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## Complete Summary

#### GUIDELINE TITLE

The teen driver.

#### BIBLIOGRAPHIC SOURCE(S)

Committee on Injury, Violence, and Poison Prevention, American Academy
of Pediatrics, Committee on Adolescence, American Academy of Pediatrics,
Weiss JC. The teen driver. Pediatrics 2006 Dec;118(6):2570-81. \[82
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17142548)

#### GUIDELINE STATUS

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Motor vehicle-related injuries

#### GUIDELINE CATEGORY

Counseling\
Prevention

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

-   To describe why teenagers are at greater risk of motor
    vehicle-related injuries

-   To suggest topics suitable for office-based counseling

-   To describe innovative programs and propose preventive interventions
    for pediatricians, parents, legislators, educators, and other child
    advocates

#### TARGET POPULATION

Teenage drivers and their families

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Counseling of parents and adolescents to encourage safe driving
    practices

2.  Community advocacy by pediatricians to encourage safe driving
    practices

3.  Legislative advocacy of pediatricians to encourage enforcement of
    alcohol and safety belt laws and graduated driver licensing

4.  Pediatrician encouragement of the alcoholic beverage and
    entertainment industries in supporting responsible behavior

#### MAJOR OUTCOMES CONSIDERED

Incidence of motor vehicle-related accidents, fatalities, and injuries
in teen drivers

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Not stated

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not applicable

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Because motor vehicle crashes pose a major, continuing threat to the
health of teenagers, the American Academy of Pediatrics makes the
following recommendations.

**Anticipatory Guidance by Pediatricians**

Pediatricians should:

-   Know their state laws regarding teenaged drivers, the teenaged
    driver-licensing process, and physician reporting requirements for
    medical conditions that could impair driving ability.

-   Distribute educational materials about local graduated driver
    licensing (GDL) programs and teenaged driver safety to their
    adolescent patients (see Appendix 1 in the original guideline
    document).

-   Alert parents and teenagers to high-risk situations for teenaged
    drivers (see Table below).

**Table. Contributors to Teenaged Driver Crashes and Injury**

  -----------------------------------------------------------------------
  Lack of driver experience\
  \
  Young age at licensure\
  \
  Failure to use safety belts\
  \
  Inadequate hazard-perception skills\
  \
  Distraction (cellular phone, food, drink, music)\
  \
  Transporting teenaged passengers\
  \
  Nighttime driving\
  \
  Speeding and reckless driving\
  \
  Fatigue\
  \
  Unsafe vehicle choice\
  \
  Alcohol use\
  \
  Drug or medication use\
  \
  Inadequate parental limit setting\
  \
  Unlicensed or revoked license\
  \
  Attention deficit hyperactivity disorder (ADHD)

  -----------------------------------------------------------------------

-   Encourage seat belt use.

-   Discourage distractions when driving (eating, drinking, music,
    cellular phones).

-   Encourage teenager-parent written contracts (see Appendix 2 in the
    original guideline document for sample) that place restrictions on
    the teenaged driver. At a minimum, parents should place restrictions
    on nighttime driving (preferably after 9:00 PM) and limits on the
    number of teenaged passengers. Initially, the rules should be fairly
    strict, but they can be relaxed as the teenager becomes older and
    gains more driving experience.

-   Counsel teenagers about the dangers of driving while impaired (under
    the influence of alcohol, drugs, or medications or feeling ill,
    tired, depressed, or angry). Encourage a \"safe-ride\" agreement in
    which the teenager agrees to call the parent rather than drive while
    impaired and the parent promises to assist in arranging a ride home
    in a nonjudgmental manner.

-   Encourage parents to require that the vehicle driven by the teenager
    is safe and in good condition.

-   Advise parents that in many states, they have the authority to
    request that the driver\'s license of their minor child be revoked.

-   Encourage parents to be positive role models.

-   Advise parents about the various driving schools, Web sites,
    computer driving simulations, and parent-supervised driving lessons
    that are available (see Appendix 1 in the original guideline
    document).

**Community Advocacy by Pediatricians**

Pediatricians should:

-   Support community efforts that encourage safe teenaged driving.

-   Work with schools to encourage safety belt use and discourage
    alcohol use.

-   Discourage school systems from continuing traditional driver
    education programs that are ineffective and encourage licensure of
    young teenagers.

-   Discourage school policies that allow students to drive off campus
    for lunch.

-   Encourage police to enforce GDL and seat belt laws.

-   Collaborate with police and media to promote sobriety checkpoints
    and safety belt education and enforcement programs.

**Legislative Advocacy by Pediatricians**

Pediatricians should:

-   Support strong GDL legislation in their states (see Table below).

