Safety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket. All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?