Ten Tips from the Doc: Summer Vacation Success

skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten!

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

That Tricky Line Between Safety and Smothering: Summer Injuries

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?

How to Prevent Carbon Monoxide Poisoning

Okay, I tried, but there is just no way to make carbon monoxide interesting. Read it anyway, because it’s good for you: you need to know this stuff. Like eating your vegetables. Every one of us encounters carbon monoxide on an almost daily basis, because it is ubiquitous and sneaky. We need to know where it comes from, how to avoid it, the symptoms it causes, and what to do if we or our children are exposed.

Carbon monoxide (CO: one carbon, one oxygen) is a colorless, odorless, tasteless, and initially nonirritating gas produced largely by partial oxygenation of carbon based fuels. Complete oxygenation would produce carbon dioxide (CO2), which we exhale every time we breathe. Plants use that to make us more oxygen.

CO can accumulate in poorly ventilated, enclosed areas. When we breathe in large amounts, the CO binds with the hemoglobin in our blood and forms carboxyhemoglobin. Carboxyhemoglobin circulates through our bloodstreams like the regular stuff, but it does not like to release its oxygen to our brains, hearts, muscles, and organs. We suffocate while still breathing the air around us.

Aristotle, who lived around 300 BC, was the first person to note that coal fumes led to “a heavy head and death.” In ancient times, it was one way criminals were killed: they were locked in a small room with smoldering coals.

It is thought that CO is to blame for some haunted houses: its accumulation can cause hallucinations, disorientation, and delirium.

Oddly, a little CO can be a good thing: it is an anti-inflammatory, encourages growth of nerves and blood vessels, communicates between nerves, and may have some function in long term memory. Very little. Don’t go looking for it.

Statistics on CO poisoning vary significantly with who’s reporting them. It is considered to be the leading cause of poisoning injury and death worldwide. Poison help lines in the US report about 15,000 calls a year, with an estimated 70 deaths. Approximately 40,000 people seek medical care for exposures, and CO accounts for around 15,000 ER visits each year. The CDC estimates more than 500 deaths per year overall in the US, with the largest percentage being in the under 5 age group. More poisonings occur in the winter (gas heaters) and after disasters (generators).

CO is created by burning carbon-based fuels (wood, gasoline, diesel, propane, kerosene, lamp oil), by smoking (tobacco is a carbon based fuel), and by exposure to methylene chloride (degreasers, solvents, paint removers). Don’t smoke (so many reasons), and use degreasers, solvents and paint removers only in well-ventilated areas. Appliances that can produce CO need to be maintained, inspected annually, and well ventilated. Some of the most common ones are:

  • Forced air furnaces
  • Wood stoves/fireplaces (open that flume!)
  • Space heaters (non-electric)
  • Gas water heaters
  • Gas stoves
  • Gas dryers
  • Anything with a pilot light
  • Barbecues, Hibachis
  • Automobiles (never run them in an enclosed space!)
  • Generators
  • Fuel powered tools (if you put gas in it, don’t use it indoors)
  • Boats (don’t use those indoors either)

Symptoms of acute (not chronic) CO poisoning include effects on the brain (dizziness, headache, confusion, lethargy, drowsiness, irritability, irrational behavior), lungs (shortness of breath) and heart (palpitations, paleness). If exposure continues, loss of consciousness and death will follow.

Chronic exposure to lower levels of CO can result in headaches, depression, confusion, memory loss, nausea, and permanent neurologic damage.

Pregnant women, fetuses, and children are especially sensitive. As with most poisonings, children’s small bodies are more sensitive, their higher metabolic rate brings it into their bodies more quickly, and they don’t have the ability to escape.

People with lung, blood, or heart disease, like asthma or anemia, are also more susceptible.

Of note is that CO damage from methylene chloride can last twice as long as that from burning carbon based fuels, because it is stored in our tissues.

Overall, it is a good idea to prevent any exposure to CO. Maintain and inspect those appliances, and make sure they are vented. Open the flume when you have a fire in the winter. Never barbecue or use a hibachi indoors. Throw out the cigarettes, because people who smoke have levels of CO in their blood streams several times higher than non-smokers. Perhaps most important, since you can’t smell this stuff, install CO detectors near every area where people sleep. Many newer fire alarms contain CO detectors, making this even more convenient.

If you are exposed, go outside into clean air. If you are having any symptoms (light-headedness, shortness of breath, seeing ghosts…) seek medical attention. They will give you oxygen and monitor your heart and brain.

Yay! You made it through, even the dreaded chemistry. Not as bad as you thought, right? Knowledge rules!

