Child Passenger Safety

Administrator: Hello, and welcome to the webcast entitled Child Passenger Safety. We have just a few announcements before we begin. The slides will advance automatically throughout the presentation. At the bottom of your browser, you will find a Help icon for technical assistance and a Q&A icon to submit a question at any time. If your screen freezes or the slides do not appear to be advancing as they should, please try exiting and restarting the session, as it may be an issue with your connectivity. And one final note, at the end-- before the end of the business today, we will be sending out a survey, and we'd appreciate it if you could fill it out and let us know what you think of today's presentation. But now I'd like to turn the call over to Nancy Topping-Tailby. Nancy, you may begin.

Nancy Topping-Tailby: Thank you. And welcome, everyone, to today's webinar on child passenger safety. My name is Nancy Topping-Tailby from the National Center on Early Childhood Health and Wellness. And over the next hour, we will be exploring a new flip chart that will be available soon, that you can use to help families protect themselves and the children riding in their vehicle, choose the right car seat for children in all age groups, and find resources to install a seat properly in their vehicle. It's my distinct pleasure to introduce our presenter today, who is Dr. Marilyn Bull, a nationally recognized child passenger safety expert. Dr. Bull is the Morris Green Professor of Pediatrics at the Indiana University School of Medicine and Riley Hospital for Children at the Indiana University Health. She is a published writer and has spoken internationally on pediatric issues, specifically in the transportation safety arena. Among child transportation safety advocates nationwide, Dr. Bull is known for her work in improving transportation safety for children with special health care needs. And now it's my pleasure to turn the webinar over to Dr. Bull.

Dr. Marilyn Bull: Thank you, Nancy. And thank you to all of you who've joined us to learn more about protecting children in cars. This resource was originally developed by the Automotive Safety Program at Indiana University School of Medicine with funding from the Indiana Criminal Justice Institute. It was designed for use with families in Head Start in child care programs. The purpose of the flip chart is to provide information that you can share in individual conversations with families about child passenger safety. And it's organized like the "Growing Healthy" flip chart, a guide for Head Start health managers and families about healthy active living for young children that some of you may be familiar with. What I share today is actually adapted into a PowerPoint format from the flip chart.

Each page on the flip chart has a front and back side, and the front side of each page is for parents. It has photos that illustrate and some of the talking points. The back side has speaker notes and background information that highlight key points that you'll want to discuss with families. As you use the flip chart or the PowerPoint version, ask parents what type of vehicle they drive. Then, as you review each page in the flip chart, you can talk about what they can do to keep their child safe in their car or truck. So let's get started. All 50 states, the territories, the District of Columbia, and most tribes have child passenger safety laws. Before you use the flip chart, make sure you know the child passenger safety line your state, territory, District of Columbia, or tribe. You can find the basic information about the laws for states and territories in the link provided or check with your local officials for information about the laws for tribes. This is a list of the topics that you'll find in the flip chart.

There is a section at the end of the flip chart with resources that you can use to share additional safety tips and ask frequently asked questions. Every family wants to keep their child safe, but some families may not know that many young children are seriously injured or killed in motor vehicle crashes. In fact, motor vehicle injuries are the leading cause of death among children in the United States. And most of these deaths occur when children are passengers in a car or truck. Families who know how to choose the right car seat and use it properly can protect the children who ride in their vehicle. And note that when we talk about car seats, we're referring to car seats, booster seats, and seat belts -- all of the different types of child passenger restraint systems that families will use at different times based on their child's age, their size, the child's height and weight, and their developmental needs. Did you know that drivers who buckle up are more likely to use a car seat, booster seat, or seat belt for their children riding in a vehicle? We know that drivers who wear a lap and shoulder belt buckle up children 92 percent of the time, while drivers who don't wear a lap shoulder belt only buckle up children 70 percent of the time.

Drivers should always wear a lap and shoulder belt on every trip, even if you're not going far. Most crashes happen closer to home. If you buckle up, you have a better chance of surviving a crash and so do the children in your vehicle because you can get them out quickly if there is a crash. If you aren't buckled up, you could be thrown out of the car. You could be thrown around the car, hurting yourself and your passengers. And also, remember to adjust your headrest so it supports your head.

