be used for child less than 1 year old or
  less than 20 pounds
• Until harness outgrown most at 40 lbs
• Some can be used as a booster gt40 pounds

31
Front Facing Only - Integrated

• Child restraints built into a vehicle seat
• Some convert to a belt-positioning booster
• Some have 5-point harness up to 40-60 pounds

32
Front Facing Only - Harness/Vest

• E-Z-On Products
• Many different styles and sizes
• OK for lap belt only position for child gt 40 lbs
• Require top tethers
• Travel vests
• For children 25-40 lbs
• Rigid back
• No tether

E-Z-On Y Harness
Cosco Travel Vest
33
Front Facing Only Booster Seats

• When harness is outgrown (usually about 40 lbs.)
• Until both the lap and shoulder belts fit
  correctly
• High back booster
• Added whiplash protection
• Backless booster
• Light weight, easy to store
• Generally less expensive

34
Safety Belts Do Not Use Until

1. Child can sit all the way back in seat
2. Child's knees bend comfortably over edge of seat
3. Shoulder belt crosses shoulder between neck and
   arm
4. Lap belt touches thighs
5. Child will stay seated like this for whole trip

35
Safety Belts Common Misuse

• Never tuck the shoulder belt under the arm or
  behind the back
• Illegal
• DANGEROUS!

36
Safety Belts Aftermarket Accessories

• NO current federal standard for testing or
  regulation
• Provides illusion of added safety
• May move belt too high on abdomen

37
Safety Belts Primary Risks of Lap Belts

• Does not restrain the upper body
• Impact with vehicle interior likely
• Can "submarine" under belt if too loose
• Belt-induced injuries Seat belt syndrome
• Injuries to the lower spine and organs such as
  spleen, liver and intestines
• Results from belt too high or too loose

3 year old in a 30 MPH frontal crash test
38
Seat Belt Syndrome

• Spinal cord or soft tissue damage due to
• Improper placement of lap belt over the abdomen
• Lap belt that rides up onto abdomen

39
Special Needs Restraints

• Use conventional restraints when possible
• Behavioral, medical or positioning needs may make
  specialized restraints necessary
• Low birth weight most common special need

40
Summary of Restraint Selection Recommendations

• Rear-facing (RF)
• Until at least 1 year of age and at least 20 lbs.
• RF convertible needed for most Infants
• AAP recommends rear facing until maximum allowed
  RF weight for convertible is reached
• Front-facing (FF)
• Children over age 1 and at least 20 lbs.
• In a FF convertible or other full harness type
  child restraint until the harness is outgrown

41
Summary of Restraint Selection Recommendations

• Belt-positioning booster seat
• After full harness child restraint is outgrown
• Use booster until
• Safety belt fits correctly and
• Child is mature enough
• Safety belt fits correctly when
• Child's bottom is against the back of the seat,
• Knees bend at the edge of the seat cushion,
• Lap belt fits low and tight across the upper
  thighs
• Shoulder belt crosses the collar bone and chest

42
Basics of Child Passenger Safety

• HARNESSING CHILDREN CORRECTLY IN CHILD RESTRAINTS

43
Harnessing Children Correctly In Child Restraints

• Function of Harness
• Reduces ejection
• Reduces contact with vehicle other occupants
• Distributes forces over widest area of body
• Loads forces on strongest parts

44
Types of Harnesses

• Three-point Harness
• Five-point harness
• Harness-Shield Combination
• T-shield
• Tray-shield
• Shield Only

45
How Tight Is Tight Enough?

• No slack
• Pinch test
• Not so tight as to press into the child's body
• Retainer clips
• Keeps the straps on the child's shoulders
• Not required on all CRs
• If required with CR, position about armpit level

46
Rear-Facing Infant And Convertible CRs

• In general Slot at or below the shoulders - or
  in the lowest slot
• If needed
• Crotch roll
• Rolled around head and/or sides

47
Rear-Facing Infant And Convertible CRs

• Recline angle
• Upright enough for crash protection but not so
  upright that the child's head falls forward
  toward the chest
• Ranges from 30 - 45 degrees
• Older children better able to tolerate more
  upright

48
Securing the Harness for Forward-Facing
Convertibles

• Straps threaded as specified by manufacturer
• Upper slots for most models
• Lower slots only if allowed by manufacturer
• Retainer clip about armpit level if needed
• Crotch strap
• Refer to instructions
• Adjust for proper positioning

49
Securing the Harness for Forward-Facing Only CRs

• Straps threaded as specified by manufacturer - at
  or above shoulders for most models
• Retainer clip about armpit level if needed
• Crotch strap
• Refer to instructions
• Adjust for proper positioning

50
Basics of Child Passenger Safety

• INSTALLATION OF CHILD RESTRAINTS IN VEHICLES

51
Basic Elements of Installation

• Correct forward versus rear facing orientation
• Correct recline angle
• Safest position in the vehicle
• Correct belt path or LATCH anchors used
• Tight and locked seatbelt or LATCH system.

