Buckled-up children: understanding the mechanism, injuries, management, and prevention of seat belt related injuries.

In the United States motor vehicle crashes are the leading cause of death in children. Although laws and public awareness campaigns have increased the use of passive restraints, many children continue to be unrestrained or improperly restrained. Age-appropriate child restraint systems are a vital means to prevent injury and death. The young school-aged child presents unique challenges to standardized vehicle restraint systems. As these children outgrow child safety seats, they frequently are placed in lap/shoulder belt systems designed for the adult. When prematurely graduated to the vehicle's restraint systems they are predisposed to injuries to the abdomen and lumbar spine known as the "seat belt syndrome" or "lap belt complex." These injuries often present subtly, and are not as obvious as the often life-threatening injuries found in the unrestrained pediatric trauma patient. However if undetected or missed these injuries can significantly impact the child's recovery and functional outcome. This article will provide a comprehensive overview of pediatric seat belt injuries. Content will explore the mechanisms responsible for producing the typical patterns of injury, recognition of these potential injuries during the trauma assessment, diagnostic evaluation and management of children with suspected or actual seat belt injuries. Prevention strategies will be discussed that will enable trauma nurses to effectively advocate the use of booster seats for the young school-aged child.