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What E.R. Doctors Wish You Knew

"If only we'd . . ." It's the phrase parents wail again and again as they pace the emergency room, awaiting news of an injured child. Each year, more than 23 million kids under 15 end up in the E.R. According to the National Safe Kids Campaign, 7 million of those children suffer accidental injuries, the leading killer of children under 14. The saddest aspect of these statistics? Most of the accidents are preventable. Parents asked physicians at ten of the nation's leading children's hospitals to share the single piece of advice that could prevent a trip to the E.R. Here's what they told us.

1. JUST SAY NO TO TRAMPOLINES

Scary Stat: Trampoline-related injuries are responsible for as many as 92,000 emergency-room visits annually.

Listen to the Doctor: "At this hospital, we see about 150 to 200 children with trampoline injuries per year, split equally between boys and girls. These kids have fractures, spinal injuries, and sometimes serious head injuries. Most injuries occur not because kids fly off the trampoline, but because another child lands on them, or they do something inappropriate, such as riding a bike on the trampoline. If you do have a trampoline, only one person at a time should be on it--with supervision. As more people get on, the risk of injury increases exponentially. If one or two kids jump up, then the trampoline is like concrete for the child coming down. Kids can even break their arms or legs as they land."--Howard Kadish, M.D., pediatric emergency medicine physician at the Primary Children's Medical Center, Salt Lake City

Find Out More: Trampolines are largely unregulated, but the American Academy of Pediatrics recommends against their use at home, in gym classes, and on playgrounds. For details, log on to www.kidshealthworks.com.

2. KEEP YOUR PLAYGROUND SAFE

Scary Stat: Falls account for 90 percent of the most severe equipment-related playground injuries (mostly head injuries and bone fractures). Lack of proper supervision accounts for about 40 percent of playground injuries.

Listen to the Doctor: "The most common injuries we see are broken arms, elbows, and clavicles--almost all of which are preventable if playgrounds are properly designed and kids are supervised. Make sure children play on age-appropriate equipment. I can't tell you how many 2-year-olds I've seen who've fallen off monkey bars. What's a 2-year-old doing on monkey bars? The other big problem is poor playground maintenance. To determine if your playground is safe, check the material under it to make sure it can absorb shock: Wood chips or shredded rubber are the safest. The coverage also needs to be sufficiently wide and deep--six feet around the equipment and 12 inches down. In their backyards, many people rely on grass, which is less absorbent than these other surfaces."--Jim Chamberlain, M.D., division chair and medical director for the Emergency Medical and Trauma Center at Children's National Medical Center, Washington, D.C.

Find Out More: The Consumer Product Safety Commission Website has a "Is Your Home Playground a Safe Place to Play?" checklist. Log on to www.cpsc.gov.

3. PROPERLY INSTALL AND USE YOUR CHILD CAR SEATS

Scary Stat: Car crashes are the leading cause of death among U.S. children. Of the 1,579 kids who died in car accidents in 2001 (the latest year for which statistics are available), 55 percent were unrestrained.

Listen to the Doctor: "Car seats are 71 percent effective in reducing infant deaths in passenger cars, so using them is a no-brainer. But even in accidents where kids are restrained, about 85 percent of the time the car seat is installed improperly. It's not tight enough, or the harness straps aren't positioned correctly, or the baby is seated in a front- rather than rear-facing position. Another crucial point: Kids under 80 pounds or 8 years old must be in a booster seat. Seat belts are designed for adults; a booster raises the child so the lap part of the belt sits across the pelvis instead of the abdomen."--Nina Gold, M.D., director of safety at the Child Protection and Safety Center at St. Joseph's Children's Hospital, Paterson, New Jersey

Find Out More: The National Highway Traffic Safety Administration has child-car-seat inspection stations in many areas of the country. To locate one near you, log on to www.nhtsa.org, or call the Auto Safety Hotline at 888-327-4236.

4. EDUCATE YOURSELF ABOUT ASTHMA

Scary Stat: Asthma is the most common chronic disease in children, affecting some 5 million American kids. Asthma is also a leading cause of absences among school children, causing approximately 10 million missed school days annually.

Listen to the Doctor: "Be alert to your child's asthma triggers--perhaps he wheezes when he gets a cold, for instance--and always have the correct medicines on hand. Start treatment immediately. If you wait, he'll end up at the E.R. A lot of kids we see are barely able to breathe and end up hospitalized for prolonged therapy. Sometimes parents say, 'We ran out of medicine.' That should never happen."--Tony Woodward, M.D., medical director of transport services at the Children's Hospital of Philadelphia

Find Out More: The American Lung Association Website, www.lungusa.org, has information on childhood asthma and links to other useful sites.

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5. AROUND WATER, KEEP YOUR EYES GLUED ON KIDS

Scary Stat: Drowning is the second leading cause of injury-related deaths in children, claiming more than 1,000 young lives per year. More than half of these accidents occur in the child's backyard pool, and one third happen at the home of a friend or relative.

Listen to the Doctor: "Drowning is a quiet killer. Your child will not start flailing--he'll just go under. A common scenario is that a bunch of adults get together, and no one's really watching the kids. The need for constant supervision cannot be overemphasized. If you have to turn away even for a second, another adult should watch the child. And all parents should know CPR. If you have a pool, surround it with a tall fence with self-closing and self-latching gates. But fences are not foolproof. Another fact: Small children can drown in an inch of water, so wading pools, bathtubs, buckets, diaper pails, toilets, spas, and hot tubs all pose a risk. Think supervision, supervision, supervision."--Alan Nager, M.D., director of the Division of Emergency and Transport Medicine at the Children's Hospital of Los Angeles

Find Out More: For excellent tips on how to prevent drowning among kids of all ages, consult the National Center for Injury Prevention and Control at www.cdc.gov/ncipc.

