Pediatrician Recommendations today [Archive] - Car Seat.Org - Carseat, Vehicle & Child Passenger Safety Forums

fyrfightermomma

03-21-2008, 11:52 AM

So today I took my daughter for her 12 month check up (she turned 1 on the 19th). She weight 22.5 pounds.

I was curious to what his answer would be to the question I was planning to ask which was "I've heard they started recommending kids stay rear facing longer....which way should be daughter face now??" I obviously know the answer, but wanted to see what'd he'd say.

For DD1 he recommended FF at 11 months at 18 pounds because she was "close enough"

Well his answer was "they recommend they must be 1 AND 20 pounds. After that point they have found their necks are strong enough to take a crash force and they can be forward facing, so your daughter can face forward now" :eek:

My thoughts are if the American Acadmey of Pediatrics is recommending ERF and Peds are suppposed to follow those recommendations....why aren't they???

I can just imagine all the parents he's told that too....its really sad

tl01

03-21-2008, 12:27 PM

SafeandSecureBaby

03-21-2008, 12:45 PM

A good reply to the Doc's statement would have been "Who are they?"

If he/she gives you an answer such as the AAP or anyone else, ask to see the study or conclusions that "they" provided.

I am not aware of a study that showed kids necks are strong enough to take crash forces at one and twenty pounds. Indeed, the studies that are actually available would seem to say just the opposite. (See Car Safety Seats For Children: Rear Facing For Best Protection; Injury Prevention 2007; 13:398-402.)

Further, morbidity and mortality reports released by The Center for Injury Research and Prevention have shown multiple incidents of FF children (usually under age two) suffering spinal injury and/or death which were likely not to have occurred if the child was RF.

Unfortunately, doctors are trained to see and treat abnormal conditions. There are some doctors that because of their training try very hard to find the abnormal in the normal. The old saying, when all you have is a hammer, everything looks like a nail, fits more than it should. Also, training in medicine, can, but usually doesn't include bio-mechanics or crash dynamics. Thus, many doctors are no more, and often less educated on child-passenger safety than those that read and post on this forum. Child passenger safety is not an abnormal condition and does not fall into the realm of medicine. Frankly, unless a doctor has special training, i.e., is a CPST, their advice on CPS is no better than the average Joe on the street. However, because they havd M.D. after their name, parents are more likely to trust them on CPS matters, sometimes to their child's detriment.

armyfam

03-21-2008, 12:54 PM

That happened to me too. In fact, the paper they pass out at the appointment says to turn the car seat around! Very frustrating:mad:
I explained to her Ped why its safer to RF but she didn't seem to take me seriously. When I got home, I spoke to the office and a more "Senoir" Ped at the office and she understood what I was saying. To my disgust, at her 15 month appt this month, the paper passed out says "to continue to put your child in a convertible car seat FF"! Not sure what I should do next?

Mommy2Marcus

03-21-2008, 01:00 PM

Hiya Ladies! My ped also told me that I could turn my DS around at his one year. I did, but was for car sickness. I plan to take some information to her about ERF when I take DS in for his 18 month in a few weeks. I also want to take her some information on EHing as well. I think she will actually listen to me as she is a very understanding ped, but she may not. I really hope she does. I have since turned my DS back to RF & am LOVING it. I am SO much happier with him RF knowing he is safer. I would recommend giving them the information to read instead of just telling them. I am also going to be giving her the link to the youtube video with the crash test on it! I think this will really help. I am also going to be giving her links to the information on EHing as well with links to videos that tell about kids having died from being in a booster to soon! The Kyle David Miller Foudation being one of my links!

crunchierthanthou

03-21-2008, 01:05 PM

Apparently he doesn't subscribe to or read the journal Pediatrics. They had an article about the importance of erf to the limits of the seat this month. The title was, Rear Facing Car Safety Seats: Getting the Message Right. It stated several times that rf was 5 times safer than ff under age 2.

fyrfightermomma

03-21-2008, 01:36 PM

Stella's Dad

03-21-2008, 01:42 PM

SafeandSecureBaby

03-21-2008, 01:55 PM

The commentary is in the March 2008 issue of Pediatrics, Volume 121, Issue 3,

The citation is: Bull, Marilyn J., Durbin, Dennis R.
Rear-Facing Car Safety Seats: Getting the Message Right
Pediatrics 2008 121: 619-620.