This can protect your head and neck from injury, too. Parents are their child's first and best teacher. You can teach them the habits you want them to use to stay safe and healthy. When you protect yourself by buckling up, you're also protecting your children in your vehicle, and you're teaching your children the habits that you want them to use to stay safe and healthy. A younger child may also be more willing to ride in a car seat when you wear a lap and shoulder belt. And an older child is more likely to buckle up because you do. Driving safely requires your full attention. Distracted driving is any activity you do in a motor vehicle that takes your attention away from staying focused on driving safely, such as talking, texting on your phone, eating, drinking, putting on makeup, talking to people in your vehicle, or playing with the music and navigation system-- anything that takes your attention away from the task of safe driving and increases your risk of a motor vehicle crash. Another important point is that younger children, younger than 13, should ride in the back seat.

Your child may look big enough to ride in the front seat, but the back seat is the safest place for children under the age of 13 to sit, regardless of their size. Don't let a child under the age of 13 sit in the front seat, even as a special privilege or reward. Studies show that children under the age of 13 are better protected in the back seat. In 2015, more than half of passenger vehicle deaths were the result of a crash to the front of the car. Riding in the back seat keeps the child farther away from the location of a front crash. It also keeps the child away from the front passenger airbags, which have caused death or serious injuries to children. Do you know that in a crash these airbags can inflate at speeds up to 200 miles an hour? That is tremendous force. Riding in the back seat is the safest place for your child. A car seat is designed to keep your child as safe as possible in the event of a crash. The right seat can save your child's life, but with over 200 different models, it can be really confusing to know how to choose the right seat for your child. Let's look at the different styles. So car seats keep children safe by spreading the forces of the clash along the strongest parts of the body. Rear-facing car seats, as in the top left, are considered the most protective since they distribute the crash forces over the child's back. Forward-facing car seats that use a five-point harness, like on the bottom, distribute forces over the child's shoulders and hips, the bony parts that are strong.

And seat belts distribute crash forces over the shoulders and hips, but only by three points. As children grow, they need the different types of car or booster seats. Choosing a seat based on your child's size, height, and weight, age, and developmental needs provides the best protection. Keep your child in their car seat until they've outgrown it, until they've reached the seat's highest weight or height allowed by the manufacturer.

Car seats label the minimum and maximum height and weight requirements on their packaging, in their instruction book, and in the seat itself. So let's talk about the different types of car seats so you know how to choose the right seat. Rear-facing reduces the risk of neck and spine injuries. It is the safest way for infants and toddlers to ride in a car or truck. And there are different types of rear-facing seats. Rear-facing only seats, like on the left, have carrying handles and usually have detachable bases. Most are wear for children who weigh up to 40 pounds, but a few are available for children who weigh only 20 or 22 pounds. Convertible seats, like on the right, and all-in-one seats change from rear-facing to forward-facing seats. Most rear-face for children who weigh up to 40 pounds. It's okay if your child's feet touch the back of the vehicle seat. It might look uncomfortable to us, but a child's legs bend easily, and leg injuries are really rare. A rear-facing seat provides the best protection because it supports the entire head, neck, and back of the child when the vehicle is in a frontal crash.

There are different types of rear-facing seats-- rear-facing only, and rear-facing convertible, and all-in-one seats. The American Academy of Pediatrics recommends that children ride rear-facing until at least age 2 or until they outgrow their rear-facing height or weight limits of the car seat. Forward-facing seats are for toddlers and preschoolers. Once a child has outgrown a rear-facing car seat, you should move them into a forward-facing car seat and continue to use the harness straps until your child reaches the manufacturer's highest height or weight limit. Some forward-facing seats change into rear-facing seats. Others change into booster seats. Make sure you're using the seat the right way for your child's age and size. You can find this information on the seat or in the instruction booklet. Use the forward-facing seat with a five-point harness. A seat with a five-point harness protects the child better than the booster seat.

