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PEDIATRICS Vol. 104 No. 4 October 1999, pp. 986-987
AMERICAN ACADEMY OF PEDIATRICS:
Safe Transportation of Newborns at Hospital Discharge
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ABSTRACT |
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All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant's maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.
All newborns discharged from hospitals should be
transported home in car safety seats that meet Federal Motor Vehicle
Safety Standard (FMVSS) 213 and that are selected to meet the specific transportation needs of healthy newborns, premature infants, or infants
with special health care needs.
In 1996, 1780 children (newborns to 14 years of age) were killed, and
305 000 were injured as occupants in motor vehicles.1 Of
the fatalities, 60% were unrestrained. The fatality rate for infants
was higher than any other age group, 4.4/100 000.2 In
1996, 653 children (newborns through 4 years of age) were killed as
occupants in motor vehicles. Of these fatalities, 52% were unrestrained.
The American Academy of Pediatrics (AAP) has made major contributions
to child passenger safety, including contributions to the passage of
legislation in all 50 states that requires the use of car safety seats
or child restraint devices for infants and young children. Assuring
that newborns are restrained properly when riding for the first time
establishes the pattern for continued compliance with a measure that
can save their lives or prevent serious injury. Correctly used car
safety seats are 71% effective in preventing fatalities attributable
to car crashes and 67% effective in preventing injury that requires
hospitalization. With 100% correct use, about 53 000 injuries and 500 deaths could be prevented each year in the United States among children
from birth to 4 years of age.3
RECOMMENDATIONS
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Admission orders for newborns should include an order written by a physician for parent instruction about use of child safety seats. This should be included as a part of standard admission orders to ensure its completion before discharge.
Discharge policies for newborns should include the following:
- Determination of the most appropriate car safety seat for each newborn according to maturity and medical condition by a designated hospital employee.
- Provision of information and training for parents and guardians should be presented before discharge on the generic issues related to correct use of car safety seats. Hands-on teaching including "return demonstration" should be a part of this instruction. The installation of a specific car seat in a specific car must be the parent's responsibility. Resources to address these issues are available from the AAP.10,11
- A period of observation in a car safety seat before hospital discharge should be provided to each infant born at <37 weeks' gestation to monitor for possible apnea, bradycardia, or oxygen desaturation.5
- Pediatricians with other child health and safety advocates should work for coverage of appropriate child restraint systems as a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers. Until that time, hospitals are encouraged to have a giveaway or loan program for parents who cannot afford to purchase a car seat.
COMMITTEE ON INJURY AND POISON PREVENTION, 1999-2000
Marilyn Bull, MD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD
LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Maternal and Child Health Bureau
Cheryl Neverman, MS
National Highway Traffic Safety Administration
Richard A. Schieber, MD, MPH
Centers for Disease Control and Prevention
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
US Consumer Product Safety Commission
William P. Tully, MD
Pediatric Orthopaedic Society of North America
SECTION LIAISON
Victor Garcia, MD
Section on Surgery
CONSULTANT
Murray L. Katcher, MD, PhD
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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FMVSS, Federal Motor Vehicle Safety Standard; AAP, American Academy of Pediatrics; NHTSA, National Highway Traffic Safety Administration.
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REFERENCES |
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- US Department of Transportation, National Highway Traffic Safety Administration. Traffic Safety Facts 1996. A Compilation of Motor Vehicle Crash Data From the Fatal Accident Reporting System and the General Estimates System. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 1997
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Fingerhut LA,
Annest JI,
Baker SP,
Injury mortality among children and teenagers in the United States: 1993.
Inj Prev
1996;
2:93-94
[Free Full Text] - An Evaluation of Child Passenger Safety: The Effectiveness and Benefits of Safety Seats. Springfield, VA: National Technical Information Service; 1986. DOT report DOT MS 806890
- National Highway Traffic Safety Administration. Standardized Child Passenger Safety Training Program. Washington, DC: National Highway Traffic Safety Administration; 1998
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American Academy of Pediatrics, Committee on Injury and Poison Prevention and Committee on Fetus and Newborn
Safe transportation of premature and low birth weight infants.
Pediatrics
1996;
97:758-760
[Abstract/Free Full Text] -
American Academy of Pediatrics, Committee on Injury and Poison Prevention
Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents.
Pediatrics
1996;
97:761-763
[Abstract/Free Full Text] - American Academy of Pediatrics, Committee on Injury and Poison Prevention. Transporting children with special health care needs. 1999;104:988-992
- Summerfelt M, Spitzer A, Wallace E, et al. Kars/Special Kars. An Easter Seals' Model Program Training Manual. Chicago, IL: National Easter Seal Society; 1992
- National Highway Traffic Safety Administration. Is This Child on the Road to Danger? Washington, DC: National Highway Traffic Safety Administration; 1997. DOT report DOT HS 808672
- American Academy of Pediatrics. 1999 Family Shopping Guide to Car Seats (brochure). Elk Grove Village, IL: American Academy of Pediatrics; 1999
- American Academy of Pediatrics. Car Seat Shopping Guide for Children With Speical Needs. (brochure). Elk Grove Village, IL: American Academy of Pediatrics; 1998
Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
Statement of reaffirmation:
- AAP Publications Retired and Reaffirmed
- American Academy of Pediatrics
Pediatrics 2006 117: 1846-1847.[Extract] [Full Text] [PDF]
The following policy statement has been revised:
- Safe Transportation of Newborns Discharged From the Hospital
- Committee on Accident and Poison Prevention
Pediatrics 1990 86: 486-487.[Abstract] [PDF]
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