The role of restraint and seat position in pediatric facial fractures

Background. Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture. Methods. A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury. Results. Ninety-two children suffered a fracture of the facial bones (0.07 % of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described. Conclusion: The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.