How to Prevent Poisonings in Children

Prevention of poisonings is the grunt work of parenting. It is completely boring, repetitive, and endless. It is also absolutely necessary. I will try to make it as painless as possible.

First, some statistics to motivate you. In 2013, there were more than 1 million calls to poison help lines for children under 6 years of age. That’s almost 3000 kids a day exposed to potential poisons. 29 children died. Not that big a number unless, of course, yours is one of the 29.

Let’s keep that from happening.

The phone number for poison control is 1-800-222-1222. Stick it on every phone in your home, input it into your cell phone, and also into the grandparents and babysitter’s cell phones. Hopefully you will never need it.

The number one thing that will keep your children from being poisoned is your attention. They can’t get those pills off the counter or that detergent from under the sink if you are watching them.

Unfortunately, it is impossible to watch every child every minute of the day, so do safety proof your house and your habits so bad things won’t happen during a moment of inattention.

  • Store poisons up high (kids can’t reach them), out of sight (they don’t see them and become curious), and locked up (when all else fails, they can’t open them).
  • Make the locks automatic so you don’t have to remember to lock them as the phone is ringing.
  • Keep poisons in their original, labeled containers.
  • Don’t ever put poisons in anything that looks like a food container. I once had a child drink gasoline out of a big soda cup.
  • Don’t keep poisons in a purse, because kids love to explore purses. And because no-one keeps purses locked up and out of sight.
  • Keep the original child safety caps on everything, even though they are a pain.
  • Throw away poisons that you no longer need or use.
  • Don’t take medicines in front of a child, because children are excellent mimics; never call medicine candy, because they like candy.

So, what is a poison? Lets keep the definition loose: anything a child can ingest, absorb through their skin, or inhale that will do him or her harm. Another list!

  • Button cell batteries: They can eat right through the gut. They are in remote controls, key fobs, musical cards and books… Keep them out of reach.
  • Medicines, including vitamins, minerals, iron pills, and herbals: these are all more dangerous in a child’s tiny body.
  • Cleaning supplies: drain cleaner is a nightmare, bleach burns, abrasives abrade, furniture polish oozes into their lungs… Lock ’em up! Lock up those little laundry detergent packets too.
  • Pesticides: yuck. They cause fever, tiny  pupils, vomiting, breathing problems, twitches, seizures, and death. Respect pesticides.
  • Car stuff: gasoline, antifreeze, wiper fluid… Make yourself a high spot in the garage, too.
  • Heating stuff: coal, wood, and kerosine heaters need to be kept clean and in good working order; Kerosine and lamp oil are on the lock up list. Install smoke detectors and carbon monoxide detectors since you can’t lock up smoke.
  • Alcohol: you wanted to lock that up anyway, didn’t you? Kids drop their blood sugar when they drink alcohol, and can go into a coma.
  • Tobacco: The big worry is the liquid nicotine for vapor refills. 1/2 tsp can be toxic, they are not regulated, and they do not have child resistant caps.
  • Small magnets: not fun when two of them get together on opposite pieces of gut.

Now, about those habits. We tend to get stuff out of those locked spaces to leave on the counter, in a purse, or sitting open where we are working. Regret is not a fun emotion. Neither is guilt. Don’t leave those pills on the counter and go get a drink to swallow them with; pour out the drink glasses immediately after the party, put away the cleaning stuff before answering that phone. Be aware of any poison you have out, until it is locked up again.

The one thing that messes up all this preparation and care is a holiday, with all its incumbent disruption. Be especially vigilant during a holiday, a special occasion, or when you have guests. Stuff is everywhere, everything is hectic, and no-one is watching the kids.

Suspect a poisoning when your child vomits, has a strange odor, has staining on their clothes or around their mouths, burns around their mouths, or when there are open containers around.

If they look OK, call the poison help line, and be prepared to tell them what you think the child took, how much, how big he or she is, and where you are. Have the bottle in your hand when you call.

If something splashed into their eye, rinse it with tepid water for 15 minutes. Hold the eye open and aim the water at the corner by the nose.

If the poison is on their skin, take off the clothes covered with the poison, and rinse the child in the shower for 15 minutes.

If the child inhaled the poison, take them outside into fresh air.

If your child is unconscious, having trouble breathing, or seizing, call 911.

Take a CPR course, because everyone should.

Prevention of poisonings may not be the most fun and inspirational thing you do as a parent, but if you set the house up right and then watch your habits, you will never have reason for regret.

How to Prevent Fire Injury and Loss

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

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

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

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

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

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.