Joseph O'Neil

Policy Statement—Child Passenger Safety

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death of children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats for most infants up to 2 years of age; (2) forward-facing car safety seats for most children through 4 years of age; (3) belt-positioning booster seats for most children through 8 years of age; and (4) lap-and-shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health-supervision visit.

Firearm-Related Injuries Affecting the Pediatric Population

The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. Adolescent suicide risk is strongly associated with firearm availability. Safe gun storage (guns unloaded and locked, ammunition locked separately) reduces children’s risk of injury. Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.

Policy Statement—Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2006, fatal drowning claimed the lives of approximately 1100 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Analysis of nonfatal dog bites in children

BACKGROUND Dog bites are a significant public health problem among children. The purpose of this study was to examine the hospital incidence, hospital charges, and characteristics of dog bite injuries among children by age group and hospitalization status who were treated at our health care system to guide prevention programs and policies. METHODS An electronic hospital database identified all patients younger than 18 years who were treated for dog bites from 1999 to 2006. Demographics, injury information, hospital admission status, length of stay, hospital charges, and payer source were collected. A further review of the narrative part of the inpatient electronic database was examined to identify owner of the dog, type of dog, and circumstances surrounding the incident. RESULTS During 8 years, 1,347 children younger than 18 years were treated for dog bites. The majority were treated and released from the emergency department (91%). Of the 66 children (4.9%) requiring inpatient admission, the median length of stay was 2 days. Victims were frequently male (56.9%) and <8 years (55.2%). Children younger than 5 years represented 34% of all dog bite victims, but 50% of all children requiring hospitalization. Thirty-seven percent of all children admitted to the hospital were bitten by a family dog. The cost of direct medical care during the study was

Seat belt misuse among children transported in belt-positioning booster seats

2.15 million. CONCLUSION Dog bite visits comprised 1.5% of all pediatric injuries treated in our hospital system during the study period. The majority (91%) of all dog bite visits were treated and released from the emergency department. Injuries to the head/neck region increased the odds of requiring 23 hour observation (OR, 1.95) and age less than 5 years increased the odds of being admitted as an inpatient (OR, 3.3).

Transporting Children With Special Health Care Needs: Comparing Recommendations and Practice

OBJECTIVE Observe and report seat belt use among children transported in belt-positioning booster seats. DESIGN We conducted a cross-sectional, observational survey of children transported in motor vehicles between 2006 and 2007. While drivers completed a survey reporting the childs age, weight and gender, and the drivers age, gender, race, income, education, and relationship to the child; a child passenger safety technician recorded vehicle seating location, restraint type, and use of the car safety seat harness or seat belt as appropriate for the child. SETTING Twenty-five fast food restaurants and discount department stores throughout Indiana. PARTICIPANTS A convenience sample of drivers transporting children younger than 16 years. MAIN EXPOSURE Seat belt use among children transported in belt-positioning booster seats. OUTCOME MEASURE Seat belt misuse. RESULTS Overall, 1446 drivers participated, 2287 children were observed with 564 children in belt-positioning booster seats. At least one seat belt misuse was observed for 64.8% of the children transported. Common misuses were the shoulder belt being placed over the booster seat armrest (35.8%); shoulder belt not at mid-shoulder position (28.5%), seat belt was too loose (24.5%), and the shoulder belt was either behind the childs back (9.1%) or under their arm (10.0%). CONCLUSION There is a high frequency of seat belt misuses among children transported in booster seats. Advice to parents on appropriate car seat selection, and encouragement to parents to supervise seat belt use may decrease misuse.

