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Child passenger injury from road traffic crashes is a leading contributor to New Zealand’s paediatric trauma-related mortality and morbidity.1 The average annualised fatality rate for child passengers under the age of 5 years is 2.1 per 100,000, second to drowning (3.0 per 100,000) (Table 1).1 New Zealand compares unfavourably to other OECD countries for child traffic crash-related trauma.2

Table 1. Incidence of child injury deaths and hospital discharges among 0-4 year olds for common causes of child injury

Mechanism of injury

Deaths
(2000–2009)

Number of hospital discharges*
(2002–2011)

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

All motor vehicle transport
Motor vehicle occupant
Drowning
Falls
Burns
Poisoning

89
61
87
10
27
2

3.1
2.1
3.0
0.3
0.9
+

749
451
209
10,548
2178
2790

25.5
15.3
7.1
358.5
74.0
94.8

Key: * Includes primary admission only, principal diagnosis of injury, and hospital stay >24 hours; + rates not calculated for fewer than 5 deaths.

Source: http://ipru3.otago.ac.nz/niqs/1Correctly used child car restraints can prevent death and severe injury of child passengers.3,4The most effective way of ensuring all children are provided with a child restraint when they are travelling in a vehicle is to have legislation that reflects current evidence, is appropriately enforced, and is coupled with widespread education and car seat distribution programmes.5–9

'A child restraint on every trip for every child' is the key message New Zealand's Paediatric Society members emphasise in their Child Passenger Safety Position Statement adopted at the Society’s 2012 Annual General Meeting.10

The position statement was developed in consultation with Plunket and is a synopsis of evidence for the safe transport of children in vehicles. It is targeted towards child health professionals, and includes a list of recommendations (Table 2).

Topics include information on the safest seating position for children; the dangers of lap belts; when children can safely use adult seat belts; the age at which infants may be seated in forward-facing restraints and child restraint related hypoxia.

The statement also urges health practitioners to engage New Zealand Qualifications Authority (NZQA) certificated child restraint technicians to provide child restraint advice.

Table 2. The Paediatric Society of New Zealand recommendations for the correct use of child car restraints

Table-2.-The-Paediatric-Society-of-New-Zealand-recommendations-for-the-correct-use-of-child-car-restraints

Despite the overwhelming scientific evidence of the effectiveness of child restraints and long-standing recommendations that they be used, the New Zealand Government has a tepid commitment to promoting child passenger safety.11 Change is needed, in both our child restraint legislation and practice.

New Zealand’s child restraint legislation was introduced in 1994 as a first step towards achieving better passenger safety for children.12 It languished unattended for over 15 years. A crucial issue for paediatricians has been the law’s failure to mandate that older children remain in child restraints (i.e. booster seats) until it is safe for them to use adult seat belts.4 In 2010 a Road Safety strategy Safer Journeys 2020 recommended updating the law.13

In 2011, a New Zealand Cabinet paper confirmed to the Executive that children are being injured and killed after prematurely graduating from child restraints into adult seat belts.14,15The Cabinet paper acknowledged that New Zealand child restraint law has lagged behind other international jurisdictions, and noted an extensive public education campaign promoting the voluntary use of booster seats had not resulted in any improvement and recommended a law change.

The law change, which was enacted in November 2013, includes a Rule that children must be seated in a child restraint until their seventh birthday, two years longer than previously required (Table 3). This Rule brings New Zealand into line with recently enacted Australian Federal law,14,15 but falls short of recommendations in many other parts of the world including the UK, Europe and Canada.2

Table 3. November 2013 New Zealand child restraint law change

The law says you must:

What’s changing?

Until 31 October 2013

From 1 November 2013

Correctly secure your child in an approved child restraint

Until their 5th birthday

Until their 7th birthday

Correctly secure your child in an approved child restraint if one is available in the vehicle (and if not, in any child restraint or safety belt that is available)

From their 5th birthday until their 8th birthday

From their 7th birthday until their 8th birthday

Source: http://www.nzta.govt.nz/about/media/releases/2669/news.html16These changes have been greeted coolly by paediatricians as 'a step in the right direction'.17The paediatrician’s lack of enthusiasm for this recent update is explained within the Paediatric Society's Statement, which says best practice is to keep children in child restraints until they reach a minimum height of 148 cm. That height is usually not reached until approximately a child’s 11th birthday.18 For this reason many overseas child restraint laws encode minimum height requirements along with age; for example the United Kingdom, European Union and Canada.2