A five-point harness has straps over both shoulders, both hips, and between the legs. The crash forces are distributed over a much larger area of the child's body. You want to keep your child in the seat until they outgrow it, usually sometime between four and seven years of age, depending on their height and weight. Most car seat manufacturers design the harness straps in a forward-facing seat for children who weigh up to 65 pounds, though some set other limits that may range from 40 to 90 pounds. Check the instructions for your car seat. Here we go. Booster seats for school-aged children are for when your child outgrows that forward-facing car seat with a harness. Your child should use a booster seat to reduce the risk of injury by 45 percent for children between the ages of 4 and 8, compared to using seat belts alone. There are two types of booster seats-- backless, like on the right, or high-back, like on the left. The backless is a small platform. It's best to use this type of booster seat if your vehicle -- oh, no, seat -- the high-back model has head and neck support. So the backless is a small platform, but the high-back model has head and neck support. And it's best to use this type of a booster seat if your vehicle doesn't have a headrest or the vehicle seat back isn't high.

A booster seat lifts your child up so that the adult seat belt fits correctly. When used in the right way, the lap portion of the belt fits snugly over the upper thighs or low on the hips. The shoulder portion fits snugly across the middle of the shoulder and chest. Without a booster seat, a seat belt can ride up on the child's stomach or across the neck, which can cause serious injuries to their stomach or spine if in a crash. Use a lap and shoulder belt with a booster. Never use just a lap belt. A properly positioned shoulder and lap belt spreads the forces of the crash along the strongest parts of your child's body. If your child puts the shoulder part of the belt under their arm or behind the back, check the seat belt fit. This is not a safe way to ride. Your child really may not be ready for a booster seat and still may need a car seat with a harness. For older children and adults, seat belt use reduces the risk of serious injury and death by about half in a crash. The seat belts will spread the forces of the crash over their shoulders and hips, the stronger parts of their body. Your child is ready to use a seat belt when he can sit all the way back on the vehicle seat without slouching, their knees hang over the edge of the vehicle seat, preferably with the feet on the floor, and the seat belt fits the right way, with the shoulder belt across the middle of the shoulder and chest, and the lap belt flat across the hips.

This is usually -- and children vary greatly -- when a child is about 4 feet 9 inches tall and between 8 and 12 years of age. Also, make sure your child has support behind the head. If your child puts the shoulder belt under their arm or behind their back, check that seat belt fit. This is not a safe way to ride, and your child may still need a booster seat. And also remember, the back seat is a safe place in the vehicle for the child to sit until they are age 13. Even if you have the right seat, if it isn't installed or placed in the car correctly, it cannot protect your child. A car seat is installed with either the vehicle seat belt, as on the right, or lower anchors, and sometimes called latch system, on the left. You only need to use one of these systems to install your car seat. Car seats that can be used rear-facing and forward-facing have different seat belt pads for each direction. It's important to use the correct belt path that's labeled on the seat or in the manufacturer's guide. If you use a seat belt, make sure that the seat belt is locked at all times and doesn't loosen. Lower anchors are attached to the car seat, and they could be used, instead of seat belts, to attach the car seat to the car or truck.

To use lower anchors, the vehicles must have anchored connectors. And all vehicles model year 2002 and later are required to offer anchor connectors. Remember to never install a rear-facing car seat in front of an airbag. The force of an airbag, that 200 miles an hour, hitting the back of a rear-facing car seat can seriously injure or kill a child. Rear-facing car seats must be installed somewhat reclined in the angle determined by the manufacturer. So if the seat is at the wrong angle, an infant's head can flop over and affect how the baby breathes. Rear-facing seats have some form of a tool, such as a leveling line or a bubble, to help you know whether the seat is at the right angle. Even if you choose the right car seat and install it correctly, it won't protect your child completely unless you position your child in the seat correctly. In a rear-facing car seat, the harness holds the child down low in the seat so they don't slide up and out. And the harness straps, as shown here, are at or below the-- at or below the child's shoulders. The crotch strap keeps the child from moving forward. If the crotch strap is too far forward, it could cause a small child to slump, and this can affect their breathing. The harness straps in a forward-facing seat, shown on the right, help keep the child in the seat and help distribute the crash forces to the strongest part of the child's body, such as the shoulders. And both harness straps should be at or above the child's shoulders.