6. BE ALERT FOR SIGNS OF ABUSE

Scary Stat: Some 1 million children a year are victims of child abuse and neglect in the United States--and most experts agree that the problem is underreported. Head trauma, including shaken baby syndrome, is the leading cause of child-abuse death among children.

Listen to the Doctor: "If your gut feeling about a caretaker tells you that something isn't quite right ... well, something probably isn't. There can be abuse with no external signs. If you pick up your baby from day care and he seems unresponsive--or he has a weak or high-pitched cry--that could be a sign of shaken baby syndrome. Your caretaker may also tell you that she put the baby down to sleep and just couldn't wake him up, yet there's no history of an accident. With external marks, look for pattern burns or bruises in places where toddlers wouldn't normally bump. The middle of the back, the abdomen, and the buttocks rarely get bruised unless there's abuse." --Kathryn Emery, M.D., emergency-room physician at the Children's Hospital in Denver

Find Out More: For detailed information about how to detect child abuse, log on to www.kidshealth.org.

7. MAKE SURE WINDOWS ARE SAFE

Scary Stat: Each year, 4,700 American children are taken to the emergency room after falling from a window, mostly at their own home.

Listen to the Doctor: "Parents should know that a screen is not sufficient to keep a child from falling out of a window. And they should also be aware that even a fall from a first-floor window can kill a child. Here's how to cut the risk: Do not put furniture by windows, since small children can climb onto a windowside chair or table and tumble out. If you have double-hung windows, open them from the top rather than the bottom. Open a window from the bottom no more than four inches. And install child-safety window guards, which are the best prevention of all."--Karen Sheehan, M.D., medical director of the Injury Free Coalition for Kids of Chicago, at Children's Memorial Hospital

Find Out More: Log on to the National Safety Council's Website at www.nsc.org.

8. PROTECT AGAINST BURNS

Scary Stat: According to the National Burn Information Exchange, scalds are the leading cause of accidental death in the home for children under 4, and scalding accounts for 40 percent of the burn injuries for children up to age 14.

Listen to the Doctor: "We see a lot of second-degree burns caused by boiling-hot liquids in the kitchen. Typically, a child will hit a pot handle on the stove and the contents will splatter her. And sometimes parents will misjudge the heat of bathwater. Pots should be on the back burner with handles turned away, and you should never put a child into a bath while the tub is still filling, or without checking the water temperature first. (Keep your hot-water heater set no higher than 120°F.) Any burn that blisters, has destroyed the top portion of the skin, or involves the face, hands, feet, or genitals should be examined by a doctor. Such burns are prone to scarring and carry a huge risk of infection. To ease the pain before you get help, run cool water over the burn for 10 to 20 minutes. Then cover the burn with sterile, nonadhesive gauze. Don't use ice, butter, or ointment. If there's a blister, don't pop it; it helps protect against infection."--David Bank, M.D., medical director of the Pediatric Emergency Department at Phoenix Children's Hospital

Find Out More: For a complete rundown on second-degree burns, log on to the University of Iowa's Virtual Hospital at www.vh.org.

9. MINIMIZE CHOKING HAZARDS--AND LEARN PEDIATRIC CPR

Scary Stat: Children under 3 are at greatest risk for choking, suffocation, and strangulation. Airway obstruction is the leading cause of death in children younger than a year.

Listen to the Doctor: "Babies and toddlers put everything into their mouth. Certain activities pose an even higher risk for choking, including eating while walking, running, or laughing. Don't feed a small child hot dogs, whole grapes, hard candy, popcorn, nuts, raw carrots, or apple chunks, and make sure all food is cut into small-enough pieces. Older siblings can be careless about leaving dangerous toys or small objects (coins, marbles, balloons, pen caps) lying around. If the object gets stuck in the trachea, the child can lose consciousness. By the time paramedics arrive or the child gets to the E.R., it could be too late. So parents need to know basic life support for both infants and toddlers." --Barbara Peña, M.D., attending physician at Miami Children's Hospital

Find Out More: Most hospitals offer classes in CPR. You can also check out the American Heart Association's course by calling 800-242-8721 or logging on to www.americanheart.org.

10. NEVER LEAVE YOUR CHILD ALONE IN A CAR

Scary Stat: Since 1996, more than 150 children have died from hyperthermia as a result of being locked or trapped in a hot car. According to a 2002 Safe Kids?GM survey, one in five parents rarely or never locks his car at home, which means kids can climb in to play--and that spells danger.

Listen to the Doctor: "Parents must lock their cars at all times--even in the driveway or garage--and hide the key, because kids could sneak off and play in the car. In hot weather, a car can heat up to 160 degrees in minutes. This can also happen in cooler weather--when it's as low as 60 degrees--though it takes a little longer then. Another important caution: Parents will sometimes leave a child in a locked car in a supermarket parking lot, run in, do the shopping, and come out to find the child suffering from heat exhaustion or heatstroke. Please, take your child with you!"--Bob Wiebe, M.D., medical director of the Emergency Center at the Children's Medical Center in Dallas

Find Out More: Log on to www.safekids.org or www.gm.cm.

06-01-2003

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