From Your CPS Board

We are pleased to bring to you this inaugural issue of the revised Tech Update, a newsletter designed to make it easier for you to keep informed of technical developments in the CPS field.

With this August issue, Tech Update offers significant new features, including the addition of "curbside notes." These notes will translate the technical content in the articles into everyday language that you can use when talking with parents and caregivers during a safety seat check. By breaking down the technical terms into simpler language, it will be easier for you to follow the curriculum's focus on the Learn, Practice, Explain (LPE) philosophy.

You will find reader-friendly information and some interesting new formats, such as Q&A interviews (in future issues) and informative articles. Newsletter content will build upon what you learned during the CPS Certification course. As an added benefit, you can earn 1 CEU credit by successfully passing quizzes that reference the content in two Tech Update issues.

There is a new Child Passenger Safety Technician Manual with an updated and expanded appendix available on the CPS Board website: www.cpsboard.org/techmanual_downloads.htm.

If you completed the course prior to June 2007, we encourage you to visit the new technician manual on the CPS Board website. The manual is an excellent ongoing reference for you.

All current and future issues of Tech Update are available online at www.cpsboard.org/techupdate.htm. It is an excellent resource for all certified technicians and instructors.

To assist technicians in accessing additional information, all websites mentioned in the Tech Update may be reached by clicking on the link.

We hope you enjoy this issue and learn practical tips you can use at the upcoming National Seat Check Saturday, September 20, and during Child Passenger Safety Week, September 21–27.

Regards,
Carole S. Guzzetta, NHTSA
Michele J. Mount, Chairperson, NCPSB

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New Study: Rear Facing is Safer for Children up to Age 2**

Dr. Marilyn Bull of the Department of Pediatrics, Indiana University School of Medicine, and Dr. Dennis Durbin of the Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, released a commentary in Pediatrics early this year stating "children are five times safer riding rear facing than forward facing into the second year of life." This information was based on earlier research* completed by Henary, Sherwood, Crandall, Kent, Vaca, Arbogast and Bull and published in Injury Prevention.

In the Henary study of crashes from 1998 to 2003, rear-facing (RF) child restraints (CRs) were given a 93 percent effectiveness rating while forward-facing (FF) CRs were rated at only 78 percent, 15 percentage points lower. The benefit was present even when the statistics were broken down in groups 0–12 months and 13–24 months. This appears to confirm Swedish research which has shown the benefits of the RF position over many years.

The study also looked at the effect of the RF position on protection in side-impact crashes. Crash data considered various vehicle types, crash types, and where the child was seated in the vehicle. While the most basic benefit in terms of how the body moves in a crash occurs in a frontal crash, there was considerable benefit found in side impacts. The researchers suggest that this may be because most side impacts also involve some frontal-impact forces. Researchers described the benefit to the RF child in a side impact as a "cocoon" effect, because the frontal forces hold the child's head confined in the head restraint area and the side-wings of the CR shell, despite the sideward forces. For a FF child, the frontal forces thrust the child's head out of the area where side-wings would be of any use to resist the sideward forces.

In the Pediatrics commentary, Dr. Bull and Dr. Durbin strongly urged pediatricians to follow a new educational approach when counseling caregivers:

1. Recommend that children continue riding rear facing until their second birthday, within the size and weight range of the convertible CR being used.
2. Assure parents it is a myth that leg injuries occur if the feet touch the back of the vehicle seat while rear facing.
3. Encourage parents to seek the assistance of a certified CPS technician for help in correct installation and use of their child's safety seat.

NHTSA's Child Passenger Safety Technician Student Manual, pages 125–126, urges caregivers to follow the American Academy of Pediatrics (AAP) policy that recommends that children ride rear facing to the maximum rear-facing weight limit of the CR as long as the child's head is one inch below the top of the CR. The manual also confirms leg injuries are not a concern. NHTSA updated its own 4 Steps for Kids to reflect these guidelines (www.boosterseat.gov/4StepsFlyer.pdf).

References:

Bull, MJ and Durbin, DR, "Rear-facing Car Safety Seats — Getting the Message Right," Pediatrics, March 2008, 121:619-620.