52
Safest Position In Vehicle

• Front seat or back seat?
• In general, back seat is safer and center rear is
  safest
• Rear and/or center not always possible
• Is there a passenger air bag?
• Never place a rear-facing CR in front of an
  active air bag
• 12 and under in the back seat
• If child must sit in front of air bag
• Proper upper and lower body restraint
• Adequate distance from dash
• Behaviorally mature

53
Child Restraints and Frontal Air Bags

• Infants in rear-facing CRs at high risk in front
  of an air bag
• Recommendations to minimize risk
• Children 12 and under in the back seat
• Rear-facing CRs must not be in front of active
  air bag
• Forward-facing CRs may or may not be allowed
• On/off switches allowed if MUST use front seat

54
Child Restraints and Side Air Bags

• Protect adults in side impacts
• Concerns for anyone, especially children,
  leaning/sleeping against side bags
• Dangers vary among different designs and vary
  from vehicle to vehicle
• Refer to vehicle owner's manual and CR
  instructions
• May be disabled since not required by federal
  standards

55
Safest Position In Vehicle Other Considerations

• Which type of safety belt and/or LATCH system is
  present?
• Other features, e.g. deep "buckets" or large
  humps
• How do needs of each child relate to needs of
  other occupants?

56
Correct Forward- Or Rear-Facing Orientation Of CR

• Face rear until at least 1 year of age and at
  least 20 pounds
• Remain rear facing to maximum weight of CR for
  optimal protection
• In general, carry handles down

57
Correct Recline Angle

• Compromise between recline needed to maintain an
  open airway, and maximum crash protection
• May need correction for steeply sloped vehicle
  seat
• Front-facing recline - any designated positions
  are OK

58
Correct Belt Path / LATCH Anchors

• CRs engineered and tested with one or more
  designated safety belt routing paths
• Failure to follow instructions
• Will reduce effectiveness and
• Can lead to catastrophic failure

59
Tight and Locked Safety Belt or LATCH System

• Lap belt (or lap belt portion of lap and shoulder
  combination) is what holds CRS
• Lap belt must stay tight and locked at all times
• Some safety belt systems cannot be used as is
  and need a fix

60
Belts that Need a Locking Clip

• Continuous loop lap shoulder belt, and
• Retractor that only locks up in a crash or sudden
  stop, and
• Webbing slides freely though latch plate
• Must be installed near latch plate and buckle

61
How tight is tight enough?

• No more than 1 front to back and side to side
• Tested at belt path
• Can be achieved without
• Causing damage to the vehicle or CR
• Brute force

62
Function of Tethers

• Strap attached near top of forward-facing CR
• Reduces forward movement and rotation
• Can also fix some situations of incompatibility
  between CR and vehicle

63
Use of Tethers

• Designated tether anchor points in most US cars
  since 1986
• Check vehicle manual for tether anchor location
• Obtain anchor hardware from vehicle dealership
• Most vehicles mfg. since Sept. 02 have
  ready-to-use anchors as part of LATCH

64
LATCH

• FMVSS 225
• Lower Anchors and Tethers for CHildren
• All passenger vehicles and CRs manufactured since
  September 2002 required to have LATCH

65
LATCH in the Vehicle

• At least two rear seating positions are required
  to be equipped with the complete LATCH system 2
  lower anchors and 1 upper tether anchor
• A third rear position is required to have tether
  anchor

66
LATCH on the Child Restraint

• Lower anchors hook to or snap on lower anchor
  bars in vehicle
• CR's can use either flexible or rigid anchor
• CR tether strap attaches to vehicle tether anchor

