History of Car Seat Recommendations

We have come along way since the old days when kids would ride around without seat belts in the front seat of the car. Or a bunch of kids would ride packed into the back of a station wagon, also without seat belts.

In those early days, kids weren’t necessarily safe even if they were strapped in while in the car…

In 1938, Popular Mechanics offered instructions on making your own car seat.
In 1938, Popular Mechanics offered instructions on making your own car seat. Problem solved!

A leash might keep your child from jumping out of the car, but offers absolutely no help if you get in an accident.
A leash might keep your child from jumping out of the car, but offers little help if you get in an accident.

Anyone remember when cars didn’t even have seat belts? It’s hard to imagine, but three-point seat belts, the lap and shoulder harnesses that we use today, didn’t become standard in cars until 1968. Before that, many cars just had optional two-point lap belts.

Latest Car Seat Recommendations

Do your kids ride safely when they are in the car?

According to the latest recommendations from the American Academy of Pediatrics, kids should ride:

  • in a rear-facing car safety seats in the back seat until they are 2 years of age or reach the weight or height limits of their car seat
  • in a forward-facing car safety seat in the back seat for as long as possible and until they reach the weight or height limits of their convertible or forward-facing car seat
  • in a belt-positioning booster seats in the back seat until they are between 8 to 12 years of age and the car’s lap and shoulder seat belts fit properly
  • with lap-and-shoulder seat belts in the back seat once they have outgrown their booster seats and until they are at least 13-years-old, when they might be ready to ride in front seat

In addition to these updated recommendations, we have seen many improvements in car seats and booster seats, including higher weight limits for rear facing car seats and car seats with harness straps.

History of Car Seat Recommendations

With all of these improvements, it is easy to remember that it wasn’t that long ago that kids rode without car seats.

Pediatricians began pushing folks to use car seats as early as 1971.Although the first car seats were invented in 1962, it wasn’t until 1968 that we got a car seat that could actually protect a child in a car accident. Before that, kids might ride in homemade car seats, safety harnesses, or leashes.

Better car seats followed once the National Highway Traffic Safety Administration issued the most minimum of car seat safety standards in 1971 and pediatricians began to push for routine car seat use. It would still take more than a decade, until 1985, that all states actually required young kids to ride in car seats.

Then, in 1996, the American Academy of Pediatrics issued their first major recommendations about car seat safety. Those recommendations included that infants should ride rear facing until they are at least 20lb or 1 year of age and that rear-facing car seats should be placed in the back seat if a car had a passenger side air bag.

Why issue recommendations if states had already passed car seat laws?

It was in response to an increasing number of air bag deaths, as more and more cars began to have passenger side airbags in the 1980s and 90s. In fact, by 1998, front side passenger side air bags were required on all new cars and light trucks sold in the United States. As we now know, a car seat in the front seat, up close to the air bag isn’t a good idea if you are in an accident and the air bag deploys.

The 1996 recommendations also called for the use of convertible car seats that could be used forward facing after a child’s first birthday and through about 40 pounds, and then booster seats until seat belts fit properly.

In 2002, we were introduced to the LATCH system, which made installing car seats easier. And the idea that school age kids needed to stay in car seats or booster seats a lot longer than most parents thought necessary was introduced. The AAP also clarified that infants should ride rear facing until they are 20lb and 1 year of age.

The 2002 car seat guidelines introduced the idea of booster seat for older kids.
The 2002 car seat guidelines introduced the idea of booster seat for older kids.

And then, in 2011, the AAP published the recommendations that we are still following today.

State car seat laws still haven’t kept up with the latest recommendations from the AAP though. Some still just use age based criteria or have criteria for car seats and booster seats that are far lower than AAP recommendations. And South Dakota still doesn’t even have a booster seat law!

Other Car Safety Recommendations

Of course, car safety isn’t all about car seats and seat belts.

Since the first laws and recommendations about car seats and seat belts, we have also learned:

Are you still sure that your kids are safe in the car?