The most recent published car restraint use surveys in New Zealand found that between 45% and 65% of child passengers were in incorrectly fitted restraints.13 Lack of information and resources have been cited as factors contributing to the incorrect use of child restraints.19,20In addition to the law change, greater effort is needed on methods shown to be effective within at risk communities, which is the distribution of child restraints through multifaceted campaigns within community settings.21

New Zealand health services do not need to look far to find gaps and limitations in the distribution of child restraint information and resources. The New Zealand Road Rules do not require an infant or child of any age to be seated in a child restraint when they are travelling in a registered passenger vehicle including minivans, taxis, or buses.22 Infants and children travelling between health services or home from hospital in taxis can legally be completely unrestrained, held in someone’s arms, or restrained only with an adult seat belt.20

This exemption, disappointingly, has resulted in occasions where rather than being viewed as an opportunity to provide child restraints for at-risk families using their services, health professionals have turned a blind eye to families engaging in obviously unsafe behaviour.

The Paediatric Society’s endorsement of Plunket’s message ‘A child restraint for every child on every trip’, and their call for health services to work more directly with community-based child restraint rental and loan agencies, are prompts aimed directly at challenging and changing this practice.10

The adoption of this position Statement by Paediatric Society members represents a refreshed focus by child health professionals on the promotion of child passenger safety. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

The full version of the Paediatric Society’s Position Statement is available online at:http://www.paediatrics.org.nz/index.asp?pageID=2145878337

Summary

Abstract

Child passenger injury from road traffic crashes is a leading contributor to New Zealands paediatric trauma-related mortality and morbidity. New Zealand has significantly higher rates of child passenger injury than internationally comparable countries. Correctly used child restraints can prevent death and severe injury of child passengers. Despite huge efforts by individuals and Non-Government Organisations to promote up-to-date height-based legislation and to distribute child restraints, the New Zealand Government has a tepid commitment to promoting child passenger safety. Further change is needed, in both our child restraint legislation and practice. This paper highlights the recommendations from a Paediatric Society of New Zealand Position Statement for the correct use of child restraints. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

Aim

Method

Results

Conclusion

Author Information

Bridget Kool, Senior Lecturer, Section of Epidemiology and Biostatistics, University of Auckland; Rebekah Ryan, Student, Faculty of Medical and Health Science, University of Auckland; Keira Radice, Student, Faculty of Medical and Health Science, University of Auckland; Elizabeth Segedin, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Gabrielle Nuthall, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Michael Shepherd, Clinical Director, Children's Emergency Department, Starship Children's Hospital, Auckland; Julie Chambers, Convenor, Injury Special Interest Group, Paediatric Society of New Zealand, Auckland

Acknowledgements

We thank the Paediatric Society of New Zealands Injury Special Interest Group for their feedback on the Position Statement as well as Plunket New Zealand for the use of their slogan A child restraint for every child on every trip.

Correspondence

Dr Bridget Kool, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019 Auckland, New Zealand. Fax: +64 (0)9 3737503

