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Hidden Summer Dangers

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You probably think you're safety-minded. After all, you've child-proofed your house, double-checked your car seat, and taken all the recommended precautions. Still, many parents underestimate the special safety threats that summer brings, says Garry Gardner, M.D., a pediatrician in Darien, IL, and member of the American Academy of Pediatrics' Injury and Poison Prevention Committee. "Kids are spending the bulk of their time outside, which raises their risk of getting hurt," he says. To learn how to keep your kids healthy this summer, Child tracked down leading experts on five summer hot spots where injuries most often occur -- playgrounds, amusement parks, water parks, public swimming pools, and beaches. Don't expect the typical advice; what they have to say will surprise -- even shock -- you.

About 200,000 children are treated in the country's emergency rooms each year for playground injuries. In fact, according to the National Program for Playground Safety (NPPS), one child is hurt every 2 ? minutes. New equipment continues to get safer, meeting improved recommendations. But a 2002 investigation of 1,037 playgrounds in 36 states by the Consumer Federation of America (CFA) and state Public Interest Research Groups (PIRG) found that most playgrounds still pose safety threats because equipment is outdated or broken.

Although there aren't mandated national safety standards for playgrounds, some schools, recreation departments, and city councils abide by guidelines from the U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials. They make a difference: A new study found that a North Carolina law requiring playgrounds at childcare centers to follow the CPSC guidelines cut injuries by 22%. Fourteen other states (Arkansas, California, Connecticut, Florida, Illinois, Michigan, New Jersey, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Utah, and Virginia) and many cities have passed laws addressing playground safety.

What You Can Do

Know the local laws. Check with the park and recreation department, school superintendent, or state attorney general's consumer-protection office to see if your city's playgrounds are subject to CPSC guidelines. Be sure to get the details -- for instance, does the law apply only to newly constructed playgrounds? Ask these local authorities for recommendations on the safest playgrounds to visit.

Rule out school playgrounds for children 4 and under. They're designed for school-age kids who are taller, have bigger hands, and possess more strength and coordination. "If you take a toddler to a school playground, you're going to end up putting him on inappropriate equipment," says Donna Thompson, NPPS director. So exactly what's a no-no for the under-5 crowd? Chain or cable walks, monkey bars, seesaws, log rolls, long spiral slides, overhead rings, arch climbers, chain or net climbers, balance beams, cable walks, dome climbers, parallel bars, track rides, and vertical sliding poles. Plus, school playgrounds likely won't have tot swings -- the type appropriate for kids under 4.

Perform your own inspections. Check out the playgrounds yourself -- ideally, before you bring your child. The most critical component: a cushy ground surface, since 79% of injuries are fall-related. Look for nine to 12 inches of sand, pea gravel, wood products, rubber products, or mats. Walk away if you see cement, asphalt, dirt, or grass: These surfaces are linked to head injuries.

Next, examine the equipment for gaps between three and nine inches (where a child's head could get stuck), hot surfaces, pinch points, sharp edges, and catch points like protruding bolts or gaps (where zippers or clothing might get caught). Also check the space between pieces; you want a "fall zone" of at least six feet for most standardized equipment. If the playground has tire swings, look for a hole at the bottom that allows water to drain; otherwise, they're likely to breed mosquitoes. Finally, the CFA/PIRG investigation found that 58% of playgrounds had climbers or slides that were too high for kids. The right size: no higher than four feet for preschoolers and six feet for older kids. They should also have guardrails to prevent falls.

Take extra care with wooden equipment. Chances are, it's been treated with chromated copper arsenate, a pesticide that the EPA will ban by the end of the year. CPSC data show that this chemical raises a child's lifetime cancer risk: Out of a million kids, between two and 100 will contract cancer as a result of this pesticide. Parents can't visually determine if wooden playgrounds have been treated. CSPC's advice: Wash your child's hands often and don't give her food while she's playing, since the extra risk stems from hand-to-mouth contact. The agency is studying sealants that can prevent arsenic from leaching.

Skip the drawstring pants. Also have your child avoid jackets with hoods, jewelry, jump ropes, and bicycle helmets, all of which can get tangled in playground equipment. It happens: CSPC found that there were 79 accidents, including 23 deaths, in a 15-year period from unintentional strangulation. And to help prevent falls, have your child wear rubber-soled shoes.

