Restate the Obvious: Remind Parents to Buckle Up Their Kids

Michael Gerchufsky, CMPP, ELS, is the managing editor of Consultant for Pediatricians and E-mail him with thoughts on this post at, or post comments directly below.

With children's health threatened by so many hard to control or even uncontrollable factors in today's world — unspeakable violence, infectious diseases, unhealthy diets, accidental trauma — you'd think parents and caregivers of young children would embrace simple, commonsense safety issues such as buckling them up in child safety seats or seat belts.

As I drove home from the office one afternoon, I stopped at a traffic light next to a small car in the left turning lane with a young woman behind the wheel. In the front seat next to her were two very young, unbuckled children—both of them about 5 or 6 years old. In the back seat were 3 more kids, ranging from maybe 5 or 6 to 10 or 12 years of age, all without booster seats or seat belts.

With today's knowledge about the dangers of front-seat airbags to kids and the indisputable fact that seat belts and car seats save lives, I felt sick to my stomach knowing that these 5 children could be protected very simply, but weren't.

As I sat there waiting for the light to turn green, I wondered whether I should do anything. Should I roll down my window and inform the driver of the danger her unbuckled children were in? Having read so many reports of road rage and freeway shootings, that might not be so smart. Should I write down her license plate number and call the police (using my hands-free cellphone, of course)?

Ultimately, I did … nothing. The light turned green. I drove ahead. The woman and the 5 kids turned left and were gone.

I felt like a chump for not doing anything, and I'm haunted by the possibility that moments after I drove away,  those children could have been seriously injured in a motor vehicle accident that would have been eminently survivable or even minor had they been buckled up. In a way, not buckling up those children was as reckless and unforgivable as storing a handgun in their toy box.

Later, I got angry. How could that mother not have known about seat belts, car seats, and airbags? She must have, but apparently, she ignored the warnings. Maybe hearing it from her pediatrician wouldn't have made an impression on her, either. But maybe it would have.

A study published last week in Pediatrics drives home that point. In their article, Michelle L. Macy, MD, MS, and colleagues at the University of Michigan in Ann Arbor surveyed more than 600 parents seeking emergency care for their 1- to 12-year-old child between October 2011 and May 2012 (Macy ML, Cunningham RM, Resnicow K, Freed GL. Disparities in age-appropriate child passenger restraint use among children aged 1 to 12 years. Pediatrics. 2014;133[2]:262-271). They asked parents about their child passenger safety practices, their demographics, and where they got information about child passenger safety.

The results likely would have been interesting and illuminating if the survey were all that the research entailed. But a twist in this study is that research assistants (RAs) accompanied some of the parents and their children to their vehicles after discharge from the ED and directly observed whether the self-reported information matched reality.

The good news is that the researchers found that for the most part — in about 83% of cases — the parents' report of their child's usual restraint jibed with the RAs' observed restraint in the parking lot at discharge. The bad news is that, appallingly, less than 30% of 8- to 12-year-olds with a height or 4 feet, 9 inches or less used a booster seat. They also found that white parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents, and that race is a significant predictor of age-appropriate restraint use, even after adjusting for parental education, family income, and information sources.

"Clinicians caring for children have the potential to influence child passenger safety practices, and efforts should be directed at eliminating disparities through culturally appropriate interventions," the authors write. "Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children."

In other words, simple reminders and advice about car safety aren't too simple that they should go unspoken in the exam room. Please, restate the obvious. Young lives may depend on it. 

—Michael Gerchufsky

Related content from Consultant for Pediatricians:

Car seat phobia: where it may stem from, how to correct it, by John Harrington, MD

ADHD and the Adolescent Driver, by Daniel J. Cox, PhD; Roger Burket, MD; Amori Yee Mikami, PhD; Melissa Moore, MD; and R. Lawrence Merkel, MD

An Ounce of Prevention ... Pediatricians Can Influence Patients' Safety Behaviors, by Larissa Hirsch, MD, and Charles A. Pohl, MD

Travel Risks: How to Help Parents Protect Infants and Young Children, by Ambka Mathur, PhD, and Deepak Kamat, MD, PhD

• A Reminder to Buckle Up, Slow Down, and Ride With a Mature Driver, by Larissa Hirsch, MD, and Charles A. Pohl, MD