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AB - Abstract An average of 37 children die of hyperthermia inside parked vehicles annually in the USA. The majority of cases are due to a caregiver forgetting them (~55%), while ~13% are due to intentionally leaving children unattended and ~28% occur when children climb into unlocked vehicles. The cause of four per cent is unknown. There are no published data on incidence in Canada. Through information provided from provincial and territorial coroner’s offices, Canadian government agencies and media reports, six cases of vehicular hyperthermia deaths were confirmed since 2013. Three were attributed to children left unintentionally in vehicles; one occurred after a child climbed into an unlocked vehicle and two cases are undetermined. Attention or memory lapses are hypothesized to occur due to distraction, stress, fatigue, or routine changes. Educating caregivers about the dangers of leaving children in vehicles and providing preventative strategies through anticipatory guidance may reduce these tragedies (see graphic abstract). From 1998 to 2017, 742 cases of paediatric mortality due to vehicular extreme hyperthermia have been documented in the USA (1). These tragedies occur every year despite widespread media coverage, social media campaigns, and other efforts to remind the public of the dangers of leaving children alone in motor vehicles. The majority of cases are believed to be due to a parent or caregiver inadvertently leaving them there (~55%), while ~13% are attributed to children being intentionally left unattended and ~28% have been reported to occur when a child unknowingly climbs into an unlocked parked car and becomes entrapped (2). The cause of four per cent of cases is unknown (2). Most victims are children 3 years of age or younger (1). Although the majority of cases happen between June and August, enclosed vehicles still pose a danger to children at mild temperatures in all seasons, and confirmed cases have occurred in every month of the year (1). Hyperthermia describes a physiological condition in which the body can no longer maintain a homeostatic body temperature within a safe physiological range. Heat exhaustion occurs when the body’s water and salt reserves are depleted. Signs and symptoms associated with heat exhaustion include intense thirst, weakness, discomfort, anxiety, dizziness, fainting, and headache. Heatstroke is characterized by a core temperature > 40°C, resulting in neurological symptoms such as delirium, convulsions, coma, and possibly death. Young children are particularly susceptible to developing heatstroke. Despite having a greater body surface area-to-mass ratio, young children’s bodies heat up more quickly due to less efficient thermoregulatory systems (3). Furthermore, depending on the developmental level of the child, children may lack the ability to manipulate their external environment, such as opening a car door, unbuckling a seatbelt, or removing articles of clothing, in order to aid heat dissipation (4). On a sunny day, the interior temperature of a vehicle can rise to dangerous levels within a short period of time. A car parked in the sun heats up rapidly due to the greenhouse effect, where the sun’s visible rays are transmitted through the glass windshield. Some of this light energy is absorbed by the interior of the car (e.g., the dashboard, seats, carpet, etc.) and radiates infrared rays. These infrared light rays cannot penetrate glass and are trapped in the car’s interior. As a result, the temperature of the car’s interior rapidly increases beyond that of its surroundings (4). The temperature levels observed in a car on a hot day can exceed temperatures at which the human body can adequately maintain homeostasis. One study showed that temperatures inside a vehicle can increase up to 22°C above that of ambient temperature, with the majority of the rise in temperature occurring rapidly within the first 30 minutes (4). For example, an outside temperature of 22.2°C can result in an interior temperature above 40°C within an hour (4). Leaving the windows slightly open had little effect in maintaining an acceptable temperature in the car (4). Research suggests survival is unlikely for humans above the critical thermal maximum of 41.6 to 42°C (5). To date, no data have been published on the overall incidence of paediatric mortality due to vehicular hyperthermia in Canada. In order to uncover the incidence of cases in Canada and their circumstances, data were obtained from all provincial and territorial coroner’s offices and Vital Statistics agencies across Canada under the Access of Information Act. Each province and territory provided the incidence of cases in children aged 0 