John Draus, a pediatric surgeon at Kentucky Children's Hospital, has seen the injuries too many times — young children with perforated bowels or small intestines, thanks to seat belts that are in the wrong place during a car accident.
"The belt is not adequately positioned, so their bodies are thrown against the seat belt; the abdominal organs get squished between the belt and spine," Draus said.
That's why advocates such as Draus want lawmakers to strengthen Kentucky's booster seat law, putting it in line with national guidelines.
Kentucky's law, enacted in 2008, requires children to be in a booster seat until they reach the age of 7 or a height of 50 inches. The National Highway Transportation Safety Administration and the American Academy of Pediatrics recommend that children use booster seats until they are at least age 8 or 57 inches tall.
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House Bill 199 would change Kentucky's law to require boosters for any child younger than 9 who is 40 to 57 inches tall.
The new rules would put Kentucky in line with all of its neighboring states, each of which had a lower death rate in 2010 for kids ages 4 to 14 who were involved in fatal wrecks.
The additional seven inches in height can make a big difference, said Susan Pollack, director of the Pediatric and Adolescent Injury Prevention Program at the Kentucky Injury Prevention and Research Center at UK.
"Seat belts in cars are made to fit adults, not children," she said. "We want to put our laws to the same national guidance. Our current law is better than it was, but Kentucky law does not give you the proper guidance for safety — it would be awesome if the law could be congruent with what is actually safe."
Although infant and toddler safety guidelines are based on weight, the booster rules really depend on height, and children reach that height at different ages.
Advocates point to numerous studies that support the increased height requirements. A study from the Children's Hospital of Philadelphia found that using a seat belt on children ages 4 to 8 reduced the risk of injury by 38 percent in a car wreck, but using a booster seat with children of the same age reduced the risk by 59 percent.
A study done in 2012 by Boston Children's Hospital found that states with booster seat laws that cover 6- and 7-year-olds had a 35 percent decreased risk of death or injury. The study reviewed 9,848 cases over a 10-year period.
In Kentucky and the nation, car crashes are the leading cause of death for children ages 3 to 14. According to the state's 2012 Child Fatality Review report, 13 children ages 5 to 9 died in car crashes in 2010 and 2011. Of these, more than half were not in any restraint and others were not using age-appropriate child safety restraints.
According to the Administrative Office of the Courts, there have been 6,705 booster seat violations issued statewide since the law passed in 2008. During that same time frame, there were 33,268 "child restraint" offenses in total, with the majority of them being for "failure to use child restraint device in vehicle."
The Democrat-led House is expected to approve tougher standards this year, but it's not clear what chance HB 199 has of getting through the Republican-led Senate. The measure is supported by Gov. Steve Beshear and sponsored by Reps. Keith Hall, D-Phelps, and Richard Henderson, D-Mount Sterling.
Pollack said it took seven years for the existing law to win approval in the Senate.
Jodi Whitaker, spokeswoman for Senate President Robert Stivers, declined to comment specifically about the proposed legislation, saying Stivers has not seen the bill. But Senate leaders "obviously want to take every feasible measure to help protect Kentucky's children," Whitaker said.
Bill Bell, executive director of the Office of Highway Safety in the state Transportation Cabinet, said he hoped the Senate would give the bill a fair hearing.
"If the Senate hears it and hears who it covers and why it is so important, then I cannot see them voting against it," Bell said. "We're talking about covering 7- and 8-year-olds in motor vehicles, just like in every surrounding state, and allowing them to ride as safe as possible in a booster seat. These kids are not going to make this decision on their own, and unfortunately some parents aren't either unless the law is changed."
Draus pointed out that the bill doesn't require parents to buy new equipment.
"It is simply asking parents to keep their kids in a booster seat for a few more years until the seat belt fits the child appropriately and functions the way it was designed," he said. "Seat belts save lives. Booster seats save lives and reduce injury. Why would anyone argue with those facts? Who doesn't want what is best for Kentucky's children?"