An extract of the article can be found here: http://pediatrics.aappublications.org/cgi/content/extract/121/3/619

However, to get the full article, you will either need to have a subscription to Pediatrics, or check your local library to see if they subscribe to the periodical. All University libraries that have a medical school will have the magazine as part of their collection.

tanyaandallie

03-21-2008, 01:57 PM

Wow, where can I get a copy of that to hand out to the other parents in the carpool line?

I'd love to hear where to find a copy as well. At my ds's 15 mos check up he hit 20 lbs and my ped joyfully announced he could ff! I told her he would not be ff and she looked at me as if I had grown 2 heads. I am going to take her some info at his 3 yr apt in a few weeks.

christineka

03-21-2008, 02:02 PM

Two years ago my dd's ped told me it was okay to ff my 17 pound 1 year old. She reached 20 pounds at 22 months of age.

My ds goes in for his 12 month check up on Monday. (He's actually 14 months though.) I have a handout with erfi on one side and eh on the other. (It is a double appointment. My older ds is having his 5 year checkup.) I'm going to give the handout to the ped. I think she honestly doesn't know much about car seats because she has no children of her own. She's pretty open about not vaxing, cloth diapering, and relaxed homeschooling. (In fact she told me not to put my dd into public school.) I think she may be very open to learning about car seat safety.

Christine

PixieEMT

03-21-2008, 02:09 PM

My DS just had his 18 month check up.
I took some ERF propaganda with me to his check up and was straight forward with the staff. I provided the "RF Unmatched Safety" brochure, ERF materials from KDM foundation and the article from New Zeland about a little girl that sever injuries from FF at 18months. :D

My ped told us to FF at 3 months old! He lied to us after I called him out about ERF and said "I've always told parents to RF until 1 y/o and 20lbs." I hate LIARS! :mad: Thank goodness I knew 1 y/o and 20lbs, before my CPST training and learning about ERF! He was riding in a FPSVD and Comfortsport after he blew out of his Snug Ride.

I filed a complaint with the HR department about his dangerous FF recommendations.
He asked to keep my ERF materials and wanted to make copies for parents. So, maybe it got through.:shrug-shoulders:
Sara

crunchierthanthou

03-21-2008, 02:09 PM

I have it in pdf version, but I don't know how it works for mass distribution. I suppose not a lot different than going to your library and photocopying the pages. :shrug-shoulders: PM me with your email if you'd like to read it.

There are also these articles (which were referenced in the Pediatrics article)-

Car safety seats for children: rear facing for best protection (http://injuryprevention.bmj.com/cgi/content/abstract/13/6/398) (abstract only)

SAFETY FOR THE GROWING CHILD – EXPERIENCES FROM SWEDISH ACCIDENT DATA (http://www-nrd.nhtsa.dot.gov/pdf/nrd-01/esv/esv19/05-0330-O.pdf)

jdubsm

03-21-2008, 04:18 PM

I asked my ped this year on what she recommended for RF even though my kids are past rf limits. She said that she's lucky to get most parents to do the 1yr/20lbs so she doesn't push ERF.

snowbird25ca

03-21-2008, 04:36 PM

The AAP official policy is rf to the limits of the seat, so all of these pedi's aren't up to date on the current policy of the AAP apparently. I don't have the link, but I'm sure someone around here does. ;)

I'd print out the policy of the AAP and take that in. As well intentioned as the youtube video and other materials are, unless it's coming from the AAP itself or a journal like injury prevention or pediatrics, most dr.'s aren't going to pay attention to or trust the information. So I'd really focus on getting those references/articles, and a copy of the AAP and not worrying so much about anything else...