What to Know About the History of Car Seat Recommendations

Car seat safety recommendations have come along way since kids began riding in cars.

More on the History of Car Seat Recommendations

Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Despite what some folks believe, most pediatricians are very interested in breastfeeding and learning as much as they can to help their families breastfeeding effectively for as long as they wish.

They are not looking to push baby formula or bottles to sabotage a mom’s chances of breastfeeding her baby.

It can help you breastfeed if you get ongoing support.
Your pediatrician should give you ongoing support to help you breastfeed effectively.

And they will typically do anything to help the mom breastfeed, as well as make sure the baby is getting enough to eat. At least they will do anything that has some evidence to show that it is effective.

Chiropractic for Breastfeeding Problems

Will they refer their babies to a chiropractor for extra help with breastfeeding?

“Chiropractic manipulation in children who are < age 12 years is considered unproven and not medically necessary as a treatment for any diagnosis as there is insufficient published evidence to assess the safety and/or impact on health outcomes in the pediatric population.”

Chiropractic Spinal Manipulation in Children

Probably not, as there is no real evidence that it would help. Unfortunately, well meaning pediatricians do often refer their patients to lactation consultants who may then recommend further management by a chiropractor.

Why?

“Based on their case studies and the volumes of previous research, these researchers concluded that subluxations and the neurological interference they cause play a major role in Hypolactation. The researchers suggest, “Chiropractic evaluation for subluxations would be a key element in the holistic assessment of the failure to establish milk supply in the post partum patient.””

icpa on Chiropractic Helps New Mothers Produce Milk

Maybe it is because they don’t understand that when chiropractors use the term subluxations, they are not referring to something you can see on an xray, but rather something they think they can feel, and when manipulated, unblocks the flow of energy that prevents your body’s innate ability to heal itself.

“DD Palmer, an American magnetic healer, believed that diseases are often caused by subluxations of the vertebrae, which, in turn, lead to an interruption of nervous impulses; and that the correction of these subluxations allows the body to heal itself. This is still a central tenet of chiropractic.”

Chiropractic care for children: Controversies and issues

Is that why your baby is having trouble breastfeeding? An invisible subluxation is blocking the flow of energy in your body?

Or is that why your baby has reflux or colic?

I doubled checked my copy of Gray's Anatomy, and our nervous system and the things it supplies don't look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.
I doubled checked my copy of Gray’s Anatomy, and our nervous system and the things it supplies does’t look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.

What about the “research” chiropractors talk about?

They are case studies, which is basically a chiropractor telling a story (glorified anecdote) about what happened to their patient, without any evidence of why it happened or how it could have happened.

“High-quality evidence supporting effectiveness of spinal manipulation for nonmusculoskeletal concerns is lacking, especially in infants and children, for whom the risks of adverse events may be the highest because of immature stability of the spine.”

AAP on Pediatric Integrative Medicine

The American Academy of Pediatrics Section on Integrative Medicine even warns parents about taking their kids to a chiropractor. And that’s saying something, as they promote some other holistic therapies that aren’t actually all that evidence based.

Craniosacral Therapy for Breastfeeding Problems

What about craniosacral therapy?

Similar to chiropractic, it has to do with has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate by massaging your baby’s head.

Is that why your baby isn’t breastfeeding well? The tides and rhythms of his cerebrospinal fluid are off?

“When a baby is unable to nurse or nurses so poorly that he causes pain to his mother, he presents a true challenge. A mother who experiences pain or who perceives that her baby is not breastfeeding effectively is a mother who is at risk of prematurely weaning this baby.

After working through all of the usual avenues of information and resources that can help in this kind of situation, some Leaders have found a new therapy, called CranioSacral Therapy (CST), can be helpful. CST is a light-touch manual therapy used to encourage the body’s self-correcting mechanisms.”

La Leche League on Considering CranioSacral Therapy in Difficult Situations

Not surprisingly, there is no real evidence that craniosacral therapy helps breastfeeding or anything else.