About 1,500 U.S. children drown annually and for every drowning there are six to 10 near-drownings, which can result in permanent brain damage. Backyard pools pose the greatest risk to children, but nearly one in five drownings occurs in a public pool with certified lifeguards present, according to recent data from the National Safety Council.

How is that possible? Drowning isn't a noisy event -- it's swift and nearly silent. The child's head slips under water, she takes one lungful, and she's gone. Undertrained or overstretched lifeguards simply may not spot a child who needs help. And drowning isn't the only hazard: According to the CDC, 1,474 people contracted waterborne diseases from swimming in chlorinated pools between 1999 and 2000.

What You Can Do

Ask about lifeguard training. Lifeguards should be certified by a national agency such as the American Red Cross or YMCA and be certified in infant, child, and adult CPR. "They should also have in-service training at least once a month where they test their skills," says Connie Harvey, who helps write aquatic programs for the American Red Cross in Washington, DC.

Make sure there are enough lifeguards. Lifeguards should be able to scan and supervise their entire area of responsibility from one side and back within a 30-second period. If this isn't possible, there aren't enough lifeguards. Incidents typically occur because a lifeguard is inappropriately positioned, is busy with other duties, or is distracted by talking. And don't assume that all employees are lifeguards; you'll have to ask. Some water parks have attendants who make sure people follow rules, meet height requirements for slides, and wait their turn to go down slides.

Watch carefully. "Nearly all pool injuries are a result of horsing around," says Bill Connolly, director of the Division of Codes and Standards with the New Jersey State Department of Community Affairs in Trenton. "Supervision is key to safety." Never take your eyes off your child, and make sure she follows the rules of the pool (especially no running around the deck!).

Prevent waterborne illness. In June 1998, a dozen children contracted E. coli bacteria at an Atlanta water park and one child died. The likely cause: a child with diarrhea. Chlorine kills most germs right away, but the bacteria from fecal material can live in pools for days until chlorine is able to do its job. Chlorine levels should be monitored at least every four hours in pools during the peak season and more often in crowded water parks, says Michael Beach, Ph.D., an epidemiologist at the Centers for Disease Control and Prevention in Atlanta. One clue that the pool may not be safe: cloudy water. "If you can't see the main drain in the deep end, that pool shouldn't be open," says Dr. Beach."Otherwise, how could a lifeguard spot a submerged child?" Stinging in your eyes is another warning sign: It's the byproduct of chlorine binding with dirt and urine.

To lower a child's risk, tell her not to swallow the water (a source of infection), and clean water out of her ears so bacteria can't incubate. Also shower before entering a pool. If your child has a bathroom accident even in a swim diaper, exit the pool.

Be mindful of all sources of water. A child can drown in only two inches of water. In a four-year period, the CPSC reported that 58 children under 5 drowned in five-gallon buckets. Also don't ignore signs on fountains that note they're not intended for play. Fountains aren't always chlorinated, and children have contracted waterborne illnesses from them, says Dr. Beach.

Dress your child appropriately. Nylon and spandex slide more easily and aren't as likely to get caught as other materials. If the park or pool permits it, insist that your child wear a U.S. Coast Guard-approved life jacket if she isn't a capable swimmer. What about water wings? Don't rely on them as a safety device; use them only with close adult supervision.

Come up with a plan in case anybody gets separated. Three water parks -- Wild Rivers in Irvine, CA, Palace Entertainments Wet 'n Wild in Las Vegas, and Dolly's Splash Country in Pigeon Forge, TN -- offer SafeTzone, a wristwatch-like unit children wear; it allows parents to look up their whereabouts on a screen. At least 20 more amusement and water parks plan to install SafeTzone over the next two years. If it's not available at the park you choose, show your child how to find the "lost parents" station. For a younger child, point out uniformed staff wearing name tags or suggest that kids ask another parent for help. One more option: Bring your own walkie-talkies.

The CPSC estimates that more than 8,000 Americans, many of them children, landed in the ER in 2001 because of an injury suffered at an amusement park. No agency can compile exact statistics because the amusement park industry isn't uniformly regulated -- or, in some cases, regulated at all.

The federal government oversees traveling carnival rides and puts amusement parks in the hands of the states. Some states do a good job; New Jersey, for instance, has seen the number of serious incidents drop from 24 in 1997 to 3 in 2002 thanks to stricter standards. But eight states -- Alabama, Arizona, Kansas, Mississippi, Montana, North Dakota, South Dakota, and Utah -- have no mandated ride regulations. And Florida exempts parks with more than 1,000 employees from state regulation. In fact, just 37 states require public reporting of amusement park accidents, and many of those states limit reporting to deaths and catastrophic injuries. Injuries such as broken bones and concussions are reported in only 24 states.