Rubinstein–Taybi syndrome associated with Chiari type I malformation caused by a large 16p13.3 microdeletion: A contiguous gene syndrome?†

OBJECTIVE: We compare the use of the American Academy of Pediatrics (AAP) guidelines for the safe transportation of children with special health care needs (CSHCN) with reported and observed practices. METHODS: This observational study was based on a convenience sample of vehicles exiting the garage of a tertiary childrens hospital. Certified child passenger safety technicians with a health care background and specialized training in the transportation of CSHCN gathered the drivers demographic information and the childs reported medical condition, weight, age, clinic visited, and relation to the driver. The safety technicians observed the car safety seat (CSS) type, vehicle seating position, and if the child required postural support. RESULTS: During the study, 275 drivers transporting 294 CSHCN were observed. Overall, most drivers complied with AAP recommendations by using a standard CSS seat (75.4%). Among the seats evaluated, 241 (82.0%) were the appropriate choice, but only 75 (26.8%) of 280 assessed had no misuses. Approximately 24% of the drivers modified the CSS, and 19.4% of the children would have benefited from additional body-positioning support. Only 8% of medical equipment was properly secured. CONCLUSIONS: Although most drivers seemed to choose the appropriate seat, many had at least 1 misuse. Drivers complied with most AAP recommendations; however, some deviated to facilitate care of the child during transport. Discussions with parents or caregivers about the proper transportation of CSHCN and referrals to child passenger safety technicians with special training may improve safety, care, and comfort in the vehicle.

Escalator-related injuries among older adults in the United States, 1991-2005

Rubinstein–Taybi Syndrome (RSTS, OMIM 180849) is a rare condition, which in 65% of cases is caused by haploinsufficiency of CREBBP (cAMP response element binding protein binding protein) localized to 16p13.3. A small subset of RSTS cases caused by 16p13.3 microdeletions involving neighboring genes have been recently suggested to be a true contiguous gene syndrome called severe RSTS or 16p13.3 deletion syndrome (OMIM 610543). In the present report, we describe a case of a 2‐year‐old female with RSTS who, besides most of the typical features of RSTS has corpus callosum dysgenesis and a Chiari type I malformation which required neurosurgical decompression. CGH microarray showed a ∼520.7 kb microdeletion on 16p13.3 involving CREBBP, ADCY9, and SRL genes. We hypothesize that the manifestations in this patient might be influenced by the haploinsufficiency for ADCY9 and SRL.

Policy statement - Child fatality review

This study describes the epidemiology of escalator-related injuries among adults age 65 and older in the U.S. between 1991 and 2005, through a retrospective analysis of data from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission. There were an estimated 39,850 escalator-related injuries and no fatalities. The overall injury rate was 7.8/100,000 population. During the study period 1991-2005, the rate of escalator-related injuries doubled. The mean age of the study population was 80.1 years (S.D.=8.5 years) with 73.3% female. The most frequent cause of injury was a slip, trip or fall (84.9%, 95% CI: 82.7-87.2%). The most frequently injured body parts were the lower extremities (25.9%, 95% CI: 21.5-30.2%) and the head (25.0%, 95% CI: 20.5-29.5%). The leading type of injury was soft tissue injuries (54.2%, 95% CI: 49.7-58.7%) followed by lacerations (22.3%, 95% CI: 18.4-26.1%) and fractures (15.6%, 95% CI: 13.1-18.1%). The rate of head injuries and the rate of hospitalizations increased with age. Escalator-related injuries occur infrequently but may result in significant trauma. These injuries are often associated with a slip, trip or fall. Awareness of the risks and the circumstances leading to escalator injuries allows for better direction of intervention strategies on the part of injury prevention specialists.

Are parents following the recommendations for keeping children younger than 2 years rear facing during motor vehicle travel

Injury remains the leading cause of pediatric mortality and requires public health approaches to reduce preventable deaths. Child fatality review teams, first established to review suspicious child deaths involving abuse or neglect, have expanded toward a public health model of prevention of child fatality through systematic review of child deaths from birth through adolescence. Approximately half of all states report reviewing child deaths from all causes, and the process of fatality review has identified effective local and state prevention strategies for reducing child deaths. This expanded approach can be a powerful tool in understanding the epidemiology and preventability of child death locally, regionally, and nationally; improving accuracy of vital statistics data; and identifying public health and legislative strategies for reducing preventable child fatalities. The American Academy of Pediatrics supports the development of federal and state legislation to enhance the child fatality review process and recommends that pediatricians become involved in local and state child death reviews.