It is very surprising that some parents are willing to pay $600 or more for a few craniosacral therapy sessions.

And it is disappointing that a lactation consultant would refer their patients for this kind of therapy, since there is no evidence that it will work.

What to Know About Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Parents looking for breastfeeding support should view a referral to a chiropractor or to get craniosacral therapy as a red flag and consider getting a second opinion for their breastfeeding problems from someone who uses evidence based therapies that have been proven to work.

More on Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Ask the Pediatrician

Got questions about your kids?

Need answers?

Ask the Pediatrician

It you likely won’t be surprised that most other parents have asked the very same questions at some point.

You should always call or make an appointment with your pediatrician if you have questions about your child.
You should always call or make an appointment with your pediatrician if you have questions about your child.

Fortunately, someone has answered them!

Find your answers?

Of course, you should always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Still, these answers can be helpful, especially for non-urgent problems.

More on Ask the Pediatrician

Dry Drowning – Hype or Hazard

Every day, about two or three kids drown in the United States.

And that’s why drowning is a leading cause of death for children and teens. In fact, it is the number two cause of unintentional death, right after motor vehicle traffic accidents. Not surprisingly, drowning is the number one cause of death for toddlers and preschoolers.

So, what are many parents afraid of?

Dry Drowning

Although the focus should be on making sure you learn CPR, fence off your pool, supervise your kids around water, and have them wear a Coast Guard approved life jacket around the water, some parents are overly worried about dry drowning instead.

“Parents are being unduly alarmed by media reports suggesting that children can die from drowning a week after swimming,” said Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians. “Some children can experience complications from swimming. For example, it is possible for a child to inhale water and develop an infection, such as pneumonia, which can become very serious and cause breathing problems. If a child has breathing problems at any time, the parent should take him or her to the emergency department. But there are no cases of completely normal, asymptomatic patients who suddenly die because they went swimming a few days ago. It’s also time to retire those incorrect terms, because it is inaccurate and incorrect to say a child was initially fine after a water event and then “dry drowned” a day or week later.”

Another story on The Today Show alerting parents to the dangers of dry drowning.
This story on The Today Show “alerting” parents to the dangers of dry drowning, ended up scaring many of them.

It isn’t hard to see why.

Although media reports of “dry drowning” deaths are rare, they are continuously shared on Facebook and other social media platforms, making it seem like they are much more common.

Still, it is important to note that what folks call dry drowning is often “delayed” drowning. Your child is not going to get sick simply because they coughed in the pool. They are going to have to cough, choke, and actually inhale some water to develop “delayed” drowning, which is rare.

Even though it is rare, you should still know about it though, right?

“You’ll want to keep a close eye on your child for about 24 hours following a close call in the water. Delayed symptoms of drowning include shortness of breath, difficulty breathing, coughing and/or chest discomfort. Extreme fatigue, irritability and behavior changes are also possible.”

Delayed Symptoms of Drowning: Know the Signs

Of course, but it shouldn’t be overblown to the point where you get panicked whenever your kids are in the water.

Or if you think more about dry drowning than you do about a much more common hazard – drowning.

What to Know About Dry Drowning Hype

Dry drowning is often a rare type of delayed drowning that occurs after a child inhales water and later develops what can become life-threatening symptoms, including fatigue, fever, coughing, and troubling breathing.

More on Dry Drowning Hype

Helping Kids Avoid Sea Sickness on a Cruise

Planning a cruise with your kids?

How do kids not get sea sick on cruises?
How do kids not get sea sick on cruises? Photo by Vincent Iannelli, MD

You’re not alone.

Cruises have become a popular family vacation.

Helping Kids Avoid Sea Sickness on a Cruise

Are you going to call your pediatrician about a prescription for some Scopolamine patches?

I’ll save you some time.

Scopolamine patches are not approved for young children or teens. They can be prescribed for adults.

Fortunately, most kids don’t have problems with sea sickness on large cruise ships.