So that would be my line of attack - cite the pediatrics article and bring in a copy of the AAP stance. Then tell him/her that if they'd like help with info to provide to parents, you'd be happy to assist with more materials. Youtube is great for parents, but dr.'s are much more evidence based for the most part and a video published on youtube likely isn't going to meet their standards for evidence based medicine - however accurate the video may be. :thumbsup:

Jeanum

03-21-2008, 04:44 PM

AAP Policy statement link: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;109/3/550

Here's the really pertinent part:

Seat Selection

1. 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.3,4 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.3

Note the date of this policy statement is 2002, and the AAP's ERFing recommendation goes back at least that far in time. It's not exactly a super new-fangled recommendation from the AAP now that it's 2008, yet word still needs to reach peds. out there.

firemomof3

03-21-2008, 06:51 PM

I have a very open minded pedi. so at my daughter's 2y/o appointment next week I have some handouts for him to show him the extreme benifits of extended RF & FF!! Because I know I have never heard him say anything to me about car seats, so maybe he'll see how many other parents just need the education! I will let you know how it goes! :thumbsup:

NHCPSTECH

03-21-2008, 08:59 PM

What I don't understand is why a CPS Tech would ask a Pediatrician a question about car seat usage when they already know the correct answer to the question. By pretending you don't know the answer, and then receiving the wrong answer, how do you maintain your professionalism and credibility as a CPS Tech when at this point you have to (or should) do a complete 360 and suddenly start talking like you DO know the answer. I think the doc might be kind of embarrassed if you trick him into telling you something you know is wrong. And as a CPST, we should be obligated to provide the correct info. Our goal should not be to catch ignorant Peditricans giving out wrong info but instead empowering them to give out correct info. There's a big difference and the latter is much much more effective. The Pediatrician should be the CPST's ally not enemy.

This is just what always comes to my mind when I read threads like this..

R.

Kat_Momof3

03-21-2008, 09:46 PM

this is why I was so thrilled when our ped (who I picked by virtue of it being the one the insurance picked on two of the three cards... so I called both, picked the friendlier receptionist on the one that was on two cards, and figured I'd give them a shot.... it's a practice with 4 peds and I love them all) office gave out handouts... have not said anything carseat related unless there is a question about the handouts... and the handout for the baby checkups always said... if baby outgrows the infant seat, they need to be moved to a bigger rearfacing convertible carseat.

the one for all the ones up to the 1yr checkup says they MUST

then the 1yr checkup says (can't remember exact wording) something to the effect that if they way 20lbs they can be forward facing, but to check the carseat manual, that many carseats rearface for much longer, that rearfacing is safest, and that the AAP recommends rearfacing to the limit of the convertible carseat.

I knew they were better than most, but I really never knew that most peds weren't at least good about knowing the minimums and deferring to "the longer you ____ the better" when it came to breastfeeding, rearfacing, harnessing, etc.

the peds I've had before, I know I got lucky with.

This time, I would have said BLESSED.

I just can't believe some of these docs that feel they are qualified to give advice and yet don't keep up to date on the plethora of info.

southpawboston

03-21-2008, 10:54 PM

I can't understand why they don't follow the new recommendations unless they just aren't paying attention to them. None of my docs have ever mentioned anything about car seats except one mentioned that DS would have to go into a convertible soon when he was 6 months but I tried to explain I had a SS1 and that wasn't the case. If our new ped mentions anything at our 2 year visit then he will surely get an earful from me.

doctors have to read an OVERWHELMING amount of medical literature to stay current, and even the best doctors can't possibly stay current on everything while keeping full-time hours. something has to get left out. frankly, i'd rather my ped be up to speed with current *medicine* than carseat recommendations. :twocents: if i need carseat advice, i'll go to a seatcheck. if i want medical advice, i'll go to my ped.

What I don't understand is why a CPS Tech would ask a Pediatrician a question about car seat usage when they already know the correct answer to the question. By pretending you don't know the answer, and then receiving the wrong answer, how do you maintain your professionalism and credibility as a CPS Tech when at this point you have to (or should) do a complete 360 and suddenly start talking like you DO know the answer. I think the doc might be kind of embarrassed if you trick him into telling you something you know is wrong. And as a CPST, we should be obligated to provide the correct info. Our goal should not be to catch ignorant Peditricans giving out wrong info but instead empowering them to give out correct info. There's a big difference and the latter is much much more effective. The Pediatrician should be the CPST's ally not enemy.

