The best advice to prevent children from drowning is to have an adult watching the water at all times

Summer has arrived. And for all its pleasant, warm-weather pastimes--pool parties, barbeques, bicycling, and more--an emergency department near you is feeling the usual seasonal spike in children's unintended injuries and deaths. No wonder summer is known in the medical business as "trauma season."

Childhood deaths from unintentional injuries, reassuringly, are rare. But add up the pain of broken bones (plus the angst of a childhood summer spent in a cast), parents' time taken off from work to nurse an injured kid, medical bills--not to mention the use of ER resources--and the possibility of a lasting disability from, say, a brain injury sustained in a bicycle accident, and you've got a costly impact on families and society.

Because of unintentional injuries, U.S. children age 14 and under made more than 2.4 million emergency room visits in the summer of 2004, the latest summer for which data are available. Those injuries resulted in 2,143 deaths, according to a report by Safe Kids Worldwide.

There are distinct patterns to summer accidents, and many could be easily prevented. Marie Lozon, division director of pediatric emergency medicine at the University of Michigan Health System, tends not only to the young patients who are rushed through the doors of her emergency department but also to shocked parents. "Every day I hear, 'I just turned my back for a second,'" she says. A brief lapse in supervision is often a critical factor in kids' visits to the ER during trauma season.

Between conversations with Lozon and another expert, Chrissy Cianflone, director of program operations at Safe Kids USA, U.S. News has compiled a list of some common trauma-season causes of unintentional injury to kids--and simple ways to avert such disasters:


Lack of adult supervision and drowning go hand in hand. In summer, kids drown at nearly twice the rate that's typical for the rest of the year--reflecting a steeper summertime increase than exists for any other kind of unintentional injury to kids. Drowning deaths among young people are still relatively rare--1.42 per 100,000 person-years. Between 2000 and 2005, there were 6,900 non-boat-related unintentional drowning deaths between 2000 and 2005 of people younger than 20 nationwide, according to the U.S. Centers for Disease Control and Prevention.

Drowning is "not like in the movies," says Cianflone. There is no wild flailing and commotion. "The child will simply just slide into the water, very silently and very quickly," she explains. In a pool setting, for example, an adult might suddenly notice a child at the bottom of the pool and have no idea how long he or she has been there. Resuscitation may be possible, but often serious damage has already been done. "You can get them back from a cardiac standpoint," explains Lozon, as children typically have resilient cardiovascular systems, "but they will have severe neurologic damage."

The most basic, common-sense advice to prevent children from drowning is to have an adult watching the water at all times. Sounds obvious, like something any parent would do instinctively, but Cianflone says a kid drowning is usually "a matter of everybody was watching, but nobody was watching." The solution, she says: Having a designated adult with his or her eyes on the water at all times and the ability to jump in quickly.

"That adult's primary job is to focus on the children in the water, not sitting on a lounge chair reading a book and eating," she adds. And lifeguards aren't a universal remedy, adds Cianflone, noting she's had calls from parents whose child drowned with a lifeguard on duty.

What about swimming lessons? "Parents often think this is the magical answer," says Lozon. She acknowledges that kids who get swimming lessons may have more competence in the water and might not panic, buying them some time in a dicey situation, like when a crush of kids are bunched together in the water or when fatigue sets in. But parents shouldn't overestimate the protective value of swimming lessons. Particularly with younger kids, she says, "swimming lessons are fantastic, but it's not a panacea for supervision."

Both Lozon and Cianflone recommend that backyard pools be surrounded by fencing on all sides and have a self-locking gate so kids cannot wander out the back door and jump into the pool. Even parents who consistently tell their young children not to go in the water without mom or dad around should not assume they'll heed their advice, says Cianflone. "Little kids are attracted to water; they don't necessarily know that water is dangerous to them." Door alarms, a retractable pool cover or floating alarms that sound if the surface of the pool's water is broken also may help prevent a child from getting into the pool unsupervised, adds Cianflone.

