The injury prevention community mourns the loss of Robert Sanders, MD (January 19,2006). In the pediatric community (and AAP) Bob is best known for his work with child passenger safety (CPS). As he once told me, he was able to get the first CPS law passed in his state (Tennessee) in the early 1970's by "talking over white picket fences." Many of you have worked with him and others have admired his work. He was a fine pediatrician and later in his career was the County Coroner. His oral history (a project conducted by AAP) is available in the AAP bookstore. The lives of thousands of children who will never know his name have been saved because of Dr. Sanders' advocacy for children.

Graduated Driver License (GDL) Law in CA Strengthened: Traffic crashes are the leading cause of death for teenagers. The rates are highest among 16-19 year olds. Risk factors are: poor hazard detection; low risk perception, risk taking, not using seat belts, inadequate driving skills, alcohol and substance use, carrying passengers and night driving. GDL laws have proven effective in crash reduction among teen drivers. Effective January 1, 2006 the GDL law was strengthened for drivers under age 18.

Drivers under 18:

1. May not transport passengers <20 years at any time for the first 12 months unless accompanied and supervised by a licensed driver 25 years or older.
2. May not drive between 11 PM and 5 AM for the first 12 months.

Addressing the risk factors for a crash with your teen patients, clients and students and reminding them of the GDL restrictions may prevent a tragedy. Urge parents to carefully monitor their teen driver’s behaviors and skills.

SUVs: Are they more protective compared to passenger vehicles? Do you and your families believe that because of their larger size and heavier weight, SUVs are more protective in case of a car crash than a passenger vehicle? “Risk of Injury to Child Passengers in Sport Utility Vehicles” was published in Pediatrics.
As in passenger vehicles children appropriately restrained were less likely to be injured. Children exposed to airbags in both vehicles were more likely to be injured. Rollover crashes increased risk of injury in both vehicles. However, roll over crashes are more than two times likely to occur in SUVs compared to passenger cars. Unrestrained children in SUVs had a 25-fold increased risk of injury in a rollover crash. The authors concluded that the potential safety advantages of SUVs are offset by other factors including the potential for rollovers.

The significant message once again is that children are best protected when properly restrained in age appropriate systems. Post our "Car Safety Seat Growth Chart" in your office and provide your families the accompanying parent handout. If you need another copy of the poster, please contact our office staff (714) 971-0695.

Connected Kids: Safe, Strong, Secure is a new American Academy of Pediatrics (AAP) program that strives to empower families to raise children that are resilient to youth violence and child abuse. Extensive research, including focus groups with parents around the country, suggested that the most effective approach to these critical areas would be a positive one, an approach that supports the alliance between parents and pediatricians by providing specific, important advice about children and families throughout childhood. This program will train pediatricians, educators and community based organizations to counsel families using an asset- based approach that builds upon anticipatory guidance. Like the National AAP's, "The Injury Prevention Program" (TIPP), Connected Kids coordinates counseling topics such as parenting, child discipline, television violence and bullying with scheduled health maintenance visits based upon children’s developmental stages. Connected Kids supports these topics with counseling suggestions and take-home materials for parents and youth.

The California Chapter 4, AAP Injury Prevention Program is excited to bring the AAP’s Connected Kids program to Orange County in 2006. To achieve this goal we are working with National AAP and the program’s principal investigators Robert Sege, MD, PhD and Howard Spivak, MD.

Pediatricians, and one office staff person are invited to register for the April 29th training.

Training begins with an initial half-day program for pediatricians and one office staff person on Saturday, April 29, 2006 to introduce the basic concepts of Connected Kids. The workshop includes interactive skills building sessions and discussion of materials and implementation strategies. A follow-up session will be conducted Saturday, September 9, 2006 to (1) allow providers to share their experiences and learn how others in the area have integrated the materials, and (2) provide in-depth instruction on topics that are of interest to the providers. This approach – an initial introduction, ongoing support, and an opportunity to meet again – will more likely lead to lasting practice change. California Chapter 4, AAP will also provide technical assistance to these sites. Subsequent trainings for school nurses, educators and community based organizations will be scheduled later in the year.

An issue of emerging concern has been the association of bullying behavior, particularly among young school-aged children with the subsequent development of serious assault behaviors. The tragic rash of high-profile school shootings beginning with the Columbine High School incident in Littleton, Colorado brought into acute focus just how serious a problem bullying may be, and how attention to it cannot be separated from a comprehensive approach to youth violence prevention. Indeed several professional medical organizations, including the American Medical Association and the Society for Adolescent Medicine, have directed specific attention by way of formal policy or resolution to the issue of youth bullying. The Health Resources and Services Administration of the U.S. Department of Health and Human Services recently launched phase II of a major multi-year awareness campaign thematically entitled “Take a Stand, Lend a Hand: Stop Bullying Now."

Although bullying among school-aged children has been well described in other parts of the world, until recently, epidemiologic characterization of the depth and extent of the problem in the United States has been lacking. Nansel and colleagues at the National Institute for Child Health and Human Development of the National Institutes of Health, have created a bullying epidemiology working group and are comparatively analyzing both domestic and international datasets. They have established a prevalence baseline of 30% for children either bullying and/or being bullied based on a large sample of 6th to 10th graders. They have also begun to critically analyze the true associations of bullying with some of the traditional violence-related behavioral markers including weapon carrying and frequent fighting. Bullying and being bullied are both associated with higher rates of weapon carriage and fighting serious enough to result in injury. These associations appear to be stronger for bullies than targets. Also of great concern are the more subtle psychosocial consequences that can be associated with bullying behavior including the subsequent development of depression and suicidal ideation. These problems are more likely to result from the indirect, relational bullying behaviors more typically engaged in by young girls and which can be notoriously elusive to identify.

European researchers have been active for more than 30 years in developing interventions around bullying prevention. The most successful programs have been implemented in Scandinavia based on the model developed by Norwegian investigator, Dan Olweus, who is universally considered the father of bullying science. The Olweus Bullying Prevention Program is a school-based model that has been replicated, refined and evaluated many times internationally. However, there are yet no published reports in the peer-reviewed literature describing implementation of the Olweus Bullying Prevention Program in the United States. It is clear that in this country we must first accept that bullying behaviors cannot be considered a normative rite of passage, and that they can be precursors for more serious downstream consequences. In terms of primary prevention, early parenting behaviors such as cognitive stimulation and emotional support have been shown to confer resilience for the future development of bullying behaviors in elementary aged school children. Promotion and reinforcement of such parenting skills plus recognition, screening and appropriate referral as secondary prevention strategies are essential components of how pediatricians can collectively contribute to this aspect of youth violence prevention.

Join us for the 5th Annual Jack and Jill Symposium, "Jack and Jill were Pushed Down the Hill", with Joseph Wright, MD.

In February 2005, the Children and Families Commission of Orange County awarded grants to the City of Aliso Viejo Police Services and Latino Health Access to develop a “pilot” child passenger safety project with assistance from California Chapter 4 of the American Academy of Pediatrics Injury Prevention Program. This unique project includes enforcement of the California child restraint laws by the Aliso Viejo deputies, "Platicas" or classes for parents to be educated on how to properly install their children's car seats, and the distribution of free car seats to families who cannot afford to buy them.

Among the project’s successes, 77 parents have been educated on how to properly install their child’s car seats and 28 car seats have been distributed. Parents who received traffic citations and attended the classes have had their $400+ tickets reduced to a $24.00 fee by the traffic court.