The harness must be tightened until you can no longer pinch the webbing at the shoulders or the hips, as shown in the lower left. A chest clip keeps the harness over the child's shoulders. It needs to be mid-chest or in line with the child's armpits. When positioning your child in the seat, first, place his back and bottom flat against the car seat. Then, position the harness straps at or slightly below the shoulders of your rear-facing child. Position the harness straps at or slightly above the shoulders of your forward-facing child. And tighten the harness until you can no longer pinch any excess webbing on the harness at the shoulders and the hips when it's buckled. If the harness is to loose, your child could be thrown from out of the seat. I also should mention that you never want to add positioning pillows, cushions, or inserts that don't come with the-- with the car seat. And avoid bulky coats. They can interfere with proper harness fit. Put the bulky coat on backwards, over your child's arm and chest, after you buckle the harness. You can also put a blanket over your child, after you buckle the harness, if they are cold. The tether is a strap that's attached to the top of your car seat, as shown on the top left. It has a hook on one end that connects that tether anchor to your vehicle. Tethers are -- and that are only used with forward-facing car seats and not rear-facing car seats. The little symbol on the lower right may help you find that tether anchor in your car.

A tether holds the back of the forward-facing car seat against the vehicle seat, and it can decrease the distance that a child's head moves forward in a crash by as much as four to six inches, making it less likely that their head would hit another part of the car and cause a head injury in the event of a crash. Check your vehicle owner's manual to learn where you can find the tether anchors. They may be on the rear window shelf, the floor, the ceiling, or the back of the vehicle seat. First, install your car seat with either a seat belt or the lower anchors, and then attach the tether, and tighten it. Well, this provides some of the basics of use of car seats, so critical for protecting every child in a crash. Even more information, however, is provided in the speaker's notes in the talking points. But now let's look at some of the important questions about car seats. Do families need to register their car seat? Yes. Send in the registration card that comes with every new car seat. Or if that card is no longer available, use the link that's provided on the slide. Do families need to sign up for car seat recall notices? Well, registering your car seat will help do that. Car seats are recalled for a variety of reasons, ranging from something that affects the buckle and may affect the crash worthiness of the car seat to missing labels. Use this link to find out how to sign up for car seat recall notices. Safercar.gov however, is a wonderful website for families. It's developed by the National Highway Traffic Safety Administration. And it has a lot of easy to use information about child passenger safety and some links to really practical resources.

Do car seats expire? Many families are surprised to learn that, yes, car seats have expiration dates. They vary by the manufacturer, and they can range from 6 to 10 years. Expiration dates can be found on the label on the shell of the seat or in the owner's manual. The plastics in the shell can weaken with time, and parts can be lost or broken. And actually, older seats may not meet current, updated safety standards. So it's important to know if the seat might be expired. Is it safe to use a car seat that's been in a crash? Well, car seats are designed to protect the child during one, not multiple, crashes. They usually have to be replaced after a crash.

And families should check with the manufacturer to learn if that seat needs to be replaced in all types of crashes, including minor ones. Is it safe to let infants sleep in the car when you're not driving? No. Car seats are only for travel. Infants, especially babies younger than four months, can get into a position that creates a risk of suffocation or airway obstruction. And once you're no longer driving, it's important to move them to a crib or other appropriate flat surface as soon as possible. Car seats should also not be used as feeding devices or behavioral restraints in the house for older children. Is it safe to use a second-hand car seat? Using a second-hand seat can be risky, especially if you don't know the history of the seat. Families need to know the seat meets federal safety standards, is not expired or on recall, has not been in a crash, and is not missing parts or the instruction booklet. The safest thing to do is to get a different seat. Families need to know that the label should-- that the seat meets federal vehicle safety standards and that that information should be on the label on the seat.

Your Head Start program, as well as local community groups, may be help-- able to help a family find out where to get a car seat. What is a certified child passenger safety technician? A certified child passenger safety technician is someone with special training about the best way to protect children in a motor vehicle. They also offer their services at car seat check-up events, such as a child safety seat inspection station and car seat clinics. And you can find a technician at the link provided here. Then you enter your zip code. A certified child passenger safety technician can help you determine if your car seat is safe, check to see if it's installed properly, and help you learn how to install your car seat. Well, that's the end of my formal questions. There are resources for families to learn more in the PowerPoint and the flip chart. But now we're going to open this up for your questions.