Correspondence Email

b.kool@auckland.ac.nz

Competing Interests

Nil

  1. Injury Prevention Research Unit. National Injury Query System:https://blogs.otago.ac.nz/ipru/ Accessed 24/9/13.
  2. New Zealand Transport Agency. Child Restraints Fact Sheet 07. Wellington: New Zealand Transport Agency, 2012.
  3. Elliott M, Kallan M, Durbin D, Winston FK. Effectiveness of child safety seats vs. seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006;160:617–21.
  4. Cameron L, Segedin E, Nuthall G, Thompson J. Safe restraint of the child passenger. Journal of Paediatrics and Child Health. 2006;42(12):752–7.
  5. Brixey S, Corden TE, Guse CE, Layde PM. Booster seat legislation: does it work for all children? Injury Prevention. 2011;17(4):233–7.
  6. Brixey S, Ravindran K, Guse CE. Legislating child restraint usage–Its effect on self-reported child restraint use rates in a central city. Journal of Safety Research. 2010;41(1):47–52.
  7. Cunningham CE, Bruce BS, Snowdon AW, Chen Y, Kolgad C, Piotrowski C, et al. Modeling improvements in booster seat use: A discrete choice conjoint experiment. Accident Analysis and Prevention. 2011;43(6):1999–2009.
  8. Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA. 2003;289(21):2835–40.
  9. Ebel BE, Koepsell TD, Bennett EE, Rivara FP. Too small for a seatbelt: predictors of booster seat use by child passengers. Pediatrics. 2003;111(4):323–327
  10. Paediatric Society of New Zealand. Rf. PSNZ Position Statement – Child Passenger Safety: Adopted at the PSNZ AGM 22nd November 2012:http://www.paediatrics.org.nz/index.asp?pageID=2145878337 Accessed 7/4/13.
  11. Geddis DC, Appleton IC. Use of restraint systems by preschool children in cars. Archives of Diseases in Childhood. 1982;57(7):549–51.
  12. Kypri K, Chalmers D, Langley JD, Wright C, S. Child injury mortality in New Zealand 1986-95. Journal of Paediatrics and Child Health. 2000;36(5):431–439
  13. Ministry of Transport. Safer Journeys 2020: New Zealand's Road Safety Strategy 2010 to 2020. Wellington: Ministry of Transport, 2010.
  14. Ministry of Transport. Cabinet Paper on Child Restraints. Wellington: Ministry of Transport, 2012.
  15. Ministry of Transport. Regulatory Impact Statement – Child Retraints. Wellington: Ministry of Transport, 2012.
  16. New Zealand Transport Agency. New child restraint laws to improve safetyhttp://www.nzta.govt.nz/about/media/releases/2669/news.html accessed 25/09/13.
  17. Auckland District Health Board. Starship team help kiwi kids ride safe. NOVA. 2013;September:5.
  18. Klinich K, Pritz H. Study of older child restraint / booster seat fit and NASS injury analysis. Washington DC: National Highway Traffic Safety Administration, Vehicle Research and Test Centre: US Department of Transportation, 1994.
  19. Rivara FP, Bennett E, Crispin B, Kruger K, Ebel B, Sarewitz A. Booster seats for child passengers: lessons for increasing their use. Injury Prevention. 2001;7:210–3.
  20. Wilson M, Chambers J, Hamill J. Barriers to the safe transport of children to and from hospital. New Zealand Medical Journal. 2013;126(1375):27–36.
  21. Istre GR, Stowe M, McCoy MA, Moore BJ, Culica D, Womack KN, et al. A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles. Injury Prevention. 2011;17(1):3–8.
  22. New Zealand Transport Agency. The official New Zealand road code. Wellington: New Zealand Transport Agency; 2012/2013.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Child passenger injury from road traffic crashes is a leading contributor to New Zealand’s paediatric trauma-related mortality and morbidity.1 The average annualised fatality rate for child passengers under the age of 5 years is 2.1 per 100,000, second to drowning (3.0 per 100,000) (Table 1).1 New Zealand compares unfavourably to other OECD countries for child traffic crash-related trauma.2

Table 1. Incidence of child injury deaths and hospital discharges among 0-4 year olds for common causes of child injury

Mechanism of injury

Deaths
(2000–2009)

Number of hospital discharges*
(2002–2011)

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

All motor vehicle transport
Motor vehicle occupant
Drowning
Falls
Burns
Poisoning

89
61
87
10
27
2

3.1
2.1
3.0
0.3
0.9
+

749
451
209
10,548
2178
2790

25.5
15.3
7.1
358.5
74.0
94.8

Key: * Includes primary admission only, principal diagnosis of injury, and hospital stay >24 hours; + rates not calculated for fewer than 5 deaths.

Source: http://ipru3.otago.ac.nz/niqs/1Correctly used child car restraints can prevent death and severe injury of child passengers.3,4The most effective way of ensuring all children are provided with a child restraint when they are travelling in a vehicle is to have legislation that reflects current evidence, is appropriately enforced, and is coupled with widespread education and car seat distribution programmes.5–9

'A child restraint on every trip for every child' is the key message New Zealand's Paediatric Society members emphasise in their Child Passenger Safety Position Statement adopted at the Society’s 2012 Annual General Meeting.10

The position statement was developed in consultation with Plunket and is a synopsis of evidence for the safe transport of children in vehicles. It is targeted towards child health professionals, and includes a list of recommendations (Table 2).