And there are other options if they do, including:

  • Dramamine for Kids – chewable tablets (dimenhydrinate) that kids between the ages of 2 and 12 years can take every 6 to 8 hours
  • Dramamine – tablets (dimenhydrinate) for kids over age 12 that they can take every 4 to 6 hours
  • Dramamine All Day Less Drowsy – tablets (meclizine) for kids over age 12 that they can take once a day

It is also nice that Dramamine is over-the-counter, so you don’t even need a prescription. Just grab some before your trip, along with sunscreen, insect repellent, and whatever else you think you need.

Keep in mind that there are also motion sickness treatments to avoid, mostly because they don’t work. This includes the Sea Band acupressure wrist bands that you see everywhere.

What about ginger?

While most alternative treatments don’t live up to their hype, there are studies to suggest that taking ginger can help relieve and prevent sea sickness and other types of motion sickness.

You can even get Dramamine Non-Drowsy Naturals with ginger root for your kids.

“Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant.”

Grøntved  et al on Ginger root against seasickness. A controlled trial on the open sea

Will it work? Most of the studies about ginger and motion sickness have been small and can probably be explained by the placebo effect.

Also keep in mind that newer, non-sedating antihistamines that work for allergies, like Zytrec, Claritin, and Allegra, don’t work for motion sickness. Neither does Zofran.

Helping Kids Avoid Motion Sickness in a Car

An even more common problem than sea sickness seems to be motion sickness in the car. As with sea sickness, Dramamine can be an option for long car rides.

For some young children, even short car rides, like to the store or across town, can be a trigger for car sickness.

What can you do then?

You may have to try different things, but it may help to:

  • avoid letting your child read, watch movies, or play video games in the car
  • have her listen to music or audio books, etc.
  • avoid big meals right before traveling, but also don’t travel on an empty stomach
  • encourage her to look at things outside the car, in the distance, preferably toward the front of the car
  • wear sunglasses

If motion sickness continues to be a routine problem for your child, an evaluation by a Pediatric Neurologist might be helpful.

What to Know About Avoiding Sea Sickness

Sea sickness isn’t often a problem for kids on big cruise ships, but you do have some options to treat and prevent motion sickness, whether it is in a boat, plane, or car.

More on Avoiding Sea Sickness

What to Do About Your Child’s Earache

Kids commonly complain of earaches.

Some don’t necessarily complain of an earache (otalgia), but just tug at their ears or a little more fussy than usual, so you might just think that it’s their ears.

Surprisingly, an earache doesn’t always mean that your kids have an ear infection.

Why Does Your Child’s Ear Hurt?

Tick bites would be a rare cause of ear pain.
Tick bites would be a rare cause of ear pain. Photo by Vincent Iannelli, MD

So what else besides an actual ear infection can cause an earache?

Does your child have a new tooth coming in?

Has he been swimming? (swimmer’s ear)

Does he have a sore throat or runny nose? (although most middle ear infections come after a few days of cold symptoms, simply having a sore throat or runny nose might cause some ear pain)

As you can imagine, lots of things can cause earaches, but the most common include:

  • teething
  • swimmer’s ear (otitis externa) – unlike otitis media, these kids typically have outer ear pain, or pain when you move or tug on their ear lobe
  • middle ear effusions – fluid that is left over in the middle ear after an ear infection (has nothing to do with swimming)
  • sinus congestion – some kids associate the extra ear popping that comes with allergies or a cold/sinus infection as being painful or uncomfortable
  • pharyngitis – because of referred pain, some kids with sore throats complain of ear pain instead of throat pain

And then some younger kids simply tug on their ears because they can. They are otherwise well, sleeping all night, eating well, and aren’t fussy.

What else can cause earaches? A toothache, too much earwax, or that rock your kid put in his ear a few weeks ago…

What to Do About Your Child’s Earache

Once you know why your child has an earache, which typically means a trip to your pediatrician, you need to know what to do about it.

You’re thinking a prescription for an antibiotic is coming, right?