Nancy: So Dr. Bull, thank you very much for that wonderful information. And we do have quite a few questions, so I'm going to try and go through them one by one. And if others would like to ask questions, again, just use the Q&A tab to log in your questions. And we'll do our best, since we have a bit of time, to try and answer them. So here's the first question. What age and weight does a child stop using a car seat or booster? So this person that wants to know when is it safe to not use a car seat or booster any longer.

Dr.vBull: Well, it's important to use a car seat to the highest weight and height allowed by the manufacturer of the seat because you have, in a car seat, five points where that car seat harnesses contact the body. And it distributes those forces over the child's weaker muscles and bones. So the more coverage they get, the better they're protected. When a child no longer fits in a car seat with a five-point harness, it's appropriate to put them in a booster seat. And the booster seat is designed to make the car seat -- and make the seat belt fit. The child should not be taken out of the booster seat until those points that I mentioned earlier in the slides-- and they'll be there for you to review. But the child needs to be able to sit with his bottom against the back of the seat and not slouch, to be able to have that seat belt fit across the middle of the shoulder and low and flat across their thighs, and their knees bent over the edge of the seat, preferably with their feet on the floor. When the child meets those criteria, they are usually large enough to use a seat belt and not use a regular car seat after that time. It's also important to mention -- one other quick thing is that many children are -- have some -- have behavioral issues that make them wiggle a lot in the back seat of the car, and that that might be another reason -- it is another reason to keep children in a car seat or a booster seat longer, so that they are the best protected possible.

Nancy: Thank you so much. So here is another one. Are children's sleep straps safe?

Dr. Bull: I'm sorry, I didn't hear that. So I'm not sure but --

Nancy: This person is asking, are sleep straps -- are they safe for children to use? I'm not sure if there's any more information because that's all that was in the question box.

Dr. Bull: Well, I'm trying to think what they may be referring to as a sleep strap. I'm wondering if they're thinking about some of the products that have been made for car seats to hold the head back. And there may be -- because when the child sleeps, their head up and falls forward and doesn't stay well positioned in the seat. And so there have been products designed to do that. To my knowledge, only one product -- and it's for a very large medical seat for children with special needs -- has been designed. And it's a cap that is attached with Velcro. It's been carefully crash-tested, and it's endorsed by the manufacturer of the seat. A basic rule is that one should never add anything to a car seat that hasn't been developed for that specific model of car seat by the manufacturer.

Nancy: Thank you. I think, from the questioner, that was what he was asking, so thank you very much. So here's another one, Dr. Bull. Do you have any suggestions for a child who says that her back hurts while she's in the car seat? She's five years old, and she's forward-facing in a correct seat.

Dr. Bull: Well, that's a really difficult question to respond to. So I'm assuming the child is using a forward-facing car seat with a five-point harness, and she says her back hurts. The one suggestion that -- first of all, I would not put anything behind her in that seat, like a pillow, to make it softer. That would be against the manufacturer's recommendations and make -- could potentially really make the seat unsafe. The only other suggestion I would have right off the top would be to have her try other car seats. You might go to a Target or a Best Buy store, and just try -- have her sit in other car seats, and see if she feels that her back hurts or if it feels better in a different seat. And I'd also ask, as a pediatrician, are there other places or times when her back hurts? Could she be heavy or are beginning to develop some problems? And you might want to have her referred to her primary care provider or pediatrician to investigate that further.

Nancy: Thank you. So, here, I think -- there was a follow-up question, but the questions are moving quickly. So there's a follow-up question about that sleep strap question. Is it okay -- instead of a sleep strap, is it Okay to tilt the car seat back with the safety seat to prevent a child's head from bobbing, or does it need to remain upright at all times?

Dr. Bull: The position of the car seat in the car -- it depends on the manufacturer of the seat. There are forward-facing seats with five-point harnesses that are convertible that do allow some recline in the forward-facing position. And that is a very -- can be very useful for children taking long trips or children with -- many children with special health care needs. So that would be one thing to consider -- is this a seat that can recline? But always follow the manufacturer's instructions with the amount of recline. Don't modify or change that seat yourself without being sure that it's allowed by the manufacturer.

Nancy: Thank you.

