As I look back over the years I spent as a resident at the Children’s Hospital of Alabama, I am reminded of many patients whose experiences with illness and injury taught me many valuable lessons.

One patient named Faith left a particularly important impression on my memory. Faith was an 8- year-old little girl who was unable to breathe on her own after a motor vehicle crash left her paralyzed from the neck down. She spent a few months in our pulmonary care unit learning how to function with a tracheotomy tube and ventilator, and to maneuver her wheel chair about the hospital. Interestingly enough, Faith was sitting in the back seat and wearing her seat belt when her crash occurred. She became another statistic amongst a large number of disabled “forgotten children” whose parents moved them to an adult seat belt too early.

In 2004, it was estimated that 62 percent of children ages 4 to 8 were killed, and more than 7,000 sustained incapacitating injuries like Faith’s. Although booster seats could not have prevented all of these deaths and injuries, the risk of injuries could have been lowered by as much as 59 percent.

A booster seat serves a vital role in the protection of a young child’s body because it lifts him or her up, allowing the lap portion of the belt to fit across the hips, and the shoulder portion of the belt to fit across the shoulders and breastbone. These bony structures of the body are designed to absorb the force of a crash, unlike the soft tissues of the abdominal cavity.

When a child is improperly restrained in an adult seat belt, the lap portion of the belt naturally moves upward over the abdomen, and the shoulder portion is usually moved behind the child, out of his or her way.

An injury pattern known as “seat belt syndrome” can occur in these cases and can involve bruising or lacerations of the internal organs, as well as damage to the spinal cord and lower extremities.

In 2004, Louisiana passed a law requiring that children be restrained in a child safety seat or booster seat until the age of 6 or 7. It is necessary that a child weighs at least 40 pounds and be tall enough that the shoulder belt falls comfortably between the shoulder and breast before he or she graduates from a child safety seat to a booster seat. Likewise, although the law allows for it, a child is not anatomically ready to move to a an adult seat belt until he or she is at least 4 feet 9 inches tall and is between the ages of 8 to 12 years old. It is also important to know that a child should not be seated in the front seat of a vehicle until he or she is at least 12 years old and 60 inches tall because of the presence of air bags. Although air bags have been proven effective in preventing adult injuries and deaths, they can cause severe injury and even death to an infant or young child seated in the front seat.

If you have a child who fits the criteria for needing to be restrained in a booster seat, you will notice that there are many different options to choose from in today’s market. Booster seats come in all shapes, colors, sizes and prices and it is important to find the one that fits properly. Make sure the model you use has not been recalled. The website of the National Highway Traffic Safety Association (www.nhtsa.gov) contains a rating system and lists recalls for all the child safety restraints available. The American Academy of Pediatrics website (www.aap.org) also provides a great deal of information regarding the issue of car seat safety and child safety in general. The Safety Council of the Louisiana Capital Area also provides car seat inspections by professionally trained individuals on a scheduled basis and can be reached at 769- 0955.

Hopefully, this article, and the websites listed, will provide you with the knowledge to keep your child safe while riding in your vehicle. I know that Faith would be thrilled to know that her story not only taught a young doctor a lot about medicine, but also encouraged a lot of young parents to protect their children from the unnecessary suffering that she endured.

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