Topics include information on the safest seating position for children; the dangers of lap belts; when children can safely use adult seat belts; the age at which infants may be seated in forward-facing restraints and child restraint related hypoxia.

The statement also urges health practitioners to engage New Zealand Qualifications Authority (NZQA) certificated child restraint technicians to provide child restraint advice.

Table 2. The Paediatric Society of New Zealand recommendations for the correct use of child car restraints

Table-2.-The-Paediatric-Society-of-New-Zealand-recommendations-for-the-correct-use-of-child-car-restraints

Despite the overwhelming scientific evidence of the effectiveness of child restraints and long-standing recommendations that they be used, the New Zealand Government has a tepid commitment to promoting child passenger safety.11 Change is needed, in both our child restraint legislation and practice.

New Zealand’s child restraint legislation was introduced in 1994 as a first step towards achieving better passenger safety for children.12 It languished unattended for over 15 years. A crucial issue for paediatricians has been the law’s failure to mandate that older children remain in child restraints (i.e. booster seats) until it is safe for them to use adult seat belts.4 In 2010 a Road Safety strategy Safer Journeys 2020 recommended updating the law.13

In 2011, a New Zealand Cabinet paper confirmed to the Executive that children are being injured and killed after prematurely graduating from child restraints into adult seat belts.14,15The Cabinet paper acknowledged that New Zealand child restraint law has lagged behind other international jurisdictions, and noted an extensive public education campaign promoting the voluntary use of booster seats had not resulted in any improvement and recommended a law change.

The law change, which was enacted in November 2013, includes a Rule that children must be seated in a child restraint until their seventh birthday, two years longer than previously required (Table 3). This Rule brings New Zealand into line with recently enacted Australian Federal law,14,15 but falls short of recommendations in many other parts of the world including the UK, Europe and Canada.2

Table 3. November 2013 New Zealand child restraint law change

The law says you must:

What’s changing?

Until 31 October 2013

From 1 November 2013

Correctly secure your child in an approved child restraint

Until their 5th birthday

Until their 7th birthday

Correctly secure your child in an approved child restraint if one is available in the vehicle (and if not, in any child restraint or safety belt that is available)

From their 5th birthday until their 8th birthday

From their 7th birthday until their 8th birthday

Source: http://www.nzta.govt.nz/about/media/releases/2669/news.html16These changes have been greeted coolly by paediatricians as 'a step in the right direction'.17The paediatrician’s lack of enthusiasm for this recent update is explained within the Paediatric Society's Statement, which says best practice is to keep children in child restraints until they reach a minimum height of 148 cm. That height is usually not reached until approximately a child’s 11th birthday.18 For this reason many overseas child restraint laws encode minimum height requirements along with age; for example the United Kingdom, European Union and Canada.2

The most recent published car restraint use surveys in New Zealand found that between 45% and 65% of child passengers were in incorrectly fitted restraints.13 Lack of information and resources have been cited as factors contributing to the incorrect use of child restraints.19,20In addition to the law change, greater effort is needed on methods shown to be effective within at risk communities, which is the distribution of child restraints through multifaceted campaigns within community settings.21

New Zealand health services do not need to look far to find gaps and limitations in the distribution of child restraint information and resources. The New Zealand Road Rules do not require an infant or child of any age to be seated in a child restraint when they are travelling in a registered passenger vehicle including minivans, taxis, or buses.22 Infants and children travelling between health services or home from hospital in taxis can legally be completely unrestrained, held in someone’s arms, or restrained only with an adult seat belt.20

This exemption, disappointingly, has resulted in occasions where rather than being viewed as an opportunity to provide child restraints for at-risk families using their services, health professionals have turned a blind eye to families engaging in obviously unsafe behaviour.