This is just what always comes to my mind when I read threads like this..

that is a very good point. :thumbsup:

crunchierthanthou

03-21-2008, 11:15 PM

doctors have to read an OVERWHELMING amount of medical literature to stay current, and even the best doctors can't possibly stay current on everything while keeping full-time hours. something has to get left out. frankly, i'd rather my ped be up to speed with current *medicine* than carseat recommendations. :twocents:

I see your point, except this has been the AAP stance for at least 8 years. If they're still recommending 1 and 20 or saying "11 and 18? close enough..." then they are almost a decade out of date. Also, most visits to the ped are well child check-ups. The office we go to hands out a sheet that includes car safety information at each appointment. That's roughly 9 opportunities per child through age 2 to expose the parents to the erf message. While I wouldn't go to my ped for carseat advice, most parents don't even think to look anywhere else.

I agree that playing "gotcha" and being beligerant isn't going to work, but I do like to hear of peds who are pro-erf.

jwren

03-22-2008, 12:01 AM

This is exactly why I take things into my own hands when it comes to any health issues, and use the internet to help me ask the right questions back to them. For me, I go in better prepared to ask the right questions when I research it first.. Otherwise I always feel like they are missing things. They don't live with you so how do they know or see exactly what you do? they don't. If I had not been this persistent my 2 1/2 yr old would not have been in early intervention for his speech delay, which was due to chronic ear infections, which the docs also missed, (they knew he had them but didn't add them up or ask for a hearing test, which I insisted on). I just knew he was having them too much, turned out he needed ear tubes and was having trouble hearing us clear do to the fluid...so I have learned you HAVE TO be proactive when it comes to your health and your families health, cause noone else has the time to worry about you...not that they don't care..

Same thing with car seats, I am teaching what I learned and most don't have a clue... they either think you are nuts or think it and don't say anything... :( This is really a tough one cause most parents just are not told the right things. I wish it was just the law for the country to follow instead of leaving things up to each state.. This country needs tough laws to protect our children in vehicles, and we honestly don't have them, and we sure don't have any training either. Noone teaches us how to keep them safe while traveling. We just read boxes at the store or read things online. There is no formal guidance, not at the hospitals, pediatricians, or even the teachers have anything to say, unless you happen to ask and then it's not always the correct answer. Lucky for me (is now how I look at it) I had two preemies, and preemies being released from the hospital have to have the car seat test...so I had to learn it all before they came home... why not do that to every baby born? Why just the preemies?

It's a sad situation, it really is. It's a shame. I wish we could somehow push till it becomes law that all children in every state be protected while traveling the "correct" way for their size and weight.. etc... I am talking real true guidelines that make a difference. Why can't this just happen...;)

PS: I know I strayed from the subject a little, but thought this was an important thing to add..;)

doctors have to read an OVERWHELMING amount of medical literature to stay current, and even the best doctors can't possibly stay current on everything while keeping full-time hours. something has to get left out. frankly, i'd rather my ped be up to speed with current *medicine* than carseat recommendations. :twocents: if i need carseat advice, i'll go to a seatcheck. if i want medical advice, i'll go to my ped.

that is a very good point. :thumbsup:

oxeye

03-22-2008, 12:07 AM

If anyone needs it, I also have access to the full-text of the article and have it saved as a pdf. PM me if you want it.

singingpond

03-22-2008, 08:50 AM

These pediatrician threads always make me glad that our ped. does not volunteer any advice on carseats. It has never occured to me to ask, either, since I don't really consider carseats to be a medical issue, and I don't expect him to cultivate any particular expertise in this area. However, I do wonder what he would say if asked directly for carseat advice (as I'm sure many parents do ask the ped). Maybe I'll ask what he usually recommends, when I take DD in for her 1-year visit, but probably the appointment time will be taken up by medical questions, and I won't remember the off-topic stuff. It would seem sort of like asking my own doctor, during my annual physical, if she happens to have opinions about which cars are safer to drive -- just not a conversation that is very likely to take place....