Children who go swimming in lakes, oceans, and rivers need life jackets, says Cianflone, and parents need to model the behavior for young kids.


Deaths related to biking increase about 45 percent in summer, compared with other times of the year. Certainly, riding around in the warm weather is a favorite childhood pastime, but doing so without wearing a properly fitted helmet could be asking for trouble.

"I can't tell you how many times I see kids wearing helmets that are too big, too small, or too far back on their heads," says Cianflone. She says that about 135 kids 14 and younger die in bicycle crashes and about 267,000 sustain nonfatal bike injuries annually.

Plenty of parents and children think of scapes and bruises as badges of honor. Cianflone doesn't disagree. But to parents who gripe about forcing their kid to wear a helmet when they survived their own childhoods without one, she says, "A traumatic brain injury is not a badge of honor." Helmet laws and public awareness campaigns, she explains, have brought down the rate of deaths and injuries significantly in the past two decades.

Bike accidents often occur when the rider hits something and pitches forward. Compounding that, younger kids' heads are, proportionately, bigger than they will be as they get older, says Lozon. As a result, she says, kids "tend to lead with their heads." So ensuring the helmet is covering the front of the head, not cocked back on the crown, is essential. A properly fit helmet should sit on a kid's head two adult finger-widths above the child's eyes, says Cianflone. The strap should fit snugly below the chin but still allow the mouth to open and close. The Y-straps should fall just below the ears--not in the middle of the ear or so low that the Y-straps are down to the chin, she adds.

Cianflone recommends buying a helmet that meets the standards of the Consumer Product Safety Commission, which should be evident by a CPSC sticker inside the helmet. Bell Sports, she adds, makes a helmet for kids called True Fit that requires only one step to adjust the helmet for a proper fit. "We think it takes the guesswork out of trying to fit a helmet," she says, although she notes that Safe Kids USA doesn't endorse specific products.


Motor vehicle crashes are the leading cause of death among kids ages 3-14 in the U.S. In 2005, according to the U.S. Centers for Disease Control and Prevention, 1,335 passengers ages 14 and younger died and 184,000 were injured in motor vehicle crashes. That's a daily average of four deaths and 504 injuries. And compared with the rest of the year, the rate of motor vehicle-related deaths spikes by about 20 percent in the summer, says Safe Kids.

A number of factors are involved, including high-traffic holidays--in particular, Memorial Day, the Fourth of July, and Labor Day--an excess of drinking, and parents who don't bring their children's car seats on vacation.

A properly fitted car or booster seat is essential to preventing a child's injury or death in an accident, says Cianflone. (Safe driving, obviously, is as well.) Size matters--only kids who are at least 4-foot-9 and weigh 80 to 100 pounds can safely wear a seat belt. It is estimated that 73 percent of car seats are either installed wrong or aren't used correctly. Parents can have their work checked at a car-seat inspection station. The Safe Kids USA website can help you find one.

Speed and collisions aren't the only hazards with motor vehicles. Between 1998 and 2004, an annual average of 33 children died of heat stroke because they were left in an unattended vehicle, Cianflone says. Sometimes a child playing hide-and-seek or mimicking her parents will pull down the back seat and climb into the trunk. In other instances, a parent might leave a child in the car to run a quick errand, or they might simply forget their child in the back seat.

"I don't know how a parent forgets a child in the back of the car, but it does happen," says Cianflone. "Usually, it's a person of a higher education level. Everybody is in a rush." She recommends that parents put their briefcase or purse next to the child in the back seat to avoid such a heat-related tragedy.

Recreational vehicles and riding lawn mowers also come out of the garage this time of year, and they pose their own dangers. For example, on the farms outside of Ann Arbor, Mich., where Lozon lives, all-terrain vehicles are very popular. They have a high center of gravity and are easy to tip over, she explains. Plus, the rider is not protected by a shell, as they would be in a car. Lozon sees numerous head and neck fractures, and kids can be crushed by an ATV rolling over them. These injuries, she says, "can be heinous."