-   Support improvement and enforcement of laws designed to limit the
    purchase, possession, and consumption of alcohol by underage
    adolescents.

-   Support primary enforcement of safety belt laws for all occupants.

**Table. Essential Features That Should Be Mandated in GDL Systems**

+-----------------------------------------------------------------------+
| 1.  A learner-permit phase that starts no earlier than 16 years of    |
|     age and lasts at least 6 months                                   |
|                                                                       |
| 2.  A minimum of 30 hours (preferably 50 hours) of adult-supervised,  |
|     on-road driving during the permit stage (at least 5 to 10 of      |
|     these supervised practice hours should be at night)               |
|                                                                       |
| 3.  A provisional (intermediate) stage, with restrictions, that lasts |
|     until 18 years of age                                             |
|                                                                       |
| 4.  A nighttime driving restriction (9:00 PM to 5:00 AM until driving |
|     with provisional license for 6 months, followed by a midnight to  |
|     5:00 AM restriction until 18 years of age)                        |
|                                                                       |
| 5.  Passenger limits (unless supervised by an adult)                  |
|                                                                       |
|     a.  First 6 months with provisional license: no teenaged          |
|         passengers                                                    |
|                                                                       |
|     b.  Until 18 years of age: no more than 1 teenaged passenger      |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| 6.  Prompt imposition of fines, remedial driver classes, or license   |
|     suspension for violation of passenger or curfew restrictions      |
|                                                                       |
| 7.  Use of safety belts and appropriate child restraints by all       |
|     occupants                                                         |
|                                                                       |
| 8.  No cellular phone use while in the provisional stage              |
|                                                                       |
| 9.  Zero tolerance for alcohol and provisions for administrative      |
|     license revocation for drunk driving, excessive speeding, or      |
|     reckless driving                                                  |
|                                                                       |
| 10. Documented safe driving record before full licensure is granted   |
+-----------------------------------------------------------------------+

It is suggested that states also consider a requirement for additional
supervised driver experience/education (focused on hazard recognition
and risk avoidance) during the provisional stage and a requirement for
an additional on-road test to graduate from provisional to full
licensure.

**Involvement of the Alcoholic Beverage and Entertainment Industries in
Encouraging Responsible Behavior**

Pediatricians should:

-   Encourage the alcoholic beverage industry to eliminate advertising
    aimed at youth.

-   Encourage the media to avoid portrayal of speeding and reckless
    driving in contexts that invite imitation.

-   Encourage the media to show universal use of safety belts.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Prevention of motor vehicle injuries related to teen driving

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Chart Documentation/Checklists/Forms

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Committee on Injury, Violence, and Poison Prevention, American Academy
of Pediatrics, Committee on Adolescence, American Academy of Pediatrics,
Weiss JC. The teen driver. Pediatrics 2006 Dec;118(6):2570-81. \[82
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17142548)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Dec

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Injury, Violence, and Poison Prevention

Committee on Adolescence

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Committee on Injury, Violence, and Poison Prevention, 2005-2006: Gary A.
Smith, MD, DrPH, *Chairperson*; Carl R. Baum, MD; M. Denise Dowd, MD,
MPH; Dennis R. Durbin, MD, MSCE; H. Garry Gardner, MD; Robert D. Sege,
MD, PhD; Michael S. Turner, MD; \*Jeffrey C. Weiss, MD; Joseph L.
Wright, MD, MPH

*Liaisons*: Ruth A. Brenner, MD, MPH, National Institute of Child Health
and Human Development; Stephanie Bryn, MPH, Health Resources and
Services Administration/Maternal and Child Health Bureau; Julie
Gilchrist, MD, Centers for Disease Control and Prevention; Jonathan D.
Midgett, PhD, US Consumer Product Safety Commission; Alexander (Sandy)
Sinclair, National Highway Traffic Safety Administration; Lynne J.
Warda, MD, Canadian Paediatric Society

*Staff*: Rebecca Levin-Goodman, MPH

*Committee on Adolescence, 2005-2006*: Joanthan D. Klein, MD,
*Chairperson*; Michelle S. Barratt, MD; Margaret J. Blythe, MD; Paula K.
Braverman, MD; Angela Diaz, MD; David S. Rosen, MD; Charles J.
Wibbelsman, MD

*Liaisons*: Miriam Kaufman, MD, Canadian Paediatric Society; Marc R.
Laufer, MD, American College of Obstetricians and Gynecologists;
Benjamin Shain, MD, American Academy of Child and Adolescent Psychiatry

*Staff*: Karen Smith

*\*Lead author*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/6/2570).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

A sample teen driver contract can be found in Appendix 2 of the
[original guideline
document](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/6/2570#SEC12).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on April 20, 2007. The
information was verified by the guideline developer on April 23, 2007.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008