Katrin

fyrfightermomma

03-22-2008, 09:16 AM

I agree that asking doc's about carseat safety is like asking your doctor about safe cars...its just not their thing...but the hard facts and unfortunate facts are that alot of parents DO ask, and I know multiple parents who ONLY listen to their peds advice, because hey, they know best. So when you have that many people taking their recommendations seriously and say ours not so seriously becuase we are all crazy carseat people :) then I think they do have to work on providing that correct info.

At well child checks they also go over injury prevention, drowing prevention, illness prevention. Their job is to keep your child healthy as well as fixing them when they are sick. Carseat safety is just one more thing to keep your child safe. Just my :twocents:

And I agree, that wasn't best on my part to "lure" him into answering the question wrong when I knew he would. I just wasnt thinking.

I guess my problem didnt fall so much with him recommending 1 and 20 becuase well, most do and thats the general conscensus (sp?). I had the problelm with the part where he said "they found that at 1 year old their necks are strong enough to take the force of an accident" because well, that isnt true, theres no evidence that says that atleast not anything published in the past few years. If he had stopped at just saying 1 and 20 I would have been fine, but when he added that as "evidence" is where my problem started. If he honestly didnt know the reasons behind it he should not have said it in my opinion. And I thought the real reason they started recommending 1 and 20 was not because at 1 you are magically strong enough to FF in a crash, but because back in the day seats only rear faced until 20 pounds so you HAD to FF and thats where the 1 and 20 thing came from. Am I wrong??

PixieEMT

03-22-2008, 03:21 PM

At well child checks they also go over injury prevention, drowing prevention, illness prevention. Their job is to keep your child healthy as well as fixing them when they are sick. Carseat safety is just one more thing to keep your child safe. Just my :twocents:

And I agree, that wasn't best on my part to "lure" him into answering the question wrong when I knew he would. I just wasnt thinking.

I guess my problem didnt fall so much with him recommending 1 and 20 becuase well, most do and thats the general conscensus (sp?). I had the problelm with the part where he said "they found that at 1 year old their necks are strong enough to take the force of an accident" because well, that isnt true, theres no evidence that says that atleast not anything published in the past few years. If he had stopped at just saying 1 and 20 I would have been fine, but when he added that as "evidence" is where my problem started. If he honestly didnt know the reasons behind it he should not have said it in my opinion. And I thought the real reason they started recommending 1 and 20 was not because at 1 you are magically strong enough to FF in a crash, but because back in the day seats only rear faced until 20 pounds so you HAD to FF and thats where the 1 and 20 thing came from. Am I wrong??

:question: Good question and thought about the 1 y/o and 20lbs , back in the "old days".
Looking at some old gems that I have found recently from the late 80s early 90s most of those shield seats only RF to 20lbs! Not to mention only had 2 MAYBE 3 sets of harness slots if you were lucky! :thumbsdown:

The LPN at our peds office has two DD that were probably born between 1989-1991. She (the LPN) had no idea that CS now go up to 35lbs RF! :) Her DD were in that era that you had to FF with the seats they had. She was very interested in the materials I left behind last week.

snowbird25ca

03-23-2008, 02:46 AM

:question: Good question and thought about the 1 y/o and 20lbs , back in the "old days".
Looking at some old gems that I have found recently from the late 80s early 90s most of those shield seats only RF to 20lbs! Not to mention only had 2 MAYBE 3 sets of harness slots if you were lucky! :thumbsdown:

I saw an AO at a seat check in 2007 that expired end of 2008 and it had a 20lb max rf'ing weight limit and 20lb min ff'ing. I had never seen a 3in1 with a low rf'ing weight limit, at first I thought the parent was wrong, then I was sure it must be expired, but the seat wasn't expired and the stickers clearly said 20lbs.

So it really wasn't all that long ago that seats only rf'ed to 20lbs. (AO had either a 7 or 8yr expiry date stamped... I know all new ones have an 8yr, but I don't recall the time frame this one had.... just that it wasn't expired and that erf'ing wasn't an option in that situation with that seat.)

