Summer Safety – PediaCast 210

Join Dr Mike Patrick and Dr Sarah Denny as they discuss the best ways to keep kids safe this summer. Each year, nearly 10,000 American families experience the loss of a child due to an accidental injury. From bicycles to swimming pools and playgrounds to trampolines, we share important tips on making the most of a fun and safe summer!

Topic

  • Summer Safety

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Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the the campus of Nationwide Children's Hospital.

And as always we are in Columbus, Ohio. It's Episode 210, 2-1-0, May 9th, 2012. And we're calling this one 'Summer Safety', this is of course part two of a two part series. Last week we covered pre-hospital emergency care.

01:00

We sort of talked about -if you didn't listen to that program, you might want to run back and check that one out. We talked about when do you call 911, when do you call your doctor? When do you go to an urgent care?

When do you go to the emergency department and sort of what to expect if you utilize those services or have to go to those places. Today we're going to sort of pick up and actually take a step back and talk about injury prevention, so what you can do to avoid needing emergency care for your children in the first place.

And as it turns out prevention of fatal injuries is an an area where we make great strides in recent years. The CDC reports the childhood death rate from unintentional injuries dropped nearly 30% between 2000 and 2009.

So, that's really huge, I mean, when you think about the number of kids who are out there living today, and you think of the death rate dropping 30% from 2000-2009, there's a lot of kids out there who would have died if injury prevention had not shown up as a priority on our national radar.

02:05

Now, I realized some of our success has been better emergency and critical care measures that's keeping injured children alive, I get that. But we also have much improved safety awareness and new safety standards for things like seatbelts, car seats, bicycle helmets, playground equipment, trampolines, swimming pools.

You name it we're trying our best to raise awareness and make it safer. And as much as we sort of poke fun at how things have changed since we were kids, I can't tell you how many conversations I've had with other moms and dads where they say, "Oh do you remember how we had this big metal slides, they're like 20 foot tall and there was concrete underneath it and we kind of make fun of that.

But the reality is, that because we've made those changes, many kids are alive today because of safety and injury awareness and prevention. Of course we still have work to do, the number of preventable childhood injury is not zero.

03:02

And even though we have seen fantastic improvement these statistics don't mean much if you're one of the 10,000 or so families who this very summer will lose a child to a preventable injury. Here at PediaCast we don't want your child to be a statistic, we want you to have a safe and happy summer, and that's the reason for our summer safety show.

We have a great studio guest joining us on the discussion Dr. Sarah Denny, she is here. She is physician with the section of emergency medicine and the Center for Injury Research and Policy here at Nationwide Children's Hospital. Before we get to her I want to remind you if there's a topic that you like us to talk about or you have a show idea, just head over to PediaCast.org, click on the contact link.

You can also email PediaCast@gmail.com, we love to hear from you. We also have a voice line 347-404-KIDS, that 347-404-K-I-D-S, and you can just leave your name, where you're from, and the question or comment that you have for the program. Also want to remind you the information presented in every episode of PediaCast is for general education purposes only, we do not diagnose medical conditions or formulate treatment plans for specific individuals.

04:08

So as always, if you have a concern about your child's health, make sure you call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find over at PediaCast.org.

All right. Let's start out attention to our studio guest Dr. Sarah Denny, is physician with the section of Emergency Medicine at Nationwide Children's Hospital, and an assistant professor of pediatrics at the Ohio State University College of Medicine. She's also an affiliated faculty member with the Center for Injury Research and Policy at the Research Institute here at Nationwide Children's.

Her interest include Pediatric injury treatment and prevention which makes here a great studio guest for our big summer safety show. So, welcome to PediaCast Dr.Denny.

Sarah Denny: Thanks, Dr. Mike. I'm happy to be here.

Mike Patrick: We are glad that you're hear joining us. And you are from Central Ohio originally? And then you actually went to Seattle Children's Hospital for your Pediatric residency?