Henary, B; Sherwood, CP; Crandall, JR; Kent, WR; Vaca, FE; Arbogast, KB; Bull, MJ, "Car Safety Seats for Children: Rear Facing for Best Protection," Injury Prevention, 2007, 13:398-402.

**Articles marked with a double asterisk (**) have been modified with permission from pieces originally published by Safe Ride News Publications and are in the public domain.

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Learn, Practice, Explain

A New Twist on Learning for All

The LPE focus of the latest NHTSA CPS curriculum is developing new technicians who are really "getting it." Students are learning what they "need to know curbside" with caregivers. By placing the tools of our trade in their hands — locking clips, belt shortening clips, seat belts, child restraints, and recall lists — we are giving them many chances to show how they can use and apply their new skills.

Most importantly, students are learning to use manuals. The new student manual is an excellent resource for use at car seat check events, and the LATCH Manual is an important reference about both tether anchor retrofits and LATCH. At the same time, they learn where to seek additional information using manual appendixes, references and websites. The last step is asking them to teach each other as if talking to caregivers.

Using the LPE approach, chapters introducing CRs follow NHTSA's 4 Steps for Kids: rear-facing, forward-facing, boosters and seat belts. For example, in Chapter 9, "Rear-facing Child Restraints," students are introduced to all aspects of rear-facing restraints including selection, installation, misuse and special needs. This all-inclusive focus lessens confusion, especially about installation, and helps students see special needs restraints as an option for certain situations in each category rather than as a stand-alone type of restraint.

Why Didn't I Think of Doing That?

An excellent application of the LPE principle is for lead instructors to send step-by-step directions to students about various recall list websites and how to access and print the recall list that will be used in class. Bringing a current recall list to class and using it in hands-on activities shows they have not only learned how to use the list, but will know where to find updated lists in the future. This saves instructor time copying recall lists for classroom use and helps the student to learn she can acquire new skills on her own and put them into practice right away. Instructors still need to check for new updates to current recall lists prior to class. Even experienced technicians need to review these simple steps for accessing useful resources.

Recall lists available from:

• www.nhtsa.gov
• www.hsrc.unc.edu/recalls*
• www.carseat.org*
• www.800bucklup.org*

* Available in various compact formats

To download a copy of the NHTSA recall list:

• Connect to the NHTSA website at www.nhtsa.gov.
• Click on "Recalls, Defects and Complaints Database" in the Quick Clicks box on the left.
• Look for "Check for Recalls" in green and click on "Child Restraint Recalls."
• Click on "Print Version" at the top of the page (small white box) to print the complete recall list.

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NHTSA Website Updates

NHTSA continues to work on improving its www.nhtsa.gov website. Check out "What's New, Latest Updates and Features on Our Site" and "Newest Studies and Reports" on the website's home page. To find the CPS page, click on the scroll down menu (under the "Information" search bar on the left) and select "Child Safety Seats."

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When Best Practice and the Real World Collide

A warm spring day brought many families to the Ohio Asian Community Car Seat Check event. The supply of replacement seats was gone and check lanes were being closed. One last car arrived, and as Su-ling, the greeting tech, was about to ask the parents to come back on Monday when more seats would be available, she glanced into the car. Peering back at her was a baby boy restrained in an obviously too small RF infant seat. When asked, the mom indicated he weighed 24 pounds and was just a year old. Remembering that all children needed to leave safer than when they came in, Su-ling asked, "Is there someone in your family with a bigger car seat who could come and help to transport your baby safely today?" The dad shook his head sadly. "No, there is no one."

Using quick-thinking CPS skills, Su-ling remembered a Fisher Price Safe Embrace convertible car seat which had been donated earlier to be destroyed because it had been used about six years and just reached the expiration date. Looking through the CR check forms, she verified that the family who left the convertible behind did know the history of the seat and checked the CR labels. With a RF weight limit of 30 pounds, this convertible was in perfect condition despite the borderline expiration date of the seat!