(OK, I'm doubting myself on the 20lbs thing since it's dorel and wondering if it might've been 22lbs? Anyone remember? And it was a 5pt seat. :thumbsup: )

Melizerd

03-23-2008, 08:08 AM

I have a friend who's a family practice doctor in Maine and I actually asked him about it.

He said that even though the AAP updates their site etc that two things happen, not all doctors receive the information and not all of them read it. There's just too much info for them to keep up on EVERYTHING so many of them skimp on carseat information especially because they feel it's not really a medical issue.

Luckily his wife is a carseat nut herself and did his reading for him so his kids were both ERFers :D Too bad he's not closer to me. I'd take my son to him in a heartbeat. He's always level headed and presents both sides of the arguments to me when I ask him questions about stuff :D

ETA: My doctor only asks if my child is in a carseat and doesn't ask which direction he's facing. She doesn't ever ask about stairs/drowning stuff after the first appt either. She went over those safety things (like the water heater temp etc) at the first and maybe the second well child check but after that she hardly mentions them. At his 15 month check she didn't even ask if he's in a carseat at all.

krystin_21a

03-24-2008, 02:36 PM

I am actually a little nervous about what my sons pedi will say here in a couple of weeks. He is a light weight (about 18 pounds, maybe on a heavy day!) and we are planning on staying RF as long as possible. I would really hate to fight with this man as he is a great pedi, but I seriously hope he has his info correct.

mommyto2angelgirls

03-24-2008, 03:25 PM

joolsplus3

03-24-2008, 03:33 PM

So here's the 'they' he was probably referring to: (Kathy Webber, this is a pretty old article, though)

http://parenting.ivillage.com/baby/bsafety/0,,9r5v,00.html

"In the research and accident review(2) that I did a few years ago, the data seemed to break at about 12 months between severe consequences and more moderate consequences for the admittedly rare events of injury to young children (http://parenting.ivillage.com/baby/bsafety/0,,9r5v-4,00.html#) facing forward that we were able to identify. One year old is also a nice benchmark, and the shift to that benchmark in the last few years has kept many kids in a safer environment longer and has probably saved some lives, some kids from paralysis and some parents from terrible grief."

As we see, she doesn't say they are automatically strong enough at age one, but that the consequences are less severe at age one. Big difference!

mish

03-24-2008, 04:40 PM

my pedetician must be out of the norm. she talked to me about my dd1. not about erf (she is too big anyway) but about extended harnessing. she asked what kind of car seat i had as she is within 5 lbs of the 40 lb limit on most seats. she said that with my daughters height and body build she does not condone her going into a belt positioning booster. she recommend a marathon, regent or nautilus. she was very happy to know i had a marathon for her and that she would be harnessed as long as possible. its reassuring that she knows about these things as i am seeing many don't

I can't believe your ped. would already be recommending a Nautilus. She must be really into car seats to know about that one. It has been out for such a short time that unless you were car seat "nerds" like us most people don't really know about it. I know that a lot of techs don't even know about it. Congrats on having a Dr. that is so safety minded!

Stretchy Glue

03-24-2008, 04:52 PM

My dd's/my doctor has an 11 month old son and at my last visit asked me about it. She thought she understood to keep him rf longer, but wanted to double check from a 'car seat expert'. She's emailed me twice with questions also for other patients. She even passes out my business cards. She admits that she doesn't know it all so she refers to her personal "expert" from time to time. I don't mind at all.:o

Stretchy Glue

03-24-2008, 04:57 PM

my pedetician must be out of the norm. she talked to me about my dd1. not about erf (she is too big anyway) but about extended harnessing. she asked what kind of car seat i had as she is within 5 lbs of the 40 lb limit on most seats. she said that with my daughters height and body build she does not condone her going into a belt positioning booster. she recommend a marathon, regent or nautilus. she was very happy to know i had a marathon for her and that she would be harnessed as long as possible. its reassuring that she knows about these things as i am seeing many don't.

Wow, with the nautilus out for just a month or so, I find it really surprising that a ped would have any clue about it. You must be lucky.