05:06

Sarah Denny:I did.

Mike Patrick: So, what do you think of the Pacific Northwest?

Sarah Denny: I love it. You know, we miss it very much. We made wonderful friends while we were there.

Mike Patrick: Yeah.

Sarah Denny: But came back for family and it was a valid choice.

Mike Patrick: Sure. I've never been, and we actually have some extended family that lived up there, and they've always offered, "Hey, anytime you want to come up", and it just never been in the cards to do it. But you know, you see pictures and just look so beautiful up there.

Sarah Denny: Yeah. We're heading back in about two weeks, or actually about a month to go back and visit.

Mike Patrick: Sure.

Sarah Denny: So looking forward to it.

Mike Patrick: So many of my listeners are kind of avid social media folks, and there is a pediatrician mommy blogger in Seattle, Dr. Wendy Sue Swanson better known as "Seattle Momma Doc". So when you were in Seattle, did you ran into her?

Sarah Denny: I did. Dr. Swanson and I did residency together. She was a year older than I was. So I know her very well and I am follower of her blog.

06:03

She's got two little kids, the same age as mine, and so she's a mom, she's a doctor, and she gets what we're all going through with our parenting.

Mike Patrick: And is she as nice as she comes across in her blog?

Sarah Denny: Absolutely.

[Laughter]

Mike Patrick: She seems like a great person and she's actually recorded a bit for us on PediaCast a couple of years ago with one of our blog post. And so she actually has been on PediaCast, although not in the studio as a guest. But for those of you who haven't heard of Seattle Momma Doc, we'll put a link in the show notes over at PediaCast.org so you can find her blog. So pediatrician and mommy blogger, and pretty much social media rockstar really.

Sarah Denny: Absolutely.

[Laughter]

Mike Patrick: All right. So let's move on to summer safety. Kids like to move fast in the summer, you know, bicycle, roller blades, skateboards, now this zip sticks which we see a lot of injuries with those. What are some of the common injury associated with these activities?

Sarah Denny: Well, we always have here minor injuries associated with these kind of things. Your scrapes, cuts, bruises, sprains.

07:05

But then we also see a significant number of more serious injuries like broken bones, head injuries. And unfortunately even sometimes stuff.

Mike Patrick: Yeah. You know, when kids go out there, and of course we encourage them to be active, and when they go out in the summer and their riding their bikes, and roller blading, you don't think about them getting hurt and having to take them to the emergency room, and yet that happens everyday.

Sarah Denny: Absolutely. It sure does.

Mike Patrick: Yeah. So I think some injury prevention tips are really important. What are some ways that parents can prevent injuries when kids are doing these things?

Sarah Denny: I think you know, some of the most important things are supervising your children and really just across all kinds of activities. Knowing what is developmentally appropriate for your child and what their skill level is, is really important. You know, when I was in Seattle they did a study just on kids crossing the street, and they realized that parents greatly overestimated their child's ability to make good decisions for crossing the street.

08:03

So knowing what your child is capable of doing and keeping them within that safe comfort zone. A great example of this is ATV's. We're seeing an increased numbers in the sales of ATV's, so we're also seeing an increase number in childhood injuries and fatalities related to ATV's.

This is because ATV's are built for adults not for children, and kids aren't developmentally able to control that kind of vehicle. So you put a child who's not developmentally able to control a vehicle on a vehicle not made for children. And then they'll put a helmet on them and unfortunately we see a lot of significant brain injury and fatalities around ATV's.

Mike Patrick: Yeah. Absolutely. When talking about the supervision issue in kids who you trying to get them make good decisions. I think one thing parents sometimes forget is you may have a kid who really seems like they're mature. And they do make good decisions in a perfect environment. But when they're doing these activities, they're distracted.

09:00

And so, it's easy even if it's a kid who usually makes good decisions, if they're distracted and they're excited, and the adrenaline is going, it's easy for snap impulse bad decisions to happen even in the kid who you would not expect it.