67
Basics of Child Passenger Safety

• CHILD RESTRAINT MISUSES

68
Importance of Correct Use

• CRs are most effective restraint available
• 70 effectiveness for properly used CRs for
  infants
• 50-60 for older children
• 40-50 effectiveness for adults in lap and
  shoulder belt combinations
• Misuse can
• Greatly reduce effectiveness of CR
• Be worse than no restraint at all

69
Consequences of Loose Installation
70
Consequences of Multiple Misuses(Loose
installation, Harnesses in wrong slots (low),
Retainer clip too low)
71
Basics of Child Passenger Safety

• CPS PROGRAMS AND SERVICES

72
CPS Programs and Services

• CPS Clinics
• Permanent Checking Stations
• Child Restraint Distribution Programs

73
NC CPS RESOURCES

• NC Governor's Highway Safety Program (GHSP)
• Overall NC highway safety programs coordinator
• Primary source for NC specific traffic safety
  related materials and funding
• Coordinates Click It or Ticket and
  Booze It and Lose It
• www.ncdot.org/secretary/ghsp/
• 800-999-9676 or 919-733-3083

74
NC CPS RESOURCES

• NC Department of Insurance
  Office of State Fire Marshal (OSFM)
• NC SAFE KIDS Buckle Up
• NC SAFE KIDS
• Buckle Bear
• Risk Watch
• www.ncsafekids.org
• 800-634-7854 or 919-661-5880

75
NC CPS RESOURCES

• University of North Carolina
  Highway Safety Research Center (HSRC)
• CPS Resource Center
• Coordination of NC CPS training
• Technical assistance to CPS advocates and
  educators
• Information for parents and care givers
• www. buckleupnc.org
• www.hsrc.unc.edu
• 800-672-4527 or 919-962-2202

76
Supplemental Slides
77
Basics of Child Passenger Safety

• Transportation of Children by Schools, Child Care
  Centers, and Other Organizations

78
Transportation of Children by Schools, Child Care
Centers, Churches, etc

• No type of organization is exempt from the NC CPS
  Law, only types of vehicles.
• If vehicle is covered
• CPS law applies
• May be subject to additional regulations
• If vehicle is exempt
• NC CPS law does not apply
• May be subject to additional regulations

79
Transporting Children in 15-Passenger Vans

• Vans are required to have belts in all seating
  positions
• Are covered by NC CPS Law
• Organizations using vans must comply
• Regulations may prohibit use of vans

80
Transporting Children in 15-Passenger Vans

• Children lt40 lbs.
• Harness restraints in lap-belt-only positions
• Children 8 years old OR 80 lbs
• Properly fitted lap and shoulder belts
• Children lt8 AND lt80 lbs
• In remaining lap and shoulder positions in belt
  positioning boosters.
• Children 40 lbs
• In any remaining lap-belt-only positions using
  lap belt only
• DO NOT use belt-positioning booster seats in
  lap-belt-only positions

81
Transporting Children in Large School Buses

• Federal standards do not require seat belts on
  buses gt10,000 lbs
• Large buses are exempt from the NC CPS Law.
• Includes school, activity, municipal transit, and
  charter buses
• School buses are safest vehicles
• Protect occupants by size, construction, and
  "compartmentalization"
• Safer than parents cars, vans, SUVs and other
  personal vehicles.

82
Transporting Children in Small School Buses

• Seat belts are required on buses 10,000 lbs or
  less
• Mostly lap-belt-only seat belts

83
Transporting Children in Small School Buses

• Seat belts are required on buses 10,000 lbs or
  less
• Mostly lap-belt-only seat belts
• Covered under the NC CPS law
• Children lt40 lbs required to be in a child
  restraint appropriate for their weight
• Children 40 lbs may be restrained by just the
  lap belt
• Belt-positioning booster seats must NEVER be used
  with just a lap belt.

84
Recommendations for Transporting Pre-School
Children on School Buses

• Use of vehicles built to school bus standards for
  transporting pre-school and school children
  recommended by
• NTSB
• NHTSA
• Use of 12 to15-passenger vans could result in
  increased liability in the event of a crash

Fatal van crash investigated by National
Transportation Safety Board
85
NHTSA Recommendations for Transporting Pre-School
Children on School Buses

• Preschool age children best transported in child
  restraints even on the larger school buses
• Must assure bus seat is seat belt ready
• Integrated child restraints are available

86
Additional State and Federal Regulations

• Federal regulations do not prohibit the use of
  vans by schools
• But do require any van (with a capacity of more
  than 10) sold or leased for use as a school bus
  to meet the safety standards applicable to school
  buses

