Children

How to Prevent Fire Injury and Loss

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safety signWhat could be more fascinating than fire? Humans have been drawn to it since we lived in caves. Fire is in every part of our lives, present in many of our daily activities, from cooking and heating our homes, to warming our souls. Fire out of control kills between three and four hundred children each year. In 2010 it was the third leading cause of accidental death in children. Preventing it is a good idea.

In order to prevent house fires, we need to know why they happen. Statistics time! In 2010, according to the U.S. Fire Administration, 36% of fires which caused injuries were started by cooking, and tended to occur in the evening. 15% of house fires that result in deaths were caused by smoking. After these two, fires are most commonly started by electrical appliances (especially dryers), heating units (especially portable heaters), open flames (matches, lighters, candles, and fireworks), and intentionally by people fascinated by fire. Fires not related to cooking most commonly start in the bedroom and occur during the night. Fires are particularly frequent around holidays, thanks to Halloween pumpkins, Thanksgiving candles, and dry Christmas trees.

There is a racial difference: in 2010, 29% of the children who died in fires were African Americans, who comprise only 15% of the U.S. population. There is also socioeconomic disparity: more deaths occur in poorer homes, likely due to substandard housing, crowded conditions, and children who are more frequently left alone. Also, boys are more likely to be injured or die in fires than girls.

Last, there is an age difference: although children as a whole are only half as likely to die in a fire as the general population, those under 4 are twice as likely to die as older children. They are unable to escape a fire on their own, and are more effected by the flame and the smoke.

So how do we prevent a house fire?

Be prepared for a kitchen fire: know to cover fire in a pan with it’s own lid to cut off the fire’s supply of air; never throw water on a grease fire; and keep a fire extinguisher readily available. Make sure the extinguisher is kitchen rated (it can stop a grease fire), and check the pressure gauge and look for any signs of corrosion annually. Turn it upside down and beat it with a rubber mallet at least annually, and replace it when it expires. Use the old one for practice. Most importantly, know to get out of the house if you are not able to quickly stop a small fire.

Install smoke detectors on every level of your house, next to the furnace, and near every bedroom door. Test them every month, and change the batteries every year (maybe when you turn the clocks back in the fall? You have that whole extra hour!). Then do not count on them to wake up the kids. Kids can sleep through anything.

Have fire drills with your kids, planning two exits from every room, what to do if it’s dark, and how to crawl on their hands and knees below any smoke. Teach them to touch any closed door with the back of their hand to see if it is hot. If it is, or if they see smoke, use that second exit you planned. Know where you will meet outside—the big tree, or the corner? Make it clear that the only thing to do in a fire is leave the house. No stopping for the cat, no checking on a sister. Firemen are superheroes.

Matches and lighters are, of course, adults only. Child resistant lighters have made a difference – don’t buy the few that are not child resistant! In 2010 the NFPA estimated that 56,000 fires were started by children playing with a heat source: 25,000 outdoors, 18,000 trash, 12,000 structure, and 900 vehicle fires. More boys than girls start fires. Younger children tend to start fires indoors, older children outdoors. 50% of these fires are started with lighters.

Clean the lint out of your dyer hose regularly (that will also make it work better). Never use a portable heater near anything flammable, especially curtains. Never leave a candle burning when you are not in the room. And watch those holiday decorations! If you light a pumpkin with a candle, put it at eye level, not on the ground. Better, use a different source of light. Keep fire away from drying holiday decor, and don’t even get me started on fireworks! Let the professionals handle them, please.

So, keep an eye on those lighters, never smoke in the house, go make sure that fire extinguisher has not solidified into a lump at the bottom of a corroded canister, and check those smoke detectors. Then surprise your kids with a fire drill.

How to Stay Safe Around Water

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Drowning is probably 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 who drowned but survived, commonly with irreversible damage to their brains.

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

Never, never, 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 not impossible 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. Knowledge and the ability to act can save a life.

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

 

 

How to Stay Safe on a Bicycle

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Learning to ride a bike is one of the great rites of passage in childhood. A child with a bike does not have to depend only on his own two feet: he has the freedom and power of transportation.

With power comes risk. Your job as a parent is to minimize this risk, so I have assembled a few important points on bike safety.

First, keep a small child off the street, and accompany him as he rides. When you feel he is old enough and mature enough to share the road with cars, establish some basic safety rules.

When biking, they should ride with traffic, on the right side of the road. They need to stop before entering a street and at all intersections, and check all directions before proceeding. They need to ride only in daylight, not at dusk or after dark.

And yes, the dorky bike helmet is an excellent idea. Thousands of children are injured or killed every year as a result of 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. The worst accidents are, of course, when a car hits a child. When this happens, 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. Make it a rule that they wear the helmet each and every time their feet hit those peddles. Hang it on the bike handlebars when not it is 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 walk over and lock up the bike. They can walk for a week. There is no need for any argument because they already knew that that was the rule.

Last, 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 the whole foot flat on the ground when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Then, within the confines of the rules, adventure awaits!

How to Stay Safe in a Motor Vehicle

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Motorized vehicle accidents are, most years, the first or second leading cause of accidental death in kids: children are improperly restrained in cars or are passengers with an impaired driver, are inexperienced teenage drivers, or are operating ATVs, dirt bikes, and Sea Doo’s…. I have nightmares.