to 18 years of age, with ‘hyperthermia’ or ‘heat stroke’ as the mechanism of death and evidence of ‘vehicular entrapment’ from 2013 to the present. Published data were also collected from online archived news articles on the cases that occurred in Canada since 2013. CANADIAN INCIDENCE, CIRCUMSTANCES, DEMOGRAPHICS, AND LEGAL OUTCOMES There have been six known cases of child deaths caused by hyperthermia while entrapped and unattended in parked motor vehicles in Canada since 2013. This resulted in an average of one death per year. Table 1 describes all of the available reported cases in Canada since 2013. Table 1. Summary of news publications of cases of paediatric vehicular hyperthermia deaths in Canada, 2013–2018 Month and year Province Ambient temperature Published news case descriptions Age of child Reported contributing factor(s) Legal outcome June 2013 (16) Ontario Low: 20°C High: 31°C A toddler was reportedly left in a car, after the grandmother had reportedly forgotten to take the toddler to daycare. 2 years 1) Possible change of routine: The toddler was reportedly under the care of the toddler’s grandmother as the mother was reportedly at an appointment and the father was reportedly at work. 2) Fatigue: The caregiver was reportedly working the night prior to the incident. • Charged with criminal negligence causing death. • Found guilty of failing to provide the necessities of life. • Received suspended sentence plus two years of probation. July 2013 (17) Alberta Low: 16°C High: 33°C A child climbed into an unlocked family vehicle and was found unconscious hours later. The child was transported to a hospital where the child was pronounced dead. 3 years 1) Unlocked parked vehicle • No charges were laid. July, 2013 (18) Ontario Low: 18°C High: 30°C A daycare worker had reportedly forgotten to remove the toddler from the car. 2 years 1) Possible divided attention: 35 children were reportedly at the daycare that day and multiple children had to be removed from the vehicle and the toddler was left in the car. • Found guilty of criminal negligence causing death. • Sentenced to 22 months in jail, plus three years of probation. August, 2016 (19) Quebec Low: 16°C High: 26°C An infant was left in a vehicle after the parent had reportedly forgotten to drop the infant off at daycare. Less than 1 year 1) Possible change in routine: The parent had reportedly taken a new route to drop off the infant that day. • No charges were laid. September, 2017 (20) Ontario Low: 17°C High: 27°C A caregiver was tasked with dropping the child off at daycare and reportedly left the child in the car. 3 years Investigation is ongoing. • Charged with criminal negligence causing death. • Released on bail (September 2017) and legal process is ongoing. May, 2018 (21) Ontario Low: 14°C High: 26°C A child was found dead in a car parked at a commercial complex where the parent was working. 3 years None reported. • Charged with criminal negligence causing death and failing to provide the necessities of life • The first charge was withdrawn. • The accused was given an absolute discharge. Month and year Province Ambient temperature Published news case descriptions Age of child Reported contributing factor(s) Legal outcome June 2013 (16) Ontario Low: 20°C High: 31°C A toddler was reportedly left in a car, after the grandmother had reportedly forgotten to take the toddler to daycare. 2 years 1) Possible change of routine: The toddler was reportedly under the care of the toddler’s grandmother as the mother was reportedly at an appointment and the father was reportedly at work. 2) Fatigue: The caregiver was reportedly working the night prior to the incident. • Charged with criminal negligence causing death. • Found guilty of failing to provide the necessities of life. • Received suspended sentence plus two years of probation. July 2013 (17) Alberta Low: 16°C High: 33°C A child climbed into an unlocked family vehicle and was found unconscious hours later. The child was transported to a hospital where the child was pronounced dead. 3 years 1) Unlocked parked vehicle • No charges were laid. July, 2013 (18) Ontario Low: 18°C High: 30°C A daycare worker had reportedly forgotten to remove the toddler from the car. 2 years 1) Possible divided attention: 35 children were reportedly at the daycare that day and multiple children had to be removed from the vehicle and the toddler was left in the car. • Found guilty of criminal negligence causing death. • Sentenced to 22 months in jail, plus three years of probation. August, 2016 (19) Quebec Low: 16°C High: 26°C An infant was left in a vehicle after the parent had reportedly forgotten to drop the infant off at daycare. Less than 1 year 1) Possible change in routine: The parent had reportedly taken a new route to drop off the infant that day. • No charges were laid. September, 2017 (20) Ontario Low: 17°C High: 27°C A caregiver was tasked with dropping the child off at daycare and reportedly left the child in the car. 3 years Investigation is ongoing. • Charged with criminal negligence causing death. • Released on bail (September 2017) and legal process is ongoing. May, 2018 (21) Ontario Low: 14°C High: 26°C A child was found dead in a car parked at a commercial complex where the parent was working. 