Part of the problem, as with riding lawn mowers, says Lozon, is that an adult will drive the vehicle with a smaller child on their lap, thinking it will be fun. "Parents think they can control the lawnmower and the toddler--and 99 out of 100 times they can," she says. But every summer she sees quite a few kids' toes or feet sheared off by mower blades.


Kids are out and about more often in the summer, frequently unsupervised, and that contributes to a 16 percent spike in child pedestrian deaths this time of year. Again, a child's level of development plays a role in their risk: Research suggests that before age 10, children are particularly impulsive and also cannot judge speed, spatial relationships, or distance very well.

Close to 10 percent of child pedestrian injuries occur in a driveway during the summer, according to Safe Kids. Nonfatal injuries related to vehicle backovers landed approximately 2,500 kids ages 14 and younger in the ER per year between 2001 and 2003, according to the CDC. Nearly half of those incidents took place at the child's home. And don't trust the car camera that allows a driver to watch a screen on the dashboard for a shot of the field to the rear. It has blind spots, too. "We recommend you walk around the back of the vehicle every time you get into the car," Cianflone says.


Fireworks, barbeques, campfires, and fire pits are all integral parts of summer. Parents just need to keep the heat away from the kids. "People don't respect fire the way they should," says Lozon, who sees plenty of toddlers with burns on their chests, legs, and faces. In many cases, the fire had gone out, which perhaps led to adults letting down their guard, and a child stumbled into the white ashes, which remain searing hot. Another common injury Lozon's emergency department gets this time of year results from kids spraying lighter fluid into the barbeque. The fire can light the arc of fluid all the way up to the container, which can explode in the hand.

And of course, the Fourth of July is notorious for injuries related to fireworks. According to the CDC, a third of individuals injured by fireworks are under the age of 15. One of the most common such injuries Lozon sees is when the fuse on a firework is lit incorrectly--or doesn't appear to catch--and someone goes back to re-light or fiddle with it. The firework explodes and fingers are blown off or the face, eyes, or head gets burned.


They're the leading cause of nonfatal unintended injury to children year-round, bringing about 8,000 kids into the ER daily, says the CDC. And fall-related deaths spike in the summer, up 21 percent over the average during the rest of the year, according to Safe Kids. Warm temperatures mean more open windows, more time on the jungle gym, and more kids hanging out on balconies or fire escapes.

There are two easy ways to prevent children from falling, says Cianflone: supervision and window guards. Exploring, climbing, touching, pushing, and grasping at the world around them is how children grow and develop, she says, so risk can't be completely eliminated. But watching kids and removing the hazards in their environment can help prevent a mishap. Keep furniture (including the baby's changing table) away from windows, install bars or a childproof gate on windows, and don't allow kids to play on balconies or roofs.

Going to the playground has its perils, too. On an annual basis, kids 14 or younger make 200,000 visits to the emergency departments in the United States because of playground accidents, according to the CDC. A few precautions can keep kids safe. To avoid trips and lost balance (and heads banged painfully into pieces of metal equipment), ditch the Crocs and flip-flops in favor of sneakers with adequate rubber on the soles, says Cianflone. As with adult supervision around the pool, says Cianflone, adult eyes focused on kids on the playground equipment is key.


Keep your kids from wearing hooded sweatshirts or anything dangling around their necks on the playground--it's a strangulation hazard if it gets caught in a piece of equipment. In fact, strangulation caused about 56 percent of the 147 playground-related deaths between 1990 and 2000; falls accounted for 20 percent, says the CDC.


Just like swimming pools, trampolines get uncovered during the summer months. Their power to injure needs to be heeded. "It's a physics lesson," says Lozon. "You've got motion, height, and bodies colliding." Heads smash together, ankles and elbows get stuck between the springs and the rim of the equipment, bones break, and bodies get launched off the trampoline.

A recent study in the British Medical Journal found that the risk of injury increases with the number of bouncers. If a trampoline is a must for your family, Lozon suggests getting one with safety walls and coverings over the springs. Allow only one bouncer at a time, she says.








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