Children are frequently in accidents when someone else is in the driver’s seat. The number one thing you can do to prevent injury to your child in an accident is to get an approved car seat of the appropriate size for your munchkin, and always latch him or her in—no matter how far you are going. No exceptions, ever. I once watched a baby die after being flung from his mother’s arms in a car going only five miles per hour in the parking lot of our children’s hospital. If the car is moving, the child needs to be locked in.  Make sure the seat fits your child, and change the seat as he or she grows. Read the manual for the car seat and for your car. If you are unsure that everything fits and is hooked up correctly, call your local fire station. Most are happy to check your child’s seat for free.

Drive rationally yourself. Leave a decent following distance.  Follow the 3 second rule (it should take you 3 seconds to reach the car in front of you if it stopped instantly), no matter what the speed. Stay off your cell phone, because studies prove distracted driving from cell phone use is as bad or worse than drunk driving. Make wearing a seatbelt such an ingrained habit that it never occurs to them not to do it, and never drive if you have been drinking.

Talk to them about getting out of a car if they don’t feel safe with the driver. Agree to pick them up anywhere, anytime if they call you. I have one patient who is alive now because he said, “No, I’ll just walk.” The boy who took his place is dead.

There is nothing to match the terror of knowing your fragile child has a driver’s licence. Most states have implemented longer required periods of time driving with learner’s permits, which has decreased injuries significantly. Graduated licenses have also helped: the more time kids drive with supervision before they are on their own, the better. Automatic seat belts and airbags are beautiful things. Also, the longer they have to drive themselves before they can drive friends, the better. When the time comes, friends bring with them a multitude of distractions: conversation, music, tech, flirting, and peer pressure.  Texting and distracted driving are the problems of the day, waiting for a solution. Talk to your children about the dangers; make sure they understand that texting and driving is never allowed, and that they must keep their attention on the road. Be a good example by doing this yourself.

If your child wants their own car, make sure they contribute to its cost in both dollars and sweat. If a child puts their hard earned money and muscle into a car he or she will take better care of it, and consequently of the person inside.

Last, the other motorized vehicles: Sea-Doo’s, ATVs and dirt bikes. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only thing that keeps 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?

Car Seats

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When I was a kid, I used to ride stretched out in the back window of the car with my carsick bucket. Hmm, so wrong. We’ve learned a few things since then.

Even today, an average of 900 children die in car accidents every year, more than 2 little ones each and every day.  One in three children who die in motor vehicle accidents are not buckled up. There is a real racial difference: one in four of the white kids who died were not buckled; this increased to almost half in the black and hispanic children who died in accidents. There is also a socioeconomic difference: not everyone can afford a car seat. Last, there is a geographic difference: far fewer children die in car accidents in states where car seat usage is mandated by law.

Buckle your child into an approved car seat any time your car is in motion, no exceptions. Bad things happen suddenly; prevention is much easier than regret.

Which car seat you buy depends on your child’s size, his or her age, and the type of car you drive. Read your car manual and the car seat’s manual because instructions and weight limits vary quite a bit between brands. Some general guidelines:

  • Infants and toddlers under two face backward as long as they fit. You can smush them a little. Check your seat instructions: there will be a maximum height or weight listed.
  • Toddlers and young children go in forward-facing car seats as long as they fit. They no longer fit if their head is above the back of the car seat with nothing to support it. Check that maximum height or weight listed on your car seat instructions again.
  • When they no longer fit into the car seat, they go in booster seats until the seat belt fits.
  • Seat belts fit when the upper belt lies over the shoulder and chest (not the neck) and the lower belt lies across the hips. Generally, that’s when the child is between eight and twelve and about four-foot-nine.
  • Children under 13 need to ride in the back seat.
  • If you have questions or just want someone to double-check your installation, local fire or police departments are usually more than happy to help.

The American Academy of Pediatrics has a comprehensive review of car seats, kept up to date every year, at HealthChildren.org. Read through it for more precise information on seats specific to your child’s age.

How to Prevent Gunshot injuries

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In America, gun violence is one of the top three causes of death for children between the ages of fifteen and nineteen; one in four deaths from injury in this age range is from a gunshot. In 2009 alone (the most recent year for which statistics are available), there were 114 unintentional gunshot deaths in children and adolescents, in addition to the deaths from homicide and suicide. The American Academy of Pediatrics estimates 10,000 kids were injured or killed by gunshots that year: 4559 intentional, 2149 accidental, and 270 suicide attempts (the rest were undetermined). 3000 of these kids don’t live long enough to get to a hospital; 453 died in a hospital in 2009. A firearm is forty-three times more likely to be used to kill friends or family than a burglar. In my perfect world, there would be no guns inside anyone’s homes. If you must have a gun in your home, keep it unloaded, lock it up, lock up the ammunition separately, and hide the keys. Then realize that your kids will figure out your hiding place.

Whether or not you have guns, teach your children that guns are not toys—and discuss what they should do if they see one: stop, walk away, and tell an adult. Then realize that your child’s curiosity will get the better of him or her when they do see a gun. Unfortunately, it is very likely that your children will end up at someone’s home where there will be a loaded gun. Half the homes in America have a gun, and thoughtless people do keep them loaded and unlocked. I have lost several children in my practice to gunshots—all but one incident took place in a neighbor’s house where the parents didn’t even know there was a gun present.

Kids are fascinated by guns. Your three-year-old can get to that loaded gun on the top shelf of your closet; your eight-year-old does know where the keys to the gun safe are kept; your five-year-old will grab that loaded rifle and attempt to take it into his tree house. Don’t learn this lesson the hard way, as these parents did, in my practice.