3 years None reported. • Charged with criminal negligence causing death and failing to provide the necessities of life • The first charge was withdrawn. • The accused was given an absolute discharge. View Large Table 1. Summary of news publications of cases of paediatric vehicular hyperthermia deaths in Canada, 2013–2018 Month and year Province Ambient temperature Published news case descriptions Age of child Reported contributing factor(s) Legal outcome June 2013 (16) Ontario Low: 20°C High: 31°C A toddler was reportedly left in a car, after the grandmother had reportedly forgotten to take the toddler to daycare. 2 years 1) Possible change of routine: The toddler was reportedly under the care of the toddler’s grandmother as the mother was reportedly at an appointment and the father was reportedly at work. 2) Fatigue: The caregiver was reportedly working the night prior to the incident. • Charged with criminal negligence causing death. • Found guilty of failing to provide the necessities of life. • Received suspended sentence plus two years of probation. July 2013 (17) Alberta Low: 16°C High: 33°C A child climbed into an unlocked family vehicle and was found unconscious hours later. The child was transported to a hospital where the child was pronounced dead. 3 years 1) Unlocked parked vehicle • No charges were laid. July, 2013 (18) Ontario Low: 18°C High: 30°C A daycare worker had reportedly forgotten to remove the toddler from the car. 2 years 1) Possible divided attention: 35 children were reportedly at the daycare that day and multiple children had to be removed from the vehicle and the toddler was left in the car. • Found guilty of criminal negligence causing death. • Sentenced to 22 months in jail, plus three years of probation. August, 2016 (19) Quebec Low: 16°C High: 26°C An infant was left in a vehicle after the parent had reportedly forgotten to drop the infant off at daycare. Less than 1 year 1) Possible change in routine: The parent had reportedly taken a new route to drop off the infant that day. • No charges were laid. September, 2017 (20) Ontario Low: 17°C High: 27°C A caregiver was tasked with dropping the child off at daycare and reportedly left the child in the car. 3 years Investigation is ongoing. • Charged with criminal negligence causing death. • Released on bail (September 2017) and legal process is ongoing. May, 2018 (21) Ontario Low: 14°C High: 26°C A child was found dead in a car parked at a commercial complex where the parent was working. 3 years None reported. • Charged with criminal negligence causing death and failing to provide the necessities of life • The first charge was withdrawn. • The accused was given an absolute discharge. Month and year Province Ambient temperature Published news case descriptions Age of child Reported contributing factor(s) Legal outcome June 2013 (16) Ontario Low: 20°C High: 31°C A toddler was reportedly left in a car, after the grandmother had reportedly forgotten to take the toddler to daycare. 2 years 1) Possible change of routine: The toddler was reportedly under the care of the toddler’s grandmother as the mother was reportedly at an appointment and the father was reportedly at work. 2) Fatigue: The caregiver was reportedly working the night prior to the incident. • Charged with criminal negligence causing death. • Found guilty of failing to provide the necessities of life. • Received suspended sentence plus two years of probation. July 2013 (17) Alberta Low: 16°C High: 33°C A child climbed into an unlocked family vehicle and was found unconscious hours later. The child was transported to a hospital where the child was pronounced dead. 3 years 1) Unlocked parked vehicle • No charges were laid. July, 2013 (18) Ontario Low: 18°C High: 30°C A daycare worker had reportedly forgotten to remove the toddler from the car. 2 years 1) Possible divided attention: 35 children were reportedly at the daycare that day and multiple children had to be removed from the vehicle and the toddler was left in the car. • Found guilty of criminal negligence causing death. • Sentenced to 22 months in jail, plus three years of probation. August, 2016 (19) Quebec Low: 16°C High: 26°C An infant was left in a vehicle after the parent had reportedly forgotten to drop the infant off at daycare. Less than 1 year 1) Possible change in routine: The parent had reportedly taken a new route to drop off the infant that day. • No charges were laid. September, 2017 (20) Ontario Low: 17°C High: 27°C A caregiver was tasked with dropping the child off at daycare and reportedly left the child in the car. 3 years Investigation is ongoing. • Charged with criminal negligence causing death. • Released on bail (September 2017) and legal process is ongoing. May, 2018 (21) Ontario Low: 14°C High: 26°C A child was found dead in a car parked at a commercial complex where the parent was working. 