Granted, most amusement parks have their own systems for regulation, including daily inspections. "We're in the business of fun, but in order to be in that business we have to be in the business of safety," says Debbie Evans, director of public relations for Six Flags, Inc., which operates parks in 14 states.

Others contend that self-policing simply isn't enough. "Although progress has been made recently -- for instance, close-fitting child restraints have become standard on new kiddie rides -- self-regulation still means that parks and ride manufacturers aren't required to make their safety records public, and state officials are barred from investigating serious accidents, even if a rider dies," says Kathy Fackler, founder of www.saferparks.org, a Web site devoted to amusement park safety.

What Can You Do

See where your state stands. Fackler's Web site includes a state-by-state guide to ride regulations. If you have a choice between two parks -- and one is regulated and the other isn't -- you're probably better off going to the regulated park, she says. The site also tells you how to lobby for improvements.

Set and review the rules. Before you leave for the park, talk to your children about the importance of keeping their hands and feet inside a ride, never turning around, and not exiting a ride until it has completely stopped. You don't want your excited child to hear this for the first time when she's next in line for a ride. Breaking these rules is the most common cause of injuries.

Choose the right rides. Besides observing the height or age rules, select rides with containment systems like belts or harnesses for young children. Also get a read on whether your child will be able to go on it without panicking. "The height requirement is to ensure that children are of the appropriate size for the ride, but it doesn't necessarily mean they're of the right maturity," says Evans. If your child wants to go on and you have doubts, tag along with him. If he doesn't want to ride, listen to him.

Observe the ride a few times. Does it look well maintained? "If parts are set aside for repair or roped off, you may want to skip the ride," says Connolly. Also make sure the operator is alert and professional, checks the safety bar of each customer, and makes all riders follow the rules.

Local health or environmental departments are required to monitor water quality and post warnings at beaches if they don't meet EPA standards. But many don't comply. The EPA suggests five water checks per month, but a 2001 EPA survey of 2,445 beaches found just 63% were tested at least once a week.

What You Can Do

Check for beach advisories or closings. In the EPA survey, 27% of beaches had at least one advisory or area closed during the swimming season; the main reason was elevated bacteria levels. Look up the latest water quality information for local beaches at www.epa.gov/waterscience/beaches or www.cleanbeaches.org, especially after a big storm, which can lead to significant sewage overflow or polluted storm-water run-off.

Opt for a beach with lifeguards. Not having them increases the risk of drowning five-fold, according to the United States Lifesaving Association (USLA). Ask lifeguards about the safest area to swim and hazards to avoid, like jelly fish. But perhaps lifeguards' most common task is something unexpected. "They frequently reunite parents and kids who have become separated," says B. Chris Brewster, USLA's liaison officer. More than 27,000 children were temporarily lost at the nation's beaches in 2000. If your child wanders off, tell a lifeguard.

Maintain constant supervision. Drownings often involve single swimmers. Young children should never enter the water without adult supervision and should be kept within arm's reach of an adult at all times. Also keep a close eye on your child when he's playing on the beach. Several children have died or been severely injured when they were buried in collapsed sand holes.

Teach older kids how to get out of a rip current. Rip currents are the top cause of injury and fatalities at beaches. So how can you escape one? Swim parallel to the beach rather than toward it.

Stick to U.S. Coast Guard-approved life jackets. Rafts, tubes, and other inflatable gear aren't safety devices, because they can suddenly lose air or slip out from underneath. They also may entice kids to go into water in which they normally wouldn't be comfortable. If your children do use these devices, stay with them at all times.

Digging Deeper

For more strategies to keep your kids safe this summer, check out the following organizations.

  • Centers for Disease Control and Prevention, www.cdc.gov. Read the new brochure "Twelve Steps for Prevention of Recreational Water Illnesses."
  • Consumer Federation of America, www.consumerfed.org. Print out a form to survey your local playground.
  • United States Lifesaving Association, www.usla.org. Look over the list of top 10 swim safety tips.
  • U.S. Consumer Product Safety Commission, www.cpsc.gov. Review the safety checklists for public and home playground equipment.

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Copyright © 2003. Reprinted with permission from the August 2003 issue of Child magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.