Health Promotion and Maintenance Q 71
A nurse is giving discharge instructions to the parents of a healthy newborn. Which of the following instructions should the nurse provide regarding car safety and the trip home from the hospital?
A. The infant should be restrained in an infant car seat, properly secured in the back seat in a rear-facing position.
B. The infant should be restrained in an infant car seat, properly secured in the front passenger seat.
C. The infant should be restrained in an infant car seat facing forward or rearward in the back seat.
D. For the trip home from the hospital, the parent may sit in the back seat and hold the newborn.
Correct Answer: A. The infant should be restrained in an infant car seat, properly secured in the back seat in a rear-facing position.
All infants under 1 year of age weighing less than 20 lbs. should be placed in a rear-facing infant car seat secured properly in the back seat. Rear-facing car safety seats for infants are perhaps the least controversial; rear-facing car seats have superior effectiveness in preventing serious injury in infants from car crashes. Children < 24 months riding in rear-facing car seats were 1.76 times less likely be seriously injured from all types of car crashes relative to children riding in forward-facing safety seats
Option B: Infant car seats should never be placed in the front passenger seat. States have implemented their own individual mandates for car safety seats, with stringent recommendations from the AAP incorporated into law in New Jersey and Oklahoma and with states including West Virginia (WV) and North Carolina having the most lenient requirements (Bae, Anderson, Silver, & Macinko, 2014; NCPSC, 2013). WV requires that children under 7 years be restrained in a car safety or booster seat, without specifying the timing of the transition.
Option C: The infant should always face rearward in the back seat while on a car seat. For side crashes, children < 24 months riding in forward-facing car seats were 5.5 times more likely to get injured as compared to those riding in rear-facing car seats. Accident data (such as from Sweden) indicate that increased duration of rear-facing car safety seat usage can decrease injuries and deaths relating to automobile accidents (SafetyBeltSafe USA, 2013).
Option D: Infants should always be placed in an approved car seat during travel, even on that first ride home from the hospital. Consistent with research, the American Academy of Pediatrics (AAP) and National Highway Traffic Safety Administration (NHTSA) have developed evidence-based practice guidelines for car safety seat use, which vary by the size and weight of the child, emphasizing the use of rear seats among infants less than 2 years of age (AAP, 2013; NHTSA, 2014).