Errors in child car seat use putting lives at risk, experts warn

Bayleigh McIntosh from Sydney’s east knows the risk if her child car restraint isn’t buckled snug and tight: “If you are in crash you will fall out a window,” the five-year-old said.

Properly secured and in the right child car seat for her age, a child like Bayleigh is the safest occupant in the car, said pediatric surgeon Susan Adams, director of surgery with The Sydney Children’s Hospitals Network.

Yet Dr Adams has treated children who were severely injured in “horrific preventable crashes” with broken necks, backs and internal injuries because of errors in how they were restrained.

Experts say the number of potentially fatal mistakes in how child restraints are fitted or installed hasn’t improved, becoming an “intractable problem” threatening the lives of children.

A 2010 study of 503 children from newborn to the age of 12 found half of all restraints had errors in how they were used. Some had up to seven errors each, ranging from failing to buckle the child in to slackness in the belts and sashes. Most often parents weren’t aware they had made a mistake.

Now, a new study has found the error rate is even worse, with nearly all parents struggling to understand manufacturers instructions and manuals.

Researchers from Neuroscience Research Australia (NeuRA)watched as parents read manuals and then attempted to correctly fit and install a child-sized mannequin in a rear-facing restraint.

They found 90 per cent made at least one mistake. Many made several. Yet after many rounds of revisions using suggestions from parents, the level of errors dropped to 10 per cent.

Professor Lynne Bilston from Neuroscience Research Australia, shows how to correctly fit a car seat to keep Bayleigh McIntosh age 5, from Coogee, nice and safe. If you can pinch the fabric, it is very likely too loose. Photo: Danielle Smith

Professor Lynne Bilston from Neuroscience Research Australia, shows how to correctly fit a car seat to keep Bayleigh McIntosh age 5, from Coogee, nice and safe. If you can pinch the fabric, it is very likely too loose. Photo: Danielle Smith

“Everyone is seeing this intractable problem of incorrect use,” said Dr Julie Brown, a senior research fellow with NeuRA.

Researchers around the world were witnessing a similar level of mistakes.

“What we’ve been doing over past decades has made no difference to correct use,” Dr Brown said. “It’s a longstanding problem, and nothing has really changed.”

You have to be inflexible: it is like you don’t let kids eat poisons.

Dr Lisa Keay, George Institute for Global Health.

Nearly all Australian children now wear the right restraint for their age, following the introduction of national laws in 2009 and 2010. Car crashes remain a leading cause of death and disabling injuries among children, but the fatality rate for child passengers has dropped from 70 to 40 a year in recent years.

Since January, 11 children under 16 have died on NSW roads alone, including a young child who died when a car rolled over late on Friday in the Hunter Valley. In 2016, nearly 1000 NSW children under 16 – many passengers in vehicles – were seriously injured in collisions.

A properly-installed and fitted child restraint stops a child moving in a crash, by attaching them to the vehicle’s rigid structure. It ensures the force of an impact hits the strongest parts of the body more likely to recover, like bones, instead of internal organs and the brain which may never heal properly.

Mistakes occur in three ways:

  1. When the child seat or restraint is installed or a restraint is moved from one car to another.
  2. When a carer puts a child in the car. For instance, any slack in a seatbelt or harness – if you can pinch some fabric between your fingers it is too loose – may allow the child to move during the crash.
  3. Errors caused by a child who may take an arm out of the restraint or fiddle with the sash.

In what could be music to the ears of anyone who has struggled to install a car seat, Dr Brown and her colleague Professor Lynne Bilston are asking parents for advice.

“Instead of a group of experts sitting around, we are actually talking to parents, and parents and consumers are driving the direction of our research,” Dr Brown said.

“We are trying to ensure information supplied with child restraints is comprehensible, and to improve restraint design so they’re actually difficult to use incorrectly,” Dr Brown said.

They are conducting three different projects: a naturalistic study where 700 families will have videos installed in their cars to see what really happens; focus groups asking parents for feedback; and laboratory studies that watch adults install car seats and then try to improve the design.

Professor Bilston said the research had shown it was possible to develop instructions and manuals that reduced dangerous mistakes. But sometimes it took seven iterations – for each type of restraint – before users could install them with 90 per cent accuracy.

“We keep going until they can be understood,” she said.

The key was breaking instructions into simple and numbered steps, and providing clear diagrams.

In focus groups of more than 40 women, users found images unrealistic and uninformative.

Others wanted prompts to remind others looking after children to do the right thing: “Have a big sign saying ‘fasten me tight.”

Another suggested linking warnings to specific risks such as “your child is going to have a punctured spleen or something if this [strap is twisted]”.

Dr Adams said the uptake of the new restraints had been good, but much more energy needed to be devoted to making them easier to use. “Parents want to do the right thing, but they need support to do that,” she said.

The impact of these crashes was “awful because it is so sudden. One day your life is going on in one direction, and if you had your time over you would do something different,” she said.

Bayleigh’s mother had taught her to sit still: “I don’t wiggle around!” she said. Older children may unbuckle restraints, or ask to sit in the front. The current recommendation is that children 12 and under should sit in the rear seat.

Lisa Keay from the George Institute for Global Health, said parents needed to introduce hard rules early and stick to them.

“You may think it is quite safe because you are just going down the street,” said Professor Keay, a deputy director of the Injury Division at The George Institute,

“But there is a risk always. Even a low speed crash can cause injury.

“You have to be inflexible: it is like you don’t let kids eat poisons.”

Professor Lynne Bilston is a Senior Principal Research Scientist at Neuroscience Research Australia.

This article was originally published in Sydney Morning Herald.