Remote motivational counseling and mobile-based support help parents use safer car seats

Parents improved use of appropriate child car seats after remote motivational counseling and mobile-based support, according to the results from a randomized clinical trial published in JAMA Network Open. The intervention included tailored web content, periodic text messages and personalized feedback on photos parents submitted every four to six weeks showing how their child usually travels in a car.

"Parents and children might resist using the recommended car seat or booster seat, even though it's the law, due to inconvenience or beliefs that their child is safe enough riding in a seat belt or recommended restraint. We tried to overcome these barriers by helping parents connect with their values to protect their child, understand the safety benefits of each car seat stage, and build their confidence in using car seats correctly," said lead author Michelle Macy, MD, MS, Scientific Director, Community, Population Health, and Outcomes, Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago, and Professor of Pediatrics (Emergency Medicine), Northwestern University Feinberg School of Medicine.

A previous study by Dr. Macy and colleagues found that nearly 70% of U.S. children in car crashes with a fatality were not using the child passenger restraints recommended by the American Academy of Pediatrics (AAP).

"We found that the intervention we tested had the greatest impact on parents with children who are 3 to 10 years old," said Dr. Macy. "More effort is needed to motivate and support parents of children who are younger than 3 years who can still benefit from rear-facing car seats."

The randomized clinical trial included 474 parents with children who were at least 6 months and younger than 11 years old. At baseline, all participating parents reported non-adherence to car seat guidelines – not using a car seat recommended for their child's age and size, child riding in the front seat, or traveling unrestrained. At six-month follow-up, parents in the intervention group exhibited guideline adherence 13 percentage points higher than parents in the group who received usual guideline education. After 12 months, guideline adherence was nearly 40 percentage points higher in the intervention group.

Our findings suggest that the motivational piece, combined with personalized education, is important. Primary care providers could ask parents open-ended questions about how the child typically travels in a car to find those who aren't following recommendations, offer encouragement as needed, and connect parents to community resources, like child passenger safety technicians. The why and the how of child passenger safety require frequent reminders."

Dr. Michelle Macy, MD, MS, lead author 

To help parents follow the AAP guidelines on car seats, Lurie Children's implemented a system of customized alerts for parents of patients who are enrolled in MyChart (the hospital's online health record portal). Parents receive reminders about the recommended car seat for their child's age, weight and height, important factors for knowing when to switch to the next seat. Links to other safety resources are also provided.

Dr. Macy holds the Mary Ann and J. Milburn Smith Research Professorship for the Director of Child Health Research at Lurie Children's.