3 years None reported. • Charged with criminal negligence causing death and failing to provide the necessities of life • The first charge was withdrawn. • The accused was given an absolute discharge. View Large LEGAL IMPLICATIONS There has been much controversy surrounding the appropriate penalties for caregivers who contribute to the death of children by leaving them in motor vehicles. A study conducted by the Associated Press (AP) in 2005 analyzed 339 fatalities of this nature and found that prosecutions and penalties vary widely (6). Charges were filed in 49% of all deaths due to paediatric vehicular hyperthermia, with 81% of these charges resulting in convictions (6). Based on our Canadian data, of the six reported cases, four led to charges of criminal negligence resulting in death. Three of these charges resulted in convictions, and one case (in 2017) has yet to be determined. Even under circumstances that did not result in the death of a child, the police have the authority to charge parents with child abandonment for leaving a child unattended in a motor vehicle. Section 218 of Canada’s Criminal Code states that anyone “who […] abandons or exposes a child under the age of ten years, so that its life is likely to be endangered or its health is or is likely to be permanently injured is guilty of an indictable offence” and can face a jail sentence of up to 5 years (7). With respect to leaving children unattended in vehicles, Quebec is the only province that has an established age limit of seven, below which children cannot be left unsupervised in vehicles (8). Although jurisprudence surrounding age and child supervision lacks consensus, what is clear is that caregivers should be educated about the dangers of leaving children unattended in a vehicle and ways to mitigate these situations. HYPOTHESIZED NEUROPSYCHOLOGICAL MECHANISMS OF SO-CALLED “FORGOTTEN BABY SYNDROME” (FBS) The majority of paediatric vehicular hyperthermia cases have reportedly occurred as a result of a parent or caregiver forgetting that a child was in the car, sometimes referred to by the media as “Forgotten Baby Syndrome”. Paediatric vehicular hyperthermia deaths were uncommon prior to the 1990s. As front seat airbags became a standard part of consumer vehicles in the early 1990s, parents were urged to place their children in the rear passenger seats. Though each province and territory varies in their car seats and booster seat legislations, Transport Canada recommends that children 12 years of age and under should always be in the back seat (9). Although these policies are meant to protect children in case of motor vehicle accidents, they also decrease the driver’s visibility of a child being present in the backseat. Kidsandcars.org (2), an American advocacy group for protecting children from injuries and tragedies related to motor vehicles, has numerous devastating stories on their website of parents and caregivers who report forgetting their infant or child was in the back seat, often attributed to a change in routine and/or being distracted. The tendency to act automatically, or go into ‘autopilot’ (i.e., when doing something routine, like driving to work on the same route daily), can explain why parents may be more likely to forget their child when there is a change in that routine. Automatic processing requires little mental effort and is robust even with fatigue or stress (10). Automatic processing also tends to proceed in a fixed manner without easily adapting to novel stimuli (10). Such neuropsychological mechanisms explain how habits can be very resistant to change and could contribute to behaviours such as following a usual routine of driving to work and forgetting that an infant, who is not usually in the vehicle, is present. Stress has also been proposed as a possible contributing factor to FBS. Impairments in memory and attention induced by stress can lead to caregivers forgetting their child in a vehicle. Upon exposure to stress, glucocorticoids, a stress hormone, are released. Research has shown reduced activity in the hippocampus, a part