Sarah Denny: That's absolutely right. And you know, you may have a child you know, for example my oldest is five, and he's really good athlete, and he thinks he's really able to do everything, and he asks for skateboard for Christmas, and we got him one.

And then I realized that he's not developmentally ready to be on the skateboard. So the AEP has some rough guidelines about things like scooters and skateboards, and they really say if your child is less than eight, they should be supervised by an adult when they're on a scooter. And really kids five and under shouldn't be on a skateboard, they just don't have the balance and coordination to safely be able to handle that kind of equipment.

Mike Patrick: And you know, part of it, do kids see other kids on TV doing fancy things and then they want, they think, hey that kid can do it, I can do it too. But what they don't realize is the kid on TV or in a competition that they're seeing didn't start to how doing that, so they had to work up to it and train, and get muscle memory on how to do things. And so I can't imagine

10:07

And so I mean, I can't imagine just called doing the gymnastic move that you see in the Olympics. I mean, you have to work up to that. And the same thing is true with the tricks and things that we see on bikes and skateboards and things.

Sarah Denny: That's exactly true. You know, making sure that a chile knows how to work the piece of equipment and then do they practice it and realize what their own skill level is before they try going out and doing all the crazy stunts they see on TV.

Mike Patrick: Right. Apart from helmets, because we're going to get to that and talk specifically about head injuries. What kind of protective gear except for helmets, what are the protective gear do kids need when they're doing these activities?

Sarah Denny:So, wrist guards, knee pads, elbow pads, sometimes kids like to wear the little gloves to kind of protect their hands if they fall on and outstretch hand. And then just making sure your equipment is in good working order, you want to make sure that something has breaks, the breaks are working, you want to make sure the tires are tight.

11:05

Mike Patrick: Yeah.

Sarah Denny:And that the piece of equipment is in good shape before you let your child use it.

Mike Patrick: Yeah. I have done this myself, and I have to you know, not be upset of myself, but sometimes we make fun of it and say you know, we're wrapping our kids in bubble wrap these days because we're protecting them so much. But then on the other end you know, when it's your kid and they have an injury, and you could have prevented it by using appropriate gear, then you feel bad about it.

Sarah Denny:You're right. And you know, you were saying the statistics about the decreased number of injuries and deaths related to injury is dropping which is great, but unintentional injury is still the leading cause of death in children. And it's unfortunate because it is so preventable.

Mike Patrick: Yup. So risk guards particularly if there's a risk for falling on an outstretched arms, so bicycle, roller blades, skateboards, I mean anything where you could fall and put your arm out, that's going to help prevent a forearm fracture.

12:01

Sarah Denny: Right.

Mike Patrick: And we see a lot of forearm fracture.

Sarah Denny: We sure do.

Mike Patrick: Head injuries are kind of in a special category, why is that?

Sarah Denny: Well, you know, if someone falls and breaks their wrist or gets a cut, it's not too hard to fix that, we put them in a cast or we stitch them up. But when they injure their head, there's not a lot we can do and you can get significant long term or permanent side effects from that kind of injury. They can cause long term effects with thinking, emotions, attention, memory, and what we call executive function. That's kind of your ability to interpret the situation, regulate your own behavior. And kids unfortunately are at increased risk of permanent damage because they have -they get recurrent head injuries.

Mike Patrick: Yeah. If there's one take home from this show that I wish parents would hear, I mean, of course all of this information that we're going to through is important, but I think making your kids wear helmets every single time and modeling that behavior by wearing a helmet yourself when you're doing this activities is just is huge.

13:06

Sarah Denny: I could not agree with you more. We know that kids look to their parents and their peers as their biggest influence on whether or not they were at home. And we also know that 75% of bicycle related fatalities in kids could have been prevented if the kid had just been wearing a helmet. So, it's such a small piece of equipment and such a small intervention that could save so many lives.

