Pediatric Trauma Society

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The Unknown Danger of the Safety Car Seat
Mary K. Arbuthnot, DO1; Joseph Fitzpatrick, DO2; Stephanie Kapfer, MD1
1Naval Medical Center Portsmouth, Portsmouth, VA; 2Naval Hospital Jacksonville, Jacksonville, FL

Background: The proper use of age and size-appropriate child restraints saves lives. Despite the benefits, prolonged immobilization of infants and children can be dangerous, and there is a paucity of recommendations regarding the safe duration of time an infant or child should remained restrained. We present the case of a 6-month old infant male who developed a sacral pressure ulcer following long car trip.

Methods: A 6-month old infant male was referred to the pediatric surgery clinic after his mother noted skin changes to the sacral area following a family vacation. Three days after returning from the trip, the patient's mother noticed a chevron shaped dark area of skin on his buttocks, which developed into a stage III pressure ulcer.

Results: The development of the patient's pressure ulcer was not deemed to be related to neglect according to Child Protective Services. He was treated with enzymatic debridement and dressing changes until the wound healed completely.

Conclusion: The development of pressure ulcers from safety car seats in healthy and neurologically normal infants and children is rare. Safety car seats are life saving, and their use should always be encouraged, but they lack recommendations on duration of time children should remain restrained. Frequent breaks during long trips should be included in any instructions and parents should be educated to ensure this preventable injury never occurs again.


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