injury

4th of July: 10 Tips to Stay out of the ER

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Sunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. 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. 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. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.

How to Help Teenagers with Grief

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CinemaUsher-01Our teenagers get to deal, today, with issues we hoped they wouldn’t see until they were adults–sudden trauma, injury, and grief. Teenagers are different, and you need to know how to help them. When you have a moment, here are some tips:

We have all heard about the 5 stages of grief that adults travel through, from denial to acceptance. The teenage brain is very different than the adult brain, and these stages don’t necessarily fit. Their journey through shock and grief is more individual and variable, with side trips and dangerous pitfalls.

Unfortunately, they sometimes travel this journey alone, as their parents are themselves derailed by shock and grief.

They travel it when their brains are in transition, when their impulse control is slim and they have trouble seeing very far into the future, where the consequences of their actions reside.

They choose their path at a time when they are struggling to achieve independence from their parents and control over their own lives, and they feel the need to find their own identity and act.

They will need watching.

Our children do not expect to have to deal with grief, so the first, most common reaction is shock, and then denial. But the teenaged brain is not the adult brain. They do not travel a straight path from there through anger, bargaining, depression and acceptance, as an adult might.

They can go down a side path into the excitement of being in a real life drama, and enjoyment of being the center of attention. Then they feel guilty because they were excited and, for a moment, happy.

They can feel like it was their fault: they just said those horrible things about this kid the other day! The accident happened because they wished it on him or her! They didn’t mean it!

Children are not always rational.

They can explode or become agressive, unable to control the powerful, overwhelming emotions churning inside them. Adults know that they will feel better in time; children live in the now, with no hope of feeling better.

When the excitement fades, they may do things to rekindle the show. Maybe if I drink too much or swallow some pills I will be the center of attention again? Maybe my parents will notice something other than their own grief? And why be good anyway if all it gets you is pain?

They can sometimes become fascinated with death–in it they see the solution to all of their own problems. Could they be strong enough, or brave enough, to end their own lives? They might try some exciting, near death “games” just to see how it feels, or to test themselves. Trauma is contagious.

They frequently feel isolated and alone. Their grief cuts them off from others, making them different right at the age when they most want to fit in. They may refuse to admit they hurt at all because they don’t want to be different, or seen as weak.

They may feel the need to do something to help the situation. Their parents are suffering; maybe if they lock down their own grief they can fix everything, make their parents feel better?

Many of these side paths are not likely to give you the happy, healthy child you desire.

So what is a parent to do?

First, pay attention. Don’t assume they are fine – poke into their business and bother them. Hang out in their space. Sooner or later they will talk. Listen. They will have crazy ideas that make no sense, and unexpected questions that you thought they already knew the answers to. Take them seriously and answer them honestly. Never lie, because they need to be able to trust you. There is no need to pretend you know all the answers. Let them know that they are not ever alone.

Whatever path through grief that they choose is normal, and different than any other path trod before, by anyone. Often teenagers will grieve in bits and pieces, and seem better in between. Unexpectedly, something will trigger a wave of grief that will overwhelm them. A wrong word, a food, a smell, some anniversary – grief will knock their knees out from under them. Normal adolescent emotional swings will be exaggerated. They will get headaches and stomach aches, they will feel exhausted, or they will act out or withdraw. Grades may plummet either as a way of acting out or because they cannot concentrate. They may not sleep, or they may sleep too much. Any of these are normal.

Try to keep to routines and a normal life as much as possible. Expect decent behavior: enforce all the usual rules because safety and security reside in what is known and routine. Allow the grief. Remember the person you grieve over in whatever way helps your child: pray, write in a journal, paint a picture… Talk about times spent with them. Share your own experiences with grief and loss. Let them help in any way they can with any arrangements that need to be made – people feel better when they are busy and have accomplished something.

Be there when they need you, give them the opportunity to grieve, and watch them for behaviors that are more destructive than helpful. Grief never ends, but it evolves into a more acceptable form, and people can learn to live their lives and think about something else.

If you or your child need help to get there, ask. There is help available at the end of a phone call if you are having trouble navigating through on your own. There are many of us whose life work is to be there to help when there is need.

The Blogger's Pit Stop

That Tricky Line Between Safety and Smothering: Summer Injuries

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safety signSafety 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 himself. 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?