of the limbic system responsible for memory retrieval, in response to such stress hormones (11), resulting in temporary impairments (12). Attention also suffers when subjected to stress. According to the capacity-resource theory, attention is depleted under stressful conditions, inhibiting controlled and effortful processing of information (13). However, automatic processes, such as the execution of routines, remain intact (14). Stresses and changes in routine can affect the way the brain processes information and predispose people to memory or attention ‘lapses’. Regardless of the exact mechanisms and environmental circumstances that lead to these tragic incidents, experts say that under the right circumstances, forgetting an infant or child in the back seat could happen to anyone (15). Being aware of these potential pitfalls and setting strategies and habits in place as reminders can help prevent these attention shifts or lapses from becoming tragedies. CONCLUSION AND RECOMMENDED ANTICIPATORY GUIDANCE In Canada, deaths by hyperthermia in vehicles in children 3 years and under have occurred an average of once per year since 2013, over the months of May to September. The majority are reported as being unintentional. Further measures are warranted to prevent these avoidable devastating tragedies. Parents may think such an incident could never happen to them, but experts say it can happen to anyone, and urge all parents and caregivers to make taking precautions a habit (15). Incidents of paediatric vehicular hyperthermia are tragic because they are preventable. Increasing awareness about the dangers of leaving children unattended in vehicles and the risk of Forgotten Baby Syndrome, will hopefully lead to a decrease in such tragedies (Figure 1). The following anticipatory guidance (Table 2) and parental/caregiver strategies (Table 3) are recommended. Figure 1. View largeDownload slide Graphic abstract Figure 1. View largeDownload slide Graphic abstract Table 2. Anticipatory guidance for parents and caregivers to prevent paediatric vehicular hyperthermia deaths Anticipatory Guidance for Parents and Caregivers • Motor vehicle hyperthermia prevention education and anticipatory guidance (see below) should be a part of the discharge education plan for parents after a baby is born and can be discussed at discharge when providing car seat education. • It is recommended that motor vehicle hyperthermia prevention should also be added in the Rourke Baby Record under the ‘Injury Prevention—Transportation in Motor Vehicles’ section as a part of the anticipatory guidance recommendations at the newborn and 2-month well-baby visits. • Parents should be instructed to inform all caregivers (i.e., grandparents and babysitters) caring for their child of this information. Motor vehicle hyperthermia prevention anticipatory guidance discussion points: • When discussing car seat safety, parents should be instructed never to leave a child unattended in a motor vehicle. • Parents and caregivers should also be reminded of the child abandonment law as it pertains to leaving children in vehicles. • Parents/caregivers should be informed that, even on mild days, a parked vehicle can heat up quickly to dangerous levels and be advised to never leave a child unattended in a motor vehicle. Leaving the windows slightly open has little impact on the overall interior temperature of a parked vehicle (4). • The potential for unintentionally leaving a child in the backseat should also be discussed with strategies for prevention (see below). • Parents/caregivers should be instructed not to leave parked vehicles unlocked, or car keys where children can access them, and to educate children about the dangers of getting into an unattended parked motor vehicle and that vehicles are not considered a place to play in. • Inform parents/caregivers and the public to call 9-1-1 if they see a child alone and in distress in a locked vehicle. If one feels the child needs to be taken out of the car immediately, one should break a car window (the front passenger window on the opposite side of the child, if possible), if able to do so. Anticipatory Guidance for Parents and Caregivers • Motor vehicle hyperthermia prevention education and anticipatory guidance (see below) should be a part of the discharge education plan for parents after a baby is born and can be discussed at discharge when providing car seat education. • It is recommended that motor vehicle hyperthermia prevention should also be added in the Rourke Baby Record under the ‘Injury Prevention—Transportation in Motor Vehicles’ section as a part of the anticipatory guidance recommendations at the newborn and 2-month well-baby visits. • Parents should be instructed to inform all