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Demographic Patterns of Age- and Size-Appropriate Child Restraint Use in Chicago
Arthi S Kozhumam1, Sideeq Ibrahim2, Abigail Guillaume2
1Medical Scientist Training Program (AS Kozhumam), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center (AS Kozhumam, S Ibrahim, A Guillaume, MM Landa, B Pollock, and ML Macy), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
Insights
Many children in emergency care settings use child restraint systems (CRS) inappropriately. Interventions targeting families in acute care can improve child passenger safety, especially for at-risk demographic groups.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Injury Prevention
Background:
- Child restraint system (CRS) use is often determined by age, but this may not account for individual size and development.
- Children lacking primary care access may miss crucial anticipatory guidance on child passenger safety.
- Emergency departments (EDs) and urgent care centers serve as key touchpoints for these families.
Purpose of the Study:
- To assess the prevalence of age- and size-appropriate CRS use among children visiting EDs and urgent care centers in metropolitan Chicago.
- To identify demographic and visit-related factors associated with premature CRS transitions.
- To inform targeted interventions for improving child passenger safety.
Main Methods:
- A cross-sectional analysis of screening data linked to electronic health records (EHR) was performed.
- Data included caregiver-reported transportation behaviors for children aged 6 months to 10 years.
- CRS use was classified as appropriate or prematurely transitioned; statistical analyses identified associated factors.
Main Results:
- Over 23% of children (933 out of 4,045) had prematurely transitioned from their CRS.
- Premature transitions were linked to child age (2-4 or 8+ years), Black race, Hispanic/Latine ethnicity, and ED visits.
- Specific disparities were observed, with higher rates among Hispanic/Latine and Black children (under 8) and larger households (8+).
Conclusions:
- Premature CRS transitions are prevalent in children utilizing acute care services in Chicago.
- This population faces an elevated risk of crash-related injuries due to inappropriate restraint use.
- Child passenger safety interventions in acute care settings are crucial and should be tailored to benefit specific demographic groups.
Objective:
Age alone is often used to define appropriate child restraint system (CRS) use. Children who lack access to primary care may rely on acute care settings and miss opportunities for anticipatory guidance on child passenger safety. We sought to characterize age- and size-appropriate CRS use among emergency department (ED) and urgent care patients in metropolitan Chicago to inform targets for intervention.
Methods:
We conducted a secondary cross-sectional analysis of clinical trial screening data collected from English- and Spanish-speaking caregivers of 6-month through 10-year-old children, January 2021 to August 2022. Caregiver-reported transportation behaviors were linked to electronic health record data. CRS use was categorized as appropriate or prematurely transitioned for age and size. Descriptive statistics were calculated. Chi-square and logistic regression analyses were used to test for child, family, and visit characteristics associated with premature transitions.
Results:
Of the 4269 caregivers with matched screening and electronic health record data, 4045 (94.8%) were included and 933 (23.1%) had prematurely transitioned their child. Premature transitions were most associated with child age 2 to 4 or 8+, Black race or Hispanic/Latine ethnicity, and being seen in the ED. Premature transitions differed across child age groups and were most common among Hispanic/Latine and Black children (age <8), families with larger household size (age 8+), and children seen in the ED (age 2-4).
Conclusions:
Premature transitions are common among children who received acute care in metropolitan Chicago. This population is at risk for crash-related injuries. Child passenger safety interventions targeted to families who seek acute care may benefit specific demographic groups.
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