Many parents will be happy to hear that most earaches won’t mean an automatic antibiotic prescription. Instead, your pediatrician will likely:

  • recommend symptomatic care for teething
  • prescribe antibiotic ear drops for swimmer’s ear
  • recheck your child’s middle ear effusion in a few months, as this goes away on it’s own in most cases without any treatment
  • treat underlying congestion from allergies, colds, or a sinus infection as needed
  • recommend symptomatic care for a sore throat

But what if your child really does have a middle ear infection? Then he will get antibiotics, right?

Not necessarily.

Since most ear infections get better on their own, antibiotics are typically reserved for:

  • children under age 6 months with acute otitis media (typically ear pain and a bulging ear drum)
  • children who are at least 6 months with acute otitis media and severe signs or symptoms, including moderate or severe pain for at least 48 hours or a temperature of 102.2°F (39°C) or higher
  • children who are under 24 months with “double” ear infections – both ears are infected at the same time, even if they just have mild symptoms

For most other children, instead of having you start antibiotics right away, your pediatrician might have you wait for 48 hours – the observation option. You can then start the antibiotics if your child doesn’t get better after a period of watchful waiting for two or three days. Until then, an age-appropriate dose of Tylenol (acetaminophen) or Motrin (ibuprofen) can often help control pain or fever.

In addition to your pediatrician, a pediatric ENT specialist can be helpful if your child has persistent ear pain.

What to Know About Children with Earaches

While it is sometimes obvious to know what is going on when older kids complain of ear pain, it is important to understand that not every earache means an ear infection, and even when it does, it might not mean a prescription for an antibiotic.

More on Children with Earaches

Is There Evidence for That Therapy, or No?

What do you think of when you think of alternative medicine?

“…there’s no such thing as conventional or alternative or complementary or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t. And the best way to sort it out is by carefully evaluating scientific studies – not by visiting Internet chat rooms, reading magazine articles, or talking to friends.”

Paul Offit, MD on Do You Believe in Magic

Do you think of acupuncture, Ayurveda, homeopathy, Reiki, or reflexology?

And do you wonder if they really work?

Evidence Based Medicine, or No?

Unfortunately, there are many things that parents do for which there is absolutely no evidence that they can actually help their kids.

Some parents are even encouraged to do them by well meaning pediatricians, who may not know the latest evidence about:

  • If her jaundice had been much worse, she would have gotten phototherapy, not sunlight.
    If her jaundice had been much worse, she would have gotten phototherapy, not sunlight. Photo by Vincent Iannelli, MD

    exposing jaundiced babies to sunlight – not only does it not work, unless they were in the sun all day long (this is done in some parts of the world, but under tinted windows to block UV and infrared light), it isn’t very practical and the AAP advises against it

  • changing your child’s toothbrush after they have strep throat – a study has shown it is not necessary
  • alternating Tylenol and Motrin – it isn’t necessary, promotes fever phobia, and can be dangerous if you mix up the times or dosages
  • putting kids on a BRAT diet when they have diarrhea – not necessary and doesn’t help kids get better any faster

For other therapies, your pediatrician isn’t likely to recommend them unless they are a so-called integrative or holistic pediatrician.

“Attaching the word “therapy” to the back end of an activity is an attempt to give it a status it may not deserve – and that status is subsequently used to garner insurance coverage, hospital resources, consumer patronage, and research dollars. It is also used to constrain how we think about an intervention – implying that perhaps there is some specific mechanism as work, when none need exist.”