The Paediatric Society’s endorsement of Plunket’s message ‘A child restraint for every child on every trip’, and their call for health services to work more directly with community-based child restraint rental and loan agencies, are prompts aimed directly at challenging and changing this practice.10

The adoption of this position Statement by Paediatric Society members represents a refreshed focus by child health professionals on the promotion of child passenger safety. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

The full version of the Paediatric Society’s Position Statement is available online at:http://www.paediatrics.org.nz/index.asp?pageID=2145878337

Summary

Abstract

Child passenger injury from road traffic crashes is a leading contributor to New Zealands paediatric trauma-related mortality and morbidity. New Zealand has significantly higher rates of child passenger injury than internationally comparable countries. Correctly used child restraints can prevent death and severe injury of child passengers. Despite huge efforts by individuals and Non-Government Organisations to promote up-to-date height-based legislation and to distribute child restraints, the New Zealand Government has a tepid commitment to promoting child passenger safety. Further change is needed, in both our child restraint legislation and practice. This paper highlights the recommendations from a Paediatric Society of New Zealand Position Statement for the correct use of child restraints. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

Aim

Method

Results

Conclusion

Author Information

Bridget Kool, Senior Lecturer, Section of Epidemiology and Biostatistics, University of Auckland; Rebekah Ryan, Student, Faculty of Medical and Health Science, University of Auckland; Keira Radice, Student, Faculty of Medical and Health Science, University of Auckland; Elizabeth Segedin, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Gabrielle Nuthall, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Michael Shepherd, Clinical Director, Children's Emergency Department, Starship Children's Hospital, Auckland; Julie Chambers, Convenor, Injury Special Interest Group, Paediatric Society of New Zealand, Auckland

Acknowledgements

We thank the Paediatric Society of New Zealands Injury Special Interest Group for their feedback on the Position Statement as well as Plunket New Zealand for the use of their slogan A child restraint for every child on every trip.

Correspondence

Dr Bridget Kool, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019 Auckland, New Zealand. Fax: +64 (0)9 3737503

Correspondence Email

b.kool@auckland.ac.nz

Competing Interests

Nil

  1. Injury Prevention Research Unit. National Injury Query System:https://blogs.otago.ac.nz/ipru/ Accessed 24/9/13.
  2. New Zealand Transport Agency. Child Restraints Fact Sheet 07. Wellington: New Zealand Transport Agency, 2012.
  3. Elliott M, Kallan M, Durbin D, Winston FK. Effectiveness of child safety seats vs. seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006;160:617–21.
  4. Cameron L, Segedin E, Nuthall G, Thompson J. Safe restraint of the child passenger. Journal of Paediatrics and Child Health. 2006;42(12):752–7.
  5. Brixey S, Corden TE, Guse CE, Layde PM. Booster seat legislation: does it work for all children? Injury Prevention. 2011;17(4):233–7.
  6. Brixey S, Ravindran K, Guse CE. Legislating child restraint usage–Its effect on self-reported child restraint use rates in a central city. Journal of Safety Research. 2010;41(1):47–52.
  7. Cunningham CE, Bruce BS, Snowdon AW, Chen Y, Kolgad C, Piotrowski C, et al. Modeling improvements in booster seat use: A discrete choice conjoint experiment. Accident Analysis and Prevention. 2011;43(6):1999–2009.
  8. Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA. 2003;289(21):2835–40.
  9. Ebel BE, Koepsell TD, Bennett EE, Rivara FP. Too small for a seatbelt: predictors of booster seat use by child passengers. Pediatrics. 2003;111(4):323–327
  10. Paediatric Society of New Zealand. Rf. PSNZ Position Statement – Child Passenger Safety: Adopted at the PSNZ AGM 22nd November 2012:http://www.paediatrics.org.nz/index.asp?pageID=2145878337 Accessed 7/4/13.
  11. Geddis DC, Appleton IC. Use of restraint systems by preschool children in cars. Archives of Diseases in Childhood. 1982;57(7):549–51.
  12. Kypri K, Chalmers D, Langley JD, Wright C, S. Child injury mortality in New Zealand 1986-95. Journal of Paediatrics and Child Health. 2000;36(5):431–439
  13. Ministry of Transport. Safer Journeys 2020: New Zealand's Road Safety Strategy 2010 to 2020. Wellington: Ministry of Transport, 2010.
  14. Ministry of Transport. Cabinet Paper on Child Restraints. Wellington: Ministry of Transport, 2012.
  15. Ministry of Transport. Regulatory Impact Statement – Child Retraints. Wellington: Ministry of Transport, 2012.
  16. New Zealand Transport Agency. New child restraint laws to improve safetyhttp://www.nzta.govt.nz/about/media/releases/2669/news.html accessed 25/09/13.
  17. Auckland District Health Board. Starship team help kiwi kids ride safe. NOVA. 2013;September:5.
  18. Klinich K, Pritz H. Study of older child restraint / booster seat fit and NASS injury analysis. Washington DC: National Highway Traffic Safety Administration, Vehicle Research and Test Centre: US Department of Transportation, 1994.
  19. Rivara FP, Bennett E, Crispin B, Kruger K, Ebel B, Sarewitz A. Booster seats for child passengers: lessons for increasing their use. Injury Prevention. 2001;7:210–3.
  20. Wilson M, Chambers J, Hamill J. Barriers to the safe transport of children to and from hospital. New Zealand Medical Journal. 2013;126(1375):27–36.
  21. Istre GR, Stowe M, McCoy MA, Moore BJ, Culica D, Womack KN, et al. A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles. Injury Prevention. 2011;17(1):3–8.
  22. New Zealand Transport Agency. The official New Zealand road code. Wellington: New Zealand Transport Agency; 2012/2013.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Child passenger injury from road traffic crashes is a leading contributor to New Zealand’s paediatric trauma-related mortality and morbidity.1 The average annualised fatality rate for child passengers under the age of 5 years is 2.1 per 100,000, second to drowning (3.0 per 100,000) (Table 1).1 New Zealand compares unfavourably to other OECD countries for child traffic crash-related trauma.2