caregivers (i.e., grandparents and babysitters) caring for their child of this information. Motor vehicle hyperthermia prevention anticipatory guidance discussion points: • When discussing car seat safety, parents should be instructed never to leave a child unattended in a motor vehicle. • Parents and caregivers should also be reminded of the child abandonment law as it pertains to leaving children in vehicles. • Parents/caregivers should be informed that, even on mild days, a parked vehicle can heat up quickly to dangerous levels and be advised to never leave a child unattended in a motor vehicle. Leaving the windows slightly open has little impact on the overall interior temperature of a parked vehicle (4). • The potential for unintentionally leaving a child in the backseat should also be discussed with strategies for prevention (see below). • Parents/caregivers should be instructed not to leave parked vehicles unlocked, or car keys where children can access them, and to educate children about the dangers of getting into an unattended parked motor vehicle and that vehicles are not considered a place to play in. • Inform parents/caregivers and the public to call 9-1-1 if they see a child alone and in distress in a locked vehicle. If one feels the child needs to be taken out of the car immediately, one should break a car window (the front passenger window on the opposite side of the child, if possible), if able to do so. View Large Table 2. Anticipatory guidance for parents and caregivers to prevent paediatric vehicular hyperthermia deaths Anticipatory Guidance for Parents and Caregivers • Motor vehicle hyperthermia prevention education and anticipatory guidance (see below) should be a part of the discharge education plan for parents after a baby is born and can be discussed at discharge when providing car seat education. • It is recommended that motor vehicle hyperthermia prevention should also be added in the Rourke Baby Record under the ‘Injury Prevention—Transportation in Motor Vehicles’ section as a part of the anticipatory guidance recommendations at the newborn and 2-month well-baby visits. • Parents should be instructed to inform all caregivers (i.e., grandparents and babysitters) caring for their child of this information. Motor vehicle hyperthermia prevention anticipatory guidance discussion points: • When discussing car seat safety, parents should be instructed never to leave a child unattended in a motor vehicle. • Parents and caregivers should also be reminded of the child abandonment law as it pertains to leaving children in vehicles. • Parents/caregivers should be informed that, even on mild days, a parked vehicle can heat up quickly to dangerous levels and be advised to never leave a child unattended in a motor vehicle. Leaving the windows slightly open has little impact on the overall interior temperature of a parked vehicle (4). • The potential for unintentionally leaving a child in the backseat should also be discussed with strategies for prevention (see below). • Parents/caregivers should be instructed not to leave parked vehicles unlocked, or car keys where children can access them, and to educate children about the dangers of getting into an unattended parked motor vehicle and that vehicles are not considered a place to play in. • Inform parents/caregivers and the public to call 9-1-1 if they see a child alone and in distress in a locked vehicle. If one feels the child needs to be taken out of the car immediately, one should break a car window (the front passenger window on the opposite side of the child, if possible), if able to do so. Anticipatory Guidance for Parents and Caregivers • Motor vehicle hyperthermia prevention education and anticipatory guidance (see below) should be a part of the discharge education plan for parents after a baby is born and can be discussed at discharge when providing car seat education. • It is recommended that motor vehicle hyperthermia prevention should also be added in the Rourke Baby Record under the ‘Injury Prevention—Transportation in Motor Vehicles’ section as a part of the anticipatory guidance recommendations at the newborn and 2-month well-baby visits. • Parents should be instructed to inform all caregivers (i.e., grandparents and babysitters) caring for their child of this information. Motor vehicle hyperthermia prevention anticipatory guidance discussion points: • When discussing car seat safety, parents should be instructed never to leave a child unattended in a motor vehicle. • Parents and caregivers should also be reminded of the child abandonment law as it pertains to leaving children in vehicles. • Parents/caregivers should be informed that, even on mild days, a parked vehicle can heat up quickly to