87
Head Start

• Head Start regulations require using school buses
  or allowable alternate vehicles
• Designed for carrying 11 people, including the
  driver
• Meets all school bus standards except those
  related to flashing lights and stop arms
• Children lt50 pounds must be in child restraints
  while the buses are in motion

88
NC Child Care Regulations (NCAC 09 .1001)

• All adults and children must be buckled
• Only one person per seat belt or child restraint
• Children not allowed in front seat if operational
  passenger airbag present
• Children lt2 must always be transported in a child
  restraint
• In large buses
• Must retrofit bus with belts to install CR if not
  already equipped with belts
• Children age 2 and older exempt and may be
  unrestrained

89
Summary of Legal Requirements and Recommendations
for ANY VEHICLE

• Lap and shoulder belt positions
• Required/Allowed
• CRs with harnesses if lt40 lbs
• Belt positioning boosters if lt8 years and lt80 lbs
  
• Lap and shoulder belt if at least 8 or 80 lbs
• RECOMMENDATION
• Continue to use booster seats until both the lap
  and shoulder belts fit correctly on the child

90
Summary of Legal Requirements and Recommendations
for ANY VEHICLE

• Lap belt only positions (with no lap and shoulder
  belted positions available)
• Required/Allowed
• CRs with harnesses if lt40 lbs
• Lap-only seat belts if 40 lbs
• RECOMMENDATION if 40 lbs
• Restraints with harnesses certified over 40 lbs
• Harnesses of various types certified over 40 lbs
• Retrofit shoulder belt kit booster possibility
  for some older cars and vans

91
Basics of Child Passenger Safety

• Child Passenger Safetyin School Buses

92
School Bus Safety Issues

• Statistically the safest transportation
• Larger heavier
• Lower risk travel
• Conspicuous
• Meets stringent FMVSSs

93
School Bus Safety Issues

• Safer than cars
• Only .2 percent of fatal crashes
• Occupant protection features
• Compartmentalization
• Safety belts required on small buses
• Installed on all new buses in some states
• Requirements for use varies

94
School Bus Safety Issues

• Compartmentalization

95
NHTSA School Bus Safety Recommendations

• Guidelines for Safe Transportation of Pre-School
  Age Children in School Buses
• Recent NHTSA testing re transport of
  preschoolers in CRS
• Easiest to use small buses with belts
• Integrated CRS seats available
• Retrofit lap belts only as manufacturers recommend

96
School Bus Safety Occupant Protection Requirements

• Large buses gt10,000 pounds
• Compartmentalization required
• Check with manufacturer for belt retrofits
• Integrated CRSs
• Small buses lt10,000 pounds
• Safety belts required
• Lower LATCH anchors required in at least 2
  seating positions (but tether anchors not
  required in school buses)
• Easier to install CRSs

97
Basics of Child Passenger Safety

• Choosing The "Best" Child Restraint
• Supplemental Slides

98
Rear-Facing Only

• Birth to 17-22 lbs
• Facing the rear ONLY
• Good fit for small infants
• 3-point or 5-point harness
• Many with detachable bases
• May outgrow in length before weight - head within
  inch of top

99
Convertible

• Birth/5 lbs. to 40 lbs.
• Rear-facing - up to 20-35 lbs.
• Forward-facing - usually 22-40 lbs.
• May outgrow in height before weight
• Rear-facing - head within inch of top
• Forward-facing - top of ears above top of shell

100
Convertible

• Three types of harnesses
• T-shields and tray-shields are not recommended
  for small infants

101
Forward-Facing Only

• 20-22 pounds up to 40 lbs
• Can ONLY be used facing to the front
• Recommended only for gt1 AND gt20 lbs
• May not be as comfortable as FF convertible

102
Forward-Facing With Harness

• Most to 40 pounds
• May go as high as 80

Britax Expressway 20-40 lbs.
Britax Husky 22-80 lbs.
103
Booster

• Provides transition from CRs with harness to
  vehicle lap/shoulder belts
• Minimum weight ranges 30-40 lbs
• Maximum weight ranges 60-100 lbs
• Maximum height limits vary

104
Booster

• Two types of booster seats
• Shield Booster
• Belt-Positioning Booster (BPB)
• High back
• Backless