Table 1. Incidence of child injury deaths and hospital discharges among 0-4 year olds for common causes of child injury

Mechanism of injury

Deaths
(2000–2009)

Number of hospital discharges*
(2002–2011)

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

Total for the 10-year period

Crude average annualised rate per 100,000 for the 10-year period

All motor vehicle transport
Motor vehicle occupant
Drowning
Falls
Burns
Poisoning

89
61
87
10
27
2

3.1
2.1
3.0
0.3
0.9
+

749
451
209
10,548
2178
2790

25.5
15.3
7.1
358.5
74.0
94.8

Key: * Includes primary admission only, principal diagnosis of injury, and hospital stay >24 hours; + rates not calculated for fewer than 5 deaths.

Source: http://ipru3.otago.ac.nz/niqs/1Correctly used child car restraints can prevent death and severe injury of child passengers.3,4The most effective way of ensuring all children are provided with a child restraint when they are travelling in a vehicle is to have legislation that reflects current evidence, is appropriately enforced, and is coupled with widespread education and car seat distribution programmes.5–9

'A child restraint on every trip for every child' is the key message New Zealand's Paediatric Society members emphasise in their Child Passenger Safety Position Statement adopted at the Society’s 2012 Annual General Meeting.10

The position statement was developed in consultation with Plunket and is a synopsis of evidence for the safe transport of children in vehicles. It is targeted towards child health professionals, and includes a list of recommendations (Table 2).

Topics include information on the safest seating position for children; the dangers of lap belts; when children can safely use adult seat belts; the age at which infants may be seated in forward-facing restraints and child restraint related hypoxia.

The statement also urges health practitioners to engage New Zealand Qualifications Authority (NZQA) certificated child restraint technicians to provide child restraint advice.

Table 2. The Paediatric Society of New Zealand recommendations for the correct use of child car restraints

Table-2.-The-Paediatric-Society-of-New-Zealand-recommendations-for-the-correct-use-of-child-car-restraints

Despite the overwhelming scientific evidence of the effectiveness of child restraints and long-standing recommendations that they be used, the New Zealand Government has a tepid commitment to promoting child passenger safety.11 Change is needed, in both our child restraint legislation and practice.

New Zealand’s child restraint legislation was introduced in 1994 as a first step towards achieving better passenger safety for children.12 It languished unattended for over 15 years. A crucial issue for paediatricians has been the law’s failure to mandate that older children remain in child restraints (i.e. booster seats) until it is safe for them to use adult seat belts.4 In 2010 a Road Safety strategy Safer Journeys 2020 recommended updating the law.13

In 2011, a New Zealand Cabinet paper confirmed to the Executive that children are being injured and killed after prematurely graduating from child restraints into adult seat belts.14,15The Cabinet paper acknowledged that New Zealand child restraint law has lagged behind other international jurisdictions, and noted an extensive public education campaign promoting the voluntary use of booster seats had not resulted in any improvement and recommended a law change.

