Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at Initial Hospital Discharge

Monday, October 13, 2014: 10:15 AM
Marriott Hall 6 (San Diego Marriott Marquis )
Benjamin Hoffman, MD, FAAP1, Kathleen Carlson, MS PhD2, Lindsay DIckey, MPH2, Adrienne Gallardo, MS1 and Marianne Bridwell-Chapman, BA1, (1)OHSU Doernbecher Children's Hospital, Portland, OR, (2)OHSU, Portland, OR

Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at initial Hospital Discharge



Approximately 84% of all rear-facing car safety seats (CSSs) are critically misused. Little is known about misuse of CSSs among families of newborns. Neonates are among the most vulnerable of motor vehicle passengers due to physical immaturity, and efforts to support appropriate use of CSSs among parents of newborns may be needed. The purpose of our study is to 1) estimate the rate of CSS misuse for newborns upon hospital discharge; and 2) elucidate risk and protective factors for CSS misuse.  


The Mother Baby Unit of the Oregon Health and Science University Hospital discharges approximately 2,500 newborns/year.  Between November 2013 and May 2014, we are randomly sampling up to 4 new mother-infant dyads daily for study recruitment. Newborns <37 weeks gestation, those with a NICU stay >4 hours, those who otherwise require an angle-tolerance test, and those not leaving in a personal vehicle are excluded. Participants complete a survey and are asked to designate someone (themselves or a designee) to position their newborn in the CSS, and then to install the CSS in the vehicle in which they will be leaving. A certified Child Passenger Safety (CPS) Technician observes these activities, recording all misuses in accordance with Safe Kids Worldwide and AAP best-practice guidelines. Prior to departure, misuses are corrected according to Safe Kids guidelines, with all tasks performed by a caregiver under the guidance of the CPS Technician. Descriptive analyses will describe participant sociodemographics, CSS attitudes/beliefs and experience, and frequency and types of CSS misuse. Multivariate regression analyses will be used to identify risk and protective factors for CSS misuse while controlling for potential confounders.


Study enrollment is ongoing. To date 191 of recruited mother-infant dyads have participated, averaging 11/week. We anticipate enrolling a total of 250-300. Participants are primarily aged 30-39 years (52%), married (77%), White (65%), college educated (41%), and primiparous (61%). A small proportion (20%) have previously had their CSS checked by a technician, and the majority (79%) have reported feeling somewhat or very confident in their ability to correctly install their CSS. However, nearly all (95%) CSSs have been critically misused, with 1 or more errors in positioning (86%) and/or installation (74%). Frequent misuses include harness and retainer clip errors, incorrect angles, and safety belt or lower anchor use errors.  Subsequent analyses will examine associations between misuse and theorized risk and protective factors (e.g., maternal parity, previous experience, socioeconomic status, and educational attainment).  


Our interim analyses suggest that nearly all parents of newborn infants critically misuse CSSs leading to increased risk for injury or death. Results of this research will help inform future interventions and shape policy regarding newborn care.