1 AND 20 Will Never Go Away

Here’s a little background on how my Safe Kids coalition runs checkup events.  Because we are so short on trained CPS technician volunteers for our events, we train nursing students during their pediatrics rotation.  Despite being one of the busier coalitions in the country, checking thousands of seats per year through scheduled events and inspection stations, many of our technicians are trained for their jobs and we just don’t see them again; our state has one of the lowest recertification rates in the country.  Training the nurses is a win-win situation really.  We get 8-hour trained people helping us at our events which leaves our core of experienced techs and senior checkers to supervise them and work with families.  The nursing students then take with them knowledge of the importance of properly used and installed child safety seats and boosters and they can educate their patients (and doctors!) when they graduate.  Before we implemented this program, we were seeing wait times at our events of a half hour or more; now our wait times are around 10 minutes.  As parents, we all know how important it is to minimize waiting around in a car seat for a child, especially when the sun is beating down on him through the window and it’s over 100° outside, regardless of whether the air conditioning is on.

So, there I was last week at one of our regularly scheduled events supervising a group of freshly trained nursing students (ah, they’re so eager and energetic at their first event!).  As I was walking past a vehicle on my way to help someone with an installation, I heard those dreaded words spoken, “And she’ll need to be rear-facing until she’s 1 and 20 lbs.”  Screech!  Wha . . .?!  What did you just say?  Was that a period at the end of your sentence?  Don’t you have something else to say after that?  I think I stopped and looked at the scene for a second or two, but again, I was called away and couldn’t say anything.  Someone else came over to sign off on that car. 

The 8-hour course is not long enough to become an expert in car seats.  I took it back in 2001 and really didn’t learn much, but then again, my car seat geekiness had begun long before then.  One thing I do know is that there’s plenty of time to emphasize the word “minimum” after 1 and 20 lbs. because really, I don’t know of any CPS tech in my coalition who would turn a child forward-facing at 1 and 20 lbs.  We do a lot of training with our instructors emphasizing extended rear-facing and we’re trying to get the word out to our technicians as well, but so many of them don’t attend events.  So where does the problem lie then?  Is it in the instructor who taught the 8-hour class or in the curriculum that just won’t get rid of the 1 and 20 lbs. minimum?

As instructors, we’re not supposed to deviate from the standardized curriculum.  This is because having a standardized curriculum makes sure that every tech in the country has the same basic knowledge.  OK.  We know that having a catch phrase like 1 and 20 is easy to remember, but people might not hear or remember that last word “minimum.”  Or they might not think it’s important, like I think the above nursing student thought (I know the instructor who taught his class would have said “1 and 20 lbs. minimum”).  Or they might get caught up in the moment—“Yay, it’s her first birthday and she’s 22 lbs., so we can turn her forward now and see her cute nose!” or “He’d be so much happier facing forward!”  (Right.  Because your 1 yr old can form sentences to express himself.  Better say goodbye to sneaking those snacks for yourself mom!)  So, who decides on these catch phrases?  Who makes them up?  Who puts them in the curriculum?

We’ve known for a long time now that rear-facing for well past 1 and 20 is safest.  We’ve had study after study and the Swedes have done it for years.  So why do we keep on with this 1 and 20?  We’ve had car seats now for several years with higher rear-facing weight limits, so we can’t use that for an excuse.  The American Academy of Pediatrics said in their 2002 policy statement that “Children should face the rear of the vehicle until they are at least 1 year of age and weigh at least 20 lb to decrease the risk of cervical spine injury in the event of a crash. Infants who weigh 20 lb before 1 year of age should ride rear facing in a convertible seat or infant seat approved for higher weights until at least 1 year of age. If a car safety seat accommodates children rear facing to higher weights, for optimal protection, the child should remain rear facing until reaching the maximum weight for the car safety seat, as long as the top of the head is below the top of the seat back.”  It’s point number 1 under their seat selection topic.

SafetyBeltSafe USA advocates rear-facing to the weight and height limits of the child restraint, which could be as long as 18-24 months, or longer if you’re lucky enough to have a small child: www.carseat.org/Technical/tech_update.htm#rearfacFF .

The CPS technician curriculum states, “Because the rear-facing position is safest, children should ride rear facing as long as possible (but never exceed the manufacturer’s weight and height limits).

At a minimum, use rear-facing CR until child is at least 1 year old and at least 20 pounds.”

It would be so simple just to rewrite the curriculum to say 2 years old and 30 lbs.  So simple.  Even 18 months would be an improvement.  Sure, my ds wouldn’t have made it to my proposed standards as he was 30 lbs. and his head was even with the top of his car seat at 15 months, but there are always going to be exceptions.  My dd did make it to 3 years 1 month, though!  (Ha!  We’ve created a new type of parental bullying—“*My* child can rf longer than your child.”)

It’s so easy to do.  Bump the minimum standards to 2 and 30.  That way we’ll have a little more leeway with those minimums and we won’t be seeing 20 lbs. 10 month olds in super reclined forward-facing Roundabouts because it’s more comfy for them.  Whaddya say?  Car seat safety is a grassroots effort—write in here with your comments about bumping the standards up.