Dr. Bull: Can I ask one -- Judith Talty's here and she just reminded me. She's someone who has worked very hard on this curriculum. So she's here with me, and she reminds me that if the child's rear-facing and having that problem, be sure that it's reclined at that semi-reclined angle that I talked about earlier that's approved by the manufacturer. So rear-facing seats tend to recline more than forward-facing seats -- another good reason to use a rear-facing seat to the highest weight height allowed by the manufacturer, because it does allow for greater recline. But be sure that it's reclined at the angle that is approved, as well.

Nancy: Thank you Dr. Bull. So here is someone who's saying that her child ripped off part of the back foam piece of her car seat, and she would like to know if it's still okay to use.

Dr. Bull: Oh, and that's not an uncommon problem, and the sad news is it is not okay to use. Once that -- that foam is an important part of the safety mechanism of the seat, as it's been engineered and designed by the manufacturer. So it needs the appropriate foam. This would be something you could contact the manufacturer of the seat and see if a replacement part is available. Sometimes replacement seat padding and other parts can be obtained for a very low cost from the manufacturer. So I would call the service department of the manufacturer of that seat and check what they can do to make that a useful seat. And also remember to make sure that it's not expired.

Nancy: Thank you. So here's a question about -- if a child is 5 feet 9 inches at the age of 13, do they still need to sit in the back seat? Which gets at your question about, even though they look big, they still need to sit, if they're under the age of 13, in the back seat. So this is a child who's 5 foot 9 inches at the age of 13.

Dr. Bull: How tall is -- he's 5 feet 9 --

Nancy: Nine. Nine. And 13 years old, and which is the age that you said that they could switch -- after 13 they could switch to the front. So this person would like to know if they're just 13, but 5 foot 9, do they still need to sit in the back?

Dr. Bull: So there-- 5 feet is -- 5 times 12 is 60 -- 69 inches. They're tall if they're 5 feet 9.

Nancy: Yeah.

Dr. Bull: They're really tall. I was trying to understand that. Okay, so they're tall and they're 13. They can sit in the back. Yes, they can sit in the front if they're 13. When they're teenagers -- if you can sit in the front. That's one way I talk to my patients is, when you're child's a teenager and turns 13, that is the statistically safe time for that child to sit in the front seat.

Nancy: Okay, great. Thank you. So for child safety, is it true that the winter coat needs to be removed before placing children into car seats? You talked about that a little bit. I think somebody just wanted to confirm.

Dr. Bull: I mentioned that very briefly because if you put a really puffy coat on the child, the risk of making that harness too loose -- because it will compress in a crash -- could be too loose and cause greater injury to the child. So the recommendation is that for heavy winter clothing -- that it be placed over the child, backwards -- on backwards after they've installed the harness system.

Nancy: Great, thank you. So we all know that sometimes families have children who are close in age or multiples. So where would you recommend placing two booster seats in a back seat?

Dr. Bull: Well, the placement of the -- all car seats in the car is determined by many things. And this is where a child passenger safety technician can be very helpful in evaluating the seat belt systems that are in that car. The seat itself- - where does it fit? Seats fit differently in different vehicle models. For instance, if your seat is the car -- the vehicle seat, the car or the truck has a hump in the middle, it may not really be appropriate for the placement of a car seat. So all of those factors are things to be considered. And a child passenger safety technician at an inspection station can be very helpful in helping the family decide how best to place their children in the car.

Nancy: Thank you, Dr. Bull. So here's another one. If a child has reached the height limit but not the weight limit, can they remain in a rear-facing infant car seat?

Dr. Bull: No, they need to change to a forward-facing seat when either the height or weight limit has been reached. And that's true for all models of car seats -- that it's the height or weight at the highest point allowed by the manufacturer of the seat.

Nancy: Great. So I'm going to switch gears on you a little bit because there are several folks who are really interested in harnesses on school buses and want to know if you have any suggestions about what would be the best harness to use on a school bus. So this is probably Head Start folks who are driving school buses and want to know about harnesses on their buses.

Dr. Bull: Yes, well, I'm actually going to ask JT If she'd like to come over and answer that question. She's very experienced and has been -- has been teaching the National Highway Traffic Safety Administration's transportation on school buses curriculum over the past several months. So at this point, I'm going to give the phone to Judith Talty, who's the director of the Automotive Safety Program here at Riley Hospital.

Nancy: Thank you so much, and welcome, Judith. Thank you for answering our bus questions. Hi.