Steven Novella on Aroma”therapy”

These non-evidence based “therapies” include:

  • acupressure – acupuncture without the needles
  • amber teething necklaces – if your baby’s amber teething necklace doesn’t seem to be doing anything, it isn’t because it’s fake and not made of genuine Baltic amber, it’s because it’s a teething necklace…
  • aromatherapy
  • chiropractic care of newborns and infants – understand that chiropractors don’t adjust real dislocations or misalignments in your spine, but instead manipulate what they think are subluxations that block the flow of energy that prevent your body’s innate ability to heal itself from working. Since these subluxations can’t be seen on xray, it makes you wonder why they chiropractors do so many xrays, doesn’t it?
  • craniosacral therapy (osteopathy) – has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate…
  • dry or wet cupping – what’s next, leeches?
  • essential oils – they don’t even smell good a lot of the times…
  • gripe water for colic
  • Oscillococcinum will not prevent flu complications.
    Oscillococcinum will not prevent flu complications.

    homeopathic “medicines” for teething, colic, gas, and the flu, etc. – do you know what’s in Oscillococcinum, the homeopathic flu medicine? It’s a mix of the pancreatic juice, liver, and heart of a duck, although it is diluted so many times, it is only the memory of those substances that remain in the little pills you take. How does that help treat your flu symptoms?

  • hyperbaric oxygen therapy – this can actually help treat folks with carbon monoxide poisoning and decompression sickness (divers), but HBOT isn’t going to help your autistic child
  • hypnosis and hypnotherapy for pain, anxiety, and insomnia – hypnosis might work as a distraction technique, but there is no good evidence beyond that
  • magic socks – please don’t make your kids wear ice-cold socks at night, either with or without first covering them with Vicks VapoRub. It’s as helpful as putting a raw, cut onion in their socks, which your shouldn’t do either…
  • magnetic field therapy – do your kids still wear one of those magnetic bracelets to “help” their balance?
  • mindfulness – while a nice idea and it may help you relax, it doesn’t have all of the health benefits that folks claim
  • restrictive and fad diets – from gluten-free diets for kids who don’t have Celiac disease to the GAPS and Gluten Free-Casein Free (GFCF) Diet, these diets don’t help, can be difficult and expensive to follow, and can be dangerous if kids don’t get all of the nutrients they need

Have you tried any of these therapies on your kids?

If you have, do you understand that they “work” by way of meridians (acupuncture), the memory of water, like cures like, and law of the minimum dose (homeopathy), energy and spinal fluid tides (craniosacral therapy), manipulating energy fields in your hands or feet (reflexology), and spiritual energy (Reiki)?

What’s the Harm of Trying Alternative Treatments?

But even if you don’t go to a holistic pediatrician that recommends any of these therapies that don’t work, does your pediatrician discourage you from trying them?

If they do, how strongly?

Do they say it isn’t going to work, so don’t do it, or do they use more permissive phrasing?

The American Academy of Pediatrics, for example, tells parents that amber teething necklaces don’t work and pose a risk for strangulation and choking, but then gives advice for “parents who choose to use these necklaces.”

Since they don’t work, why not just tell them to save their money and not use them?

Do you ever wonder, what’s the harm in using these things that don’t work?

“Rather than getting distracted by alluring rituals and elaborate pseudoscientific explanations for how they work, we should focus on maximizing the non-specific elements of the therapeutic interaction, and adding that to physiological or psychological interventions that have specific efficacy.”

Steven Novella on EMDR and Acupuncture – Selling Non-specific Effects

If your pediatrician knows that homeopathic medicines aren’t going to work, but tells you to try them if you want, what are they going to let you try next – black salve, coffee enemas, colloidal silver, dry needling, earthing, faith healing, iridology, psychic surgery, slapping, tapping, or shamanism?

In addition to kids actually being harmed by many of these alternative therapies and by missing out on real medicine that could have helped them, putting so much focus on these non-evidence based “treatments” is a waste of time and money that could go towards really helping people.

And be many of the folks who pursue and push these types of alternative treatments also push myths and propaganda about vaccines or seek to skip or delay their child’s vaccines, choosing to follow a follow a non-standard, parent-selected, delayed protection vaccine schedule that leaves their kids at risk for vaccine-preventable diseases.

Don’t be fooled.

Learn to be skeptical, stick to the evidence, and stick with medicine that works.

What to Know About Evidence Based Medicine

There is plenty of evidence that alternative therapies don’t work and can do harm. Stick with medicine that works to keep your kids safe and healthy.

More on Evidence Based Medicine