Anticipatory guidance about child safety seat misuse: lessons from safety seat "checkups".

OBJECTIVES To quantify the frequency of improper child safety seat use and to identify the most common mistakes in safety seat use, so that priorities for anticipatory guidance about misuse can be identified. DESIGN Descriptive survey of types and frequency of safety seat misuse. SETTING Eleven safety seat "checkups" sponsored by the Louisiana SAFE KIDS Coalition in southeastern Louisiana in 1998. PARTICIPANTS Convenience sample of parents recruited for checkups through local media and sponsoring businesses. Three hundred seventeen child safety seats were checked. RESULTS Of the 266 forward- and rear-facing seats checked, 250 (94%) were installed incorrectly. Sixty-one (23%) of the seats had minor misuse or were correctly used, 107 (40%) were partially misused, and 98 (37%) were extensively misused. The 3 most frequently found problems were seat not belted into vehicle tightly (142 [88%] of forward-facing seats and 84 [81%] of rear-facing seats), safety seat harness straps not snug (70 [43%] of forward-facing seats and 49 [47%] of rear-facing seats), and harness retainer clip not at armpit level (55 [34%] of forward-facing seats and 38 [37%] of rear-facing seats). CONCLUSIONS As part of the routine anticipatory guidance offered during well-child visits, health care providers (ie, physician, nurse, or nurse practitioner) should counsel parents specifically about these 3 frequent errors in child safety seat use.