Judith Talty: Hi. Basically with school buses, it depends on what size bus it is in terms of what type of occupant protection can be provided. The really small buses that are under 10,000 pounds will have seat belts, so it's conceivable you could use a child's car seat in there. With the larger buses, they don't have to have seat belts, so a lot of creative people have come up with some really nice options, which are add-on restraints, specifically for the school bus. And those are made by different manufacturers. Some buses also now have integrated seats. So they're built into the school bus seat. And then, as the question referred to, there are some harness systems that attach to the bus seat, as well. And it's just a matter of the type of school bus, what the child needs. You really want to make sure that they're buckled up in the most appropriate restraint for them. But it's very encouraging to see different school districts going to integrated seats or specific school bus add-on restraints that provide more support.

Nancy: And as you know, in Head Start, we follow the federal transportation regulations, which requires that all children be in an appropriate child passenger restraint system on the bus. So in the beginning, folks were just trying to retrofit their -- or figuring out if they could retrofit, and now it sounds like there are more options that are available on the market for folks who are buying new buses when they age out and need to be replaced. Any other questions on buses? I'm sorry. Go ahead, Judith.

Judith: Oh no, that's okay.

Nancy: Any other questions about buses? So I'm just going to scroll through and see if we've gotten most of the questions. I think we have. So if you have a question that we haven't answered, please feel free to ask. I wonder if you could tell us a little bit about the child passenger safety technician, and whether or not they are available in most communities across the country, and whether or not you have experience with actually having them come out, like to do a parent night. I know some of our programs have wanted to have parent nights where folks can check the car seats to make sure that they are actually installed correctly because lots of times, in my experience, we've learned that parents have car seats and are surprised to learn that they weren't installed in the car or truck properly.

Dr. Bull: Well, it's very common for parents to think they've done everything correctly and then discover that there really was something they could have done to make that seat safer. I would love to talk about child passenger safety technicians because there are over 37,000 certified child passenger safety technicians in this country. And they are all especially trained. They have a three and a half to four day training with a lot of experience. And they all -- it's amazing requirements. They have to be re-certified. And one of the things that is part of that re-certification is doing the community event. So it is really a not -- it is very reasonable that there might be a child passenger safety technician in the community that would be happy to come and talk to parents about car seats. I know it's also possible, in many communities, to arrange a car seat check-up event at a Head Start or early childhood facility. We're doing that in Indianapolis, and it's been extremely well received and very popular. So I would encourage Head Start staff and early childhood program developers to consider the safety of transportation as an important part of what they do in their programs and to reach out to the local resources. Safe Kids Worldwide has chapters across the country, as well as the child passenger safety technicians that exist in absolutely every state. They may be more populous in some areas than others, but they are everywhere. And they're very eager to participate.

Nancy: Somebody was really impressed with the fact that there are 40,000 technicians across all the states.

Dr. Bull: Not quite 40 -- 37,000, I think. But I may be off by a thousand or two, but it's not-- it's a lot.

Nancy: Yeah, it is a lot. And if somebody who works in a child care program, Dr. Bull, or a Head Start program decides that they want to take the training so that they can then come back and work with their families and show other staff what they've learned, is that something that you encourage folks to check out, as well?

Dr. Bull: Absolutely. That would be the very best if they had someone in their program that could take that training and then provide advice and counseling for the other staff, as well as the families. And you find out how to -- I want to make sure I see this correctly -- but at the -- we can provide them a link with Safe Kids Worldwide. It's called -- it's just Safe Kids Worldwide, Find a Tech -- certification -- under cert. Yeah, the website is Cert.SafeKids.org -- Cert.SafeKids.org. And they can- - all the classes are coordinated through Safe Kids Worldwide, and you can find a class in your community at Cert.SafeKids.org.