Removable Shield
Backless
High Back
105
Combination Child Restraint/Booster

• Internal harness 20 to 40 pounds
• Modified for use as a BPB gt 40 lbs
• May not be as suitable as FF convertible for
  smaller children

106
Basics of Child Passenger Safety

• Transporting Children with Disabilities and
  Special Needs

107
Children with Disabilities and Special Needs

• CRS selection should be determined by health
  professional and IEP team
• Conventional CRS may be appropriate
• Specialty devices are generally more expensive
• More difficult to access and use
• CPS Technician can install and advise
• Wheelchairs should be last resort and only crash
  tested models with voluntary compliance label
  should be used

108
Children with Disabilities and Special Needs

• Main classifications
• Respiratory Conditions
• Low Birth Weight
• Orthopedic Conditions
• Neuromuscular Conditions
• Behavioral Conditions

109
Securing Child In Car Bed

• For small, premature, or medically fragile who
  should ride flat
• Infant lies prone/supine
• Head placed toward the center of the vehicle

110
Children with Disabilities Special Needs

• Orthopedic Conditions
• Seat for Hip Spica Cast
• E-Z-On Modified Vest for full body cast

111
Children with Disabilities Special Needs

• Neuromuscular Conditions
• Provides additional upper body restraint and
  positioning for higher weights

112
Normal Behavioral Issues

• There are no childproof seats. Switching seats
  is not the answer to normal behavioral problems
• Parent must be in charge and limit choices
• Firmness and consistency are key to reducing and
  correcting problems
• Effort expended is worth the benefits of
  long-term behavioral training
• Babies become TEENAGERS!!!
• Train early for less worry then

113
Behavioral Disorders

• May need safety devices that they cannot get out
  of themselves

E-Z-On Vest with back zipper closure
114
Auxiliary equipment

• Required auxiliary equipment (e.g., oxygen tanks
  and monitors) must be secured
• No single product/method available
• Recommendations include
• Wedging the equipment on the vehicle floor with
  pillows
• Securing it with bungee cords or seat belts not
  being used by a passenger.

115
Basics of Child Passenger Safety

• CHILD RESTRAINT MISUSES
• Supplemental Slides

116
Reasons for Misuse

• Human Factors
• Failure to read instructions
• Inability to understand confusing instructions
• Choosing the "convenient way"

Misuse - 3
117
Reasons for Misuse

• Equipment
• Many combinations of belts, CRs and vehicle
  configurations create incompatibilities
• CR instructions may conflict with vehicles
  instructions
• Lack of instructions
• Used seats are often missing parts, instructions,
  and labels

Misuse -4
118
Types of Misuse Gross Misuse

• Misuse that makes restraint virtually useless -
  likely to result in serious injury or death
• CR not secured to vehicle at all
• Child not harnessed in CR
• Infant lt 20 lbs. or lt age 1 facing front
• RF CR in front of air bag
• RF-only CR used facing front

119
Types of Misuse Other Misuses

• Other Misuses
• Many ways misuses reduce effectiveness of CRs
• Can be related to selection, harnessing, or
  installation
• If it can be done it WILL be done!
• Multiple misuses compound and become a serious
  danger to the child

Misuse - 6
120
Restraint Selection Errors

• Inappropriate restraint selection
• Recalled CR not repaired
• CR damaged or not working correctly

WRONG Household carrier, not a CRD
121
Harnessing Errors

• Straps in wrong slot
• Harness not placed on child correctly
• Too loose
• Adjustment mechanism not locked
• Retainer clip too high or too low
• Frayed, twisted, pinned, knotted or damaged
  webbing

WRONG Harness too loose, not on shoulder,
retainer too low
122
Installation Errors

• Safety belt not locked
• Safety belt locked but too loose
• CR installed in wrong direction
• Incorrect recline angle

WRONG Rear-facing only CR facing front
123
Installation Errors

• Safety belt through wrong belt path
• Locking clip not used or used incorrectly
• No tether used if required or incorrect use of
  tether system

WRONG Incorrect belt path
124
Misuse of Safety Belts

• Lap belt too high leads to internal injuries
• Shoulder belt too loose allows too much upper
  body movement
• Shoulder belt under the arm
• Too much upper body movement
• Can result in internal injuries
• Shoulder belt behind the back
• Provides no upper body protection
• Does not work as well as does a lap belt only
• Any misused seatbelt is especially dangerous in
  front of an air bag

WRONG Shoulder belt under arm