After conferring with other techs and the instructor/ senior checker, Su-ling explained to the parents that there would be additional car seats available on Monday and they could come back then. Meanwhile, would the family accept this gently used but barely outdated convertible to transport the baby safely until Monday? The parents gratefully accepted the offer and learned how to use the convertible CR. Dad installed the CR while Mom tightened the new harnesses, remarking what a beautiful seat this was and how lucky they were to have come at this time. Another child left safer than when he came in, and the event was closed for the day on a positive note.

Editor's Note: NHTSA does not endorse any products. The purpose of this column is to share the tough decisions caregivers and technicians are facing in the field, how to use knowledge of the CPS curriculum to help make the best decision with resources available, and how to make sure children always leave the safest way possible in any given circumstance.

Share your examples of "When Best Practice and Real World Collide"!

Be a part of Tech Update. E-mail your story to mary@saferidenews.com and your example may be used here. Identifying names and exact locations may be changed to provide privacy.

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Special Needs Website

www.ohiokidsareridingsafe.org

This website, designed with separate sections for CPSTs, caregivers, healthcare professionals, and school/bus personnel, focuses on those who work with or care for children with special needs. However, much of the information can be used for all children. Some of the special features include information and CR recommendations for specific disabilities and differences, a bus and van quiz for drivers, PDFs for a bus/van booklet and a "tweens" brochure, a news and updates section, a car seat chart, website addresses for most manufacturers, a sample insurance letter, and a glossary. Opportunities for CEUs will soon be available. The site was originally funded through a NHTSA grant, but is now maintained by Goodwill Industries of the Miami Valley (OH) and Easter Seals West Central Ohio's special needs child passenger safety program

Check out these additional Special Needs resources:

• www.preventinjury.org. Indiana University School of Medicine's Automotive Safety Program website includes a list of CPSTs who have been through the special needs course.
• www.saferidenews.com. Coming soon to this site is an addition on comprehensive vests and harness information which covers details of use in school buses, airplanes, commercial vehicles, ambulances, and personal vehicles.

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Research Notes

NHTSA Child Restraint Use Survey Results

In January 2008, NHTSA published the 2007 restraint use rates for children under 12 by age as follows:

Birth to 12 months: 98 percent
1–3 years old: 96 percent
4–7 years old: 85 percent
8–12 years old: 83 percent

These rates are from the 2007 National Survey of the Use of Booster Seats (NSUBS), conducted by NHTSA. Since age information in NSUBS is obtained through interviews instead of through visual assessment as in NOPUS (National Occupant Protection Use Survey), it is considered more accurate, so NHTSA publishes rates for various age groups from NSUBS. Child restraint use rates from both surveys are highly consistent.

See the NSUBS publications Child Restraint Use in 2007 — Demographic Results and Child Restraint Use in 2007 — Use of Correct Restraint Types for race and ethnicity, restraint types, and other information for each age group. Also see Child Restraint Use in 2007 — Overall Results. This survey showed a significant increase in restraint use overall in children ages birth to 7 years, from 84 percent in 2006 to 89 percent in 2007.

For more information and to download these reports, go to:
www-nrd.nhtsa.dot.gov

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Are Booster Seat Laws Effective?

A survey of states with and without booster seat laws demonstrated children ages 4–7 years in states with booster seat laws were 39 percent more likely to be appropriately restrained. Children ages 4–5 years were 23 percent more likely and 6–7 years were twice as likely to be appropriately restrained.

The conclusion drawn from this survey: States with booster seat laws inclusive of children through age 7 years are more effective in promoting booster use.

Winston, Kallan, Gilbert and Durbin, Pediatric Adolescent Medicine, March 2007.

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How Effective are Boosters?

For children ages 4–7 years, the odds of injury are 59% lower for children in booster seats than for those in seat belts alone. In a 2003 study, children in booster seats had no injuries to the abdomen, neck/spine/back, or lower extremities, while children in seat belts alone had injuries to all body regions.

Durbin, DR; Elliott, MR; Winston, FK, "Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Children in Vehicle Crashes," JAMA, 2003; 289:2835–2840.

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Mark Your Calendars!