Nancy: Thank you, Dr. Bull, and before we close out, everyone, we're going to advance the slides. And you'll see that we listed Safe Kids Worldwide as one of their resources. And so if you can just -- if you can't remember the link until you get a chance to get a hold of the slides, if you just go to that website, you'll be able to search for a safety technician. And here's a program that says that they are sending some of their transportation staff to become certified, so that's very exciting. And actually, someone else is sharing that the state of Mississippi, I think, provides car seat safety installation at local health departments for parents who can receive free car seats, and they also provide a short session to parents on safety, on oral health and nutrition, to prevent snacking in car seats and minimize decay risk. So I share that because one of the participants wanted to share that with you all. And perhaps you are from that state and didn't know about that resource. And someone else has entered the Cert.SafeKids -- so C-E-R-T-dot -— SafeKids.org. There's a follow-up question about Early Head Start. And I think I just lost it because a lot of questions just came in. Hold on. I'm trying to see if I can scroll back. Oh yes, here it is. I'm sorry. For Early Head Start, when is it okay for a one-year-old to transfer out of a rear car seat into the five-point seat?

Dr. Bull: Well, so first of all -- yes, a one-year-old. So a rear-facing only car seat also has five points, by the way. So it is a five-point harness. That added value of a rear-facing only car seat in keeping your child in transfer from a rear-facing only child car seat to a convertible seat placed rear-facing --  remember, that convertible seat is one that can ride rear-facing and then turn forward-facing when the child reaches the highest weight and height allowed by the manufacturer of that seat. Usually, for most of them, it's 40 pounds. So that child can ride rear-facing and get that added benefit of the protection that distributes the forces along the entire head, trunk, and back of that child to prevent neck and spine injuries as high as 40 pounds. And we strongly recommend that. The American Academy of Pediatrics recommends children ride rear-facing until they're at least two and to the highest weight and height allowed by the manufacturer of the seat because of that added protection. I'd like to make just another comment about the American Academy of Pediatrics because it is a resource for families, as well. And it's listed on our resource list under HealthyChildren.org. And every year, we publish a car seat guide, which gives the -- all the manufacturers send us the specifications for their car seats that they're manufacturing currently. And those are listed by type of seat, the weight and height, and rear-facing and forward-facing requirements for that seat. So it's an easy resource online for families to sort of let their fingers do the preliminary shopping and see what might be best for their needs. That's sounds great -- a wonderful resource for people to know about. So I'm wondering -- did you think you might want to show folks some of the resources on the next slide because we're getting close to the end? You know, I lost the slides, somehow. They're just gone.

Nancy: Okay, so you know what -- I'm going to do it.

Dr. Bull: That would be great.

Nancy: Okay, so here they are. Can you see it now, Dr. Bull? Can you --

Dr. Bull: I can't see it now, no, but if you have "Resources for Families to Learn More." Is that the resource list that's up?

Nancy: Yes, it is.

Dr. Bull: Yes. And the American Academy of Pediatrics is up at the top. The National Highway Traffic Safety Administration, SaferCar.gov, that has wonderful information. We mentioned Safe Kids Worldwide, and you can go directly to Cert.SafeKids.org for how to find a class to take for child passenger safety. And then the CDC has additional information and specific information for tribes.

Nancy: That's wonderful. And someone else is saying that they also, in their program, have seat technicians and fitting stations. This is in South Carolina. And the program is administered through the South Carolina Children's Trust and the Car Seat Coalition, which is housed at the Trust. So I think that if you go and check out some of these resources and didn't know about what was available in your state, that hopefully -- we're hoping that you'll find that there are resources that you can use with the families that you serve in your program. So I think we're pretty close to the end, now. And there are lots of questions about, how can we get a copy of the slides and also the flip chart, which April has answered for those of you who have asked, but I'm sure other people are wondering the same question. So all I can say is that it's very close to being released. The webinar, including all of the questions and the answers, will be recorded in the transcript that gets posted on the Office of Head Start's Early Childhood Learning and Knowledge Center. And the flip chart will be available very, very soon because we are in the process of just designing it. So it should be available before the end of the year. So I think that we are close to the top of the hour. And I'm just going to advance the slide so that you can see -- if you have additional questions that you think of after you end today, and you want to ask us, please use our info line -- health@ecetta.info. And we also have a toll-free number, and we're happy to answer your questions. And I hope those of you who are on MyPeers will be able to start a great dialogue about what you're doing in your programs and resources that you know that are available on the health, safety, and wellness community on MyPeers. So, I think, Dr. Bull, unless you have any other final remarks, that that covers it for today.

Dr. Bull: No, I just want to thank everyone for your participation and enthusiasm. And we look forward to working with you in the future.

[End video]

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