dangerous levels and be advised to never leave a child unattended in a motor vehicle. Leaving the windows slightly open has little impact on the overall interior temperature of a parked vehicle (4). • The potential for unintentionally leaving a child in the backseat should also be discussed with strategies for prevention (see below). • Parents/caregivers should be instructed not to leave parked vehicles unlocked, or car keys where children can access them, and to educate children about the dangers of getting into an unattended parked motor vehicle and that vehicles are not considered a place to play in. • Inform parents/caregivers and the public to call 9-1-1 if they see a child alone and in distress in a locked vehicle. If one feels the child needs to be taken out of the car immediately, one should break a car window (the front passenger window on the opposite side of the child, if possible), if able to do so. View Large Table 3. Strategies for parents and caregivers to prevent paediatric vehicular hyperthermia deaths (2) Parent/Caregiver strategies for prevention Make it a habit Habits are powerful in guiding our actions. Have parents make a habit of exercising the following safety measures to reduce the chance of them leaving a child behind in a car. • Make a habit of always checking in the back seat before locking the car, even if a child is not with you. • Engage with your child during the drive. Sing or talk to them—even when the baby is asleep or not yet talking. • Be extra vigilant when fatigued and/or when your usual routines change. • Slow down and avoid distractions. Avoid rushing and talking on the phone when driving. Create reminders Encourage parents to set reminders as a secondary safety measure. • Put something you will need when you leave the vehicle in the backseat (i.e., your phone, purse, wallet, briefcase, employee badge). • Place a stuffed animal on the car seat, and move it to the front seat, whenever you place a child in the car seat, to serve as a reminder that a child is in the back seat. Alternatively, put a toy rattle on the driver’s lap. It will make a noise as you get out of the car. • Place the diaper bag in the front seat whenever you are driving an infant. • Place a mirror on the rear-facing car seat so that the child’s face is visible in rear view mirror. • Have your childcare provider contact you in the event that your child does not show up. • Smartphone apps (i.e., Precious Cargo, SafeKids Alert, Kars4Kids Safety) and vehicle devices (i.e., Intel Smart Clip, TOMY’s First Years Brand car seats, ChildMinder SoftClip System) can be installed to help remind parents and caregivers that an infant or child is still in the car. Ensure that children cannot access parked vehicles • Keep vehicles locked when parked (i.e., in the garage, driveway or on the street), to ensure a child cannot get in and become entrapped. • Keep vehicle keys out of reach of children. • Check all vehicles thoroughly if a child goes missing. Parent/Caregiver strategies for prevention Make it a habit Habits are powerful in guiding our actions. Have parents make a habit of exercising the following safety measures to reduce the chance of them leaving a child behind in a car. • Make a habit of always checking in the back seat before locking the car, even if a child is not with you. • Engage with your child during the drive. Sing or talk to them—even when the baby is asleep or not yet talking. • Be extra vigilant when fatigued and/or when your usual routines change. • Slow down and avoid distractions. Avoid rushing and talking on the phone when driving. Create reminders Encourage parents to set reminders as a secondary safety measure. • Put something you will need when you leave the vehicle in the backseat (i.e., your phone, purse, wallet, briefcase, employee badge). • Place a stuffed animal on the car seat, and move it to the front seat, whenever you place a child in the car seat, to serve as a reminder that a child is in the back seat. Alternatively, put a toy rattle on the driver’s lap. It will make a noise as you get out of the car. • Place the diaper bag in the front seat whenever you are driving an infant. • Place a mirror on the rear-facing car seat so that the child’s face is visible in rear view mirror. • Have your childcare provider contact you in the event that your child does not show up. • Smartphone apps (i.e., Precious Cargo, SafeKids Alert, Kars4Kids Safety) and vehicle devices (i.e., Intel Smart Clip, TOMY’s First Years Brand car seats, ChildMinder SoftClip System) can be installed to help remind parents and caregivers that an infant or child is still in the car. Ensure that children cannot access parked vehicles • Keep vehicles locked when parked (i.e., in the