The law change, which was enacted in November 2013, includes a Rule that children must be seated in a child restraint until their seventh birthday, two years longer than previously required (Table 3). This Rule brings New Zealand into line with recently enacted Australian Federal law,14,15 but falls short of recommendations in many other parts of the world including the UK, Europe and Canada.2

Table 3. November 2013 New Zealand child restraint law change

The law says you must:

What’s changing?

Until 31 October 2013

From 1 November 2013

Correctly secure your child in an approved child restraint

Until their 5th birthday

Until their 7th birthday

Correctly secure your child in an approved child restraint if one is available in the vehicle (and if not, in any child restraint or safety belt that is available)

From their 5th birthday until their 8th birthday

From their 7th birthday until their 8th birthday

Source: http://www.nzta.govt.nz/about/media/releases/2669/news.html16These changes have been greeted coolly by paediatricians as 'a step in the right direction'.17The paediatrician’s lack of enthusiasm for this recent update is explained within the Paediatric Society's Statement, which says best practice is to keep children in child restraints until they reach a minimum height of 148 cm. That height is usually not reached until approximately a child’s 11th birthday.18 For this reason many overseas child restraint laws encode minimum height requirements along with age; for example the United Kingdom, European Union and Canada.2

The most recent published car restraint use surveys in New Zealand found that between 45% and 65% of child passengers were in incorrectly fitted restraints.13 Lack of information and resources have been cited as factors contributing to the incorrect use of child restraints.19,20In addition to the law change, greater effort is needed on methods shown to be effective within at risk communities, which is the distribution of child restraints through multifaceted campaigns within community settings.21

New Zealand health services do not need to look far to find gaps and limitations in the distribution of child restraint information and resources. The New Zealand Road Rules do not require an infant or child of any age to be seated in a child restraint when they are travelling in a registered passenger vehicle including minivans, taxis, or buses.22 Infants and children travelling between health services or home from hospital in taxis can legally be completely unrestrained, held in someone’s arms, or restrained only with an adult seat belt.20

This exemption, disappointingly, has resulted in occasions where rather than being viewed as an opportunity to provide child restraints for at-risk families using their services, health professionals have turned a blind eye to families engaging in obviously unsafe behaviour.

The Paediatric Society’s endorsement of Plunket’s message ‘A child restraint for every child on every trip’, and their call for health services to work more directly with community-based child restraint rental and loan agencies, are prompts aimed directly at challenging and changing this practice.10

The adoption of this position Statement by Paediatric Society members represents a refreshed focus by child health professionals on the promotion of child passenger safety. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

The full version of the Paediatric Society’s Position Statement is available online at:http://www.paediatrics.org.nz/index.asp?pageID=2145878337

Summary

Abstract

Child passenger injury from road traffic crashes is a leading contributor to New Zealands paediatric trauma-related mortality and morbidity. New Zealand has significantly higher rates of child passenger injury than internationally comparable countries. Correctly used child restraints can prevent death and severe injury of child passengers. Despite huge efforts by individuals and Non-Government Organisations to promote up-to-date height-based legislation and to distribute child restraints, the New Zealand Government has a tepid commitment to promoting child passenger safety. Further change is needed, in both our child restraint legislation and practice. This paper highlights the recommendations from a Paediatric Society of New Zealand Position Statement for the correct use of child restraints. This information should be used by all health professionals to advocate for and implement this important injury prevention initiative.

Aim

Method

Results

Conclusion

Author Information

Bridget Kool, Senior Lecturer, Section of Epidemiology and Biostatistics, University of Auckland; Rebekah Ryan, Student, Faculty of Medical and Health Science, University of Auckland; Keira Radice, Student, Faculty of Medical and Health Science, University of Auckland; Elizabeth Segedin, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Gabrielle Nuthall, Paediatric Intensivist, Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland; Michael Shepherd, Clinical Director, Children's Emergency Department, Starship Children's Hospital, Auckland; Julie Chambers, Convenor, Injury Special Interest Group, Paediatric Society of New Zealand, Auckland

Acknowledgements

We thank the Paediatric Society of New Zealands Injury Special Interest Group for their feedback on the Position Statement as well as Plunket New Zealand for the use of their slogan A child restraint for every child on every trip.

Correspondence

Dr Bridget Kool, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019 Auckland, New Zealand. Fax: +64 (0)9 3737503

Correspondence Email

b.kool@auckland.ac.nz

Competing Interests

Nil

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