National Seat Check Saturday, September 20, 2008, kicks off National CPS Week, September 21–27.

September 21–27, 2008, is CPS Week. NHTSA's theme is Seat Check Saturday, which will kick off the week on Sept. 20th. Surveys show that at least three out of four child safety seats are improperly installed. On National Seat Check Saturday, NHTSA wants parents and caregivers to ensure child restraints are used correctly by visiting local inspection stations.

To find an inspection station, visit: www.nhtsa.gov.

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Head Restraints Protect the Whole Family

In Dayton, Ohio, a driver, correctly belted in his seat belt, stopped for a changing traffic light. Two cars behind him apparently thought they could make it through the intersection on yellow, and consequently all were involved in a chain-reaction, rear-end crash. The driver of the lead car died instantly when his head and neck hyper-extended over his head restraint, which was positioned too low.

According to the August 2007 Consumer Reports, a rear-end crash occurs every 17 seconds in the U.S. Neck injuries are the most commonly reported type of crash-related injury for adults and can occur in crash speeds as low as 10 mph. An IIHS (Insurance Institute for Highway Safety) 2003 observational survey found that 56 percent of male drivers and 24 percent of female drivers had their head restraints positioned too low.

NHTSA has recently updated FMVSS 202, which covers head restraints. The new version includes significant improvements that require automakers' compliance by 2010. Although the changes do not require head restraints in rear seating positions, they do require any head restraints voluntarily installed in the rear seats to meet the same criteria as front seat head restraints—they must reach a minimum height of 29.5 inches upward from an occupant's hip and be able to be adjusted to within 2.2 inches of the back of the occupant's head (backset). (Backset refers to the distance between the head restraint and the back of a person's head.) The prior standard required a 27.5-inch height and did not specify a backset requirement.

Head Restraints and CRs

There are various types of head restraints found in vehicles that may cause some problems when installing taller CRs. One type adjusts upward and usually can be removed to allow better installation for CRs. Integral head restraints are built in to the vehicle seat and can't be removed or adjusted. This type, with the new standard's height requirement, may make it hard to access the tether anchor for a FF CR. Newer, "active" head restraints, most often found only in the front seat, stay retracted during normal driving but move forward to protect during a crash.

Due to the new backset requirement, more head restraints will tilt toward the driver or passenger. When these cannot be removed or adjusted, they may present an incompatibility with taller FF CRs, such as higher weight CRs made to protect heavier, older children and those with special needs.

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Free KIDS IN BACK Materials

Kids are safer in back! But it can be a surprise to many people that this is recommended through age 12 years. To communicate the "kids are safer in back" message, visit www.kidsinback.org for free brochures, posters and public service announcements in English and Spanish from the National Safety Council. All materials and shipping are FREE, including bulk orders! Stock up now for your fall events, September's Seat Check Saturday, and Child Passenger Safety Week. Feel free to pass this opportunity to others you know who educate parents and other caregivers, who can spread this lifesaving message. This material may not be available after September.

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CEUs for Tech Update

Join the Team of Techs and Instructors who read Tech Update for CEUs and WIN a Free CPS Recertification — a $40–$60 Value!

1. If you have not done so already, sign up for automatic notification of updates to the cpsboard.org website: www.cpsboard.org/elist.htm
2. Read two issues of TU and take the quizzes found on the "Online Recertification CEU's" page: www.cpsboard.org/ceus.htm. Maintain and file the quizzes for proof.
3. Twice each year, the CPS Board will draw the e-mail address of one technician or instructor who is signed up for the cpsboard.org e-mail list.
4. The winner will be contacted by e-mail and asked to present proof of completed quizzes immediately.
5. Each winner will have the $40 or $60 fee paid for her next recertification, when all other requirements for recertification are completed.

Be a Winner! Read the Tech Update!

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Tech Update is published by the National Highway Traffic Safety Administration and the Child Passenger Safety Board (www.cpsboard.org) for certified Child Passenger Safety Technicians and Instructors.

Articles marked with a double asterisk (**) have been modified with permission from pieces originally published by Safe Ride News Publications and are in the public domain.