garage, driveway or on the street), to ensure a child cannot get in and become entrapped. • Keep vehicle keys out of reach of children. • Check all vehicles thoroughly if a child goes missing. View Large Table 3. Strategies for parents and caregivers to prevent paediatric vehicular hyperthermia deaths (2) Parent/Caregiver strategies for prevention Make it a habit Habits are powerful in guiding our actions. Have parents make a habit of exercising the following safety measures to reduce the chance of them leaving a child behind in a car. • Make a habit of always checking in the back seat before locking the car, even if a child is not with you. • Engage with your child during the drive. Sing or talk to them—even when the baby is asleep or not yet talking. • Be extra vigilant when fatigued and/or when your usual routines change. • Slow down and avoid distractions. Avoid rushing and talking on the phone when driving. Create reminders Encourage parents to set reminders as a secondary safety measure. • Put something you will need when you leave the vehicle in the backseat (i.e., your phone, purse, wallet, briefcase, employee badge). • Place a stuffed animal on the car seat, and move it to the front seat, whenever you place a child in the car seat, to serve as a reminder that a child is in the back seat. Alternatively, put a toy rattle on the driver’s lap. It will make a noise as you get out of the car. • Place the diaper bag in the front seat whenever you are driving an infant. • Place a mirror on the rear-facing car seat so that the child’s face is visible in rear view mirror. • Have your childcare provider contact you in the event that your child does not show up. • Smartphone apps (i.e., Precious Cargo, SafeKids Alert, Kars4Kids Safety) and vehicle devices (i.e., Intel Smart Clip, TOMY’s First Years Brand car seats, ChildMinder SoftClip System) can be installed to help remind parents and caregivers that an infant or child is still in the car. Ensure that children cannot access parked vehicles • Keep vehicles locked when parked (i.e., in the garage, driveway or on the street), to ensure a child cannot get in and become entrapped. • Keep vehicle keys out of reach of children. • Check all vehicles thoroughly if a child goes missing. Parent/Caregiver strategies for prevention Make it a habit Habits are powerful in guiding our actions. Have parents make a habit of exercising the following safety measures to reduce the chance of them leaving a child behind in a car. • Make a habit of always checking in the back seat before locking the car, even if a child is not with you. • Engage with your child during the drive. Sing or talk to them—even when the baby is asleep or not yet talking. • Be extra vigilant when fatigued and/or when your usual routines change. • Slow down and avoid distractions. Avoid rushing and talking on the phone when driving. Create reminders Encourage parents to set reminders as a secondary safety measure. • Put something you will need when you leave the vehicle in the backseat (i.e., your phone, purse, wallet, briefcase, employee badge). • Place a stuffed animal on the car seat, and move it to the front seat, whenever you place a child in the car seat, to serve as a reminder that a child is in the back seat. Alternatively, put a toy rattle on the driver’s lap. It will make a noise as you get out of the car. • Place the diaper bag in the front seat whenever you are driving an infant. • Place a mirror on the rear-facing car seat so that the child’s face is visible in rear view mirror. • Have your childcare provider contact you in the event that your child does not show up. • Smartphone apps (i.e., Precious Cargo, SafeKids Alert, Kars4Kids Safety) and vehicle devices (i.e., Intel Smart Clip, TOMY’s First Years Brand car seats, ChildMinder SoftClip System) can be installed to help remind parents and caregivers that an infant or child is still in the car. Ensure that children cannot access parked vehicles • Keep vehicles locked when parked (i.e., in the garage, driveway or on the street), to ensure a child cannot get in and become entrapped. • Keep vehicle keys out of reach of children. • Check all vehicles thoroughly if a child goes missing. View Large Funding: There are no funders to report for this submission. 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TI - Paediatric hyperthermia-related deaths while entrapped and unattended inside vehicles: The Canadian experience and anticipatory guidance for prevention
JF - Paediatrics & Child Health
DO - 10.1093/pch/pxz087
DA - 2020-04-10
UR - https://www.deepdyve.com/lp/oxford-university-press/paediatric-hyperthermia-related-deaths-while-entrapped-and-unattended-9FiS0Cteq9
SP - 1
VL - Advance Article
IS - 
DP - DeepDyve
ER -