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July 2007
Obese children could be at risk in standard car seats
 With rates of obesity in children increasing in South Carolina and nationwide, a group of MUSC researchers set out to determine whether some children are too heavy for -- and therefore unsafe in -- age-appropriate child passenger safety seats.
"Parents usually select car seats based on their child's age and weight. Because of the childhood obesity epidemic, we wanted to look at how many kids have an increased injury risk in car accidents. Obese children do not have a weight that appropriately matches their age," explains Dr. Paul Hletko, associate clinical professor in the Department of Pediatrics and a private practitioner in Georgetown, SC, who participated in the study.
Motor vehicle-related injury is the number one cause of unintentional injury and death in children in South Carolina and the US. Research shows that improper use of child automobile restraints contributes to the risk of such deaths.
"It's a very preventable situation. We wanted to know how much trouble we're in," says Dr. Hletko. "It's more than we thought."
Coordinated by the South Carolina Pediatric Practice Research Network (SCPPRN), which conducts collaborative practice-based research, the study included the findings of eight pediatric care groups (including MUSC Children's Care in North Charleston and Moncks Corner, and MUSC Pediatric Primary Care) located in six different areas of the state for a total of 1,390 children subjects.
The study found that 24 percent of children less than 12 months of age, and 21 percent of one- to six-year-olds were too heavy for standard car seats.
"The childhood obesity epidemic," Dr. Hletko says, "means it's no longer safe to assume age is a proxy for weight.
"In the real world, belt positioning is not about age," cautions Dr. Hletko. "Instead, it's about weight, height and, to some degree, the child's behavior."
Using age as the criterion for selecting a car seat often results in many children riding in infant-only or convertible car seats that are too small for them, or in the use of belt positioning booster seats that are too large, says Dr. Hletko. It also could result in a misbehaving child defeating an initially correct belt position. "This diminishes protection in car crashes," concludes Dr. Hletko.
In particular, he cautions parents of children ages three and up.
"Many of the children in this age group are too big for a five-point harness seat and too small for a belt-positioning booster -- a sort of 'no-man's land' created by the obesity epidemic," explains Dr. Hletko. "There are seats that fit children in this group, but there's a very limited selection, they're expensive and generally have convenience issues that may lead to further misuse or nonuse." (See the sidebar below for options for child passengers.)
While Dr. Hletko would like to see the seatbelt law reflect the needs of an increasingly obese child population, it's not likely nor is it his main objective.
He said the current child car seat and seat belt laws have flaws but are very helpful. "They were created to protect as many kids as possible, with guidelines that are simple and easy to understand."
His goal is increased public education, with possible future subsidization of more effective Ð but also more expensive - car seats for heavier children.
"The issue of cost surfaced years ago, when state laws requiring car seats first came out," he recalls. "Back then, hospitals and other organizations donated car seats and considered it a cost of doing business in caring for newborns. There are solutions."
More importantly, the study provides yet another reason to attack childhood obesity in a more logical way.
"Childhood obesity is not just about lying around watching TV or eating unhealthily," Hletko explains. "The problem has underlying complex endocrinology implications."
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