Mike Patrick: Yeah. It's one of those places where I think parents need to take a stand, and even if their kids say you know, "Johnny next door is not wearing a helmet", no you're wearing a helmet, I mean it's really you got to bleed a lot down on this one.

Sarah Denny: I know. And you know, sometimes people in my neighborhood I think they come a little silly because I have my little one year old on his little scooter bike wearing a helmet. But I feel like the earlier you can get that as part of their natural routine if I'm getting on my bike, I'm putting on my helmet, then the easier it gets and you don't have to have those battles when they get a little bit older.

Mike Patrick: And if those parents could see what you see in the emergency department, I mean you see kids who their parents meant well and they get hurt and they get severely injured, and it just breaks your heart because you know it could have been prevented.

14:11

Sarah Denny: Right. And these traumatic brain injuries can be life altering, it can really take a significant toll on not only the patient, but the family as well.

Mike Patrick: Yup. Now so what type of helmet? How do parents go about picking a helmet for these kind of activities. So, we're talking bikes in lower speed movement, you know, so bikes, skateboards, roller blades, what kind of helmet do they need?

Sarah Denny: OK. Well, when you think about falls off a bike, you're usually falling forward so the area that's most likely to get injured is the front or the side of the head. So, a bicycle helmet would be ideal for riding. Again like you said, we're talking about non motorized vehicles here.

So, a true bicycle helmet is what you would want if you're riding a bike. But when you're looking at scooters, roller blades, the rip sticks, any of those kinds of things, you could hit any part of your head.

15:00

So, a multi support helmet goes down lower in the back and so that can be used in really anything including bicycling and gives you a little bit better protection on the back of your head that a bicycle helmet does not cover.

Mike Patrick: Sure.

Sarah Denny: They also make toddler helmets for the littler ones and those also go down back further there down lower on the head.

Mike Patrick: Great. Now, well we're going to get to sort of safety standards with helmets and how to pick a helmet. I think we should make a point that some helmets are for specific things. So you know, like a batting helmet for instance.

Yeah, its got padding, but it's not as snug of a fit, you know so that if you were to fall while you're moving fast, it might fall off your head and not protect you. So, it is important you know don't just throw whatever helmet if your kid plays lacrosse you probably don't want their lacrosse helmet whether doing these other activities.

Sarah Denny: Right. That's absolutely true. And the other thing with the multi support helmet, you don't want to forget I know we're in the middle of summer break, you don't want to think, forget about things like skiing, sledding, even ice skating those are all definitely areas where you can get a head injury.

16:11

Mike Patrick: Yup.

Sarah Denny: And helmet could be protective.

Mike Patrick: Yeah. Absolutely. Again, we don't recommend kids being on motorized things.

Sarah Denny: Absolutely not.

Mike Patrick: But if you're a parent that is going to do that anyway, and again not to give anyone permission, but we want people to be safe. These kind of helmets are not for high velocity stuff?

Sarah Denny: No.

Mike Patrick: I mean, you need like a motorcycle helmet.

Sarah Denny: That's true. And again strongly, strongly, strongly do not recommend children under 16 to be on something motorized like an ATV, but yes a bicycle helmet.

Mike Patrick: We're talking about 18 year olds?

Sarah Denny: Right. Exactly 18 year olds, while a bicycle helmet is better than nothing at all. They really need to have kind of a higher impact sort of helmet like a motorcycle helmet.

17:01

Mike Patrick: Yeah. So, where can parents find inappropriate helmet?

Sarah Denny: Well fortunately bicycle helmets are now readily available almost anywhere. Any kind of sporting goods store would have it, as well as kind of the big box stores like Babies "R" Us, Toys "R" Us, Walmart, Target. But I also can recognize it because it can sometimes be an issue, and so there's a lot of community groups that provide helmet free of charge or at a reduced rate.

Every county in Ohio has a safe kids department and they all have helmets. You could always contact your local police station and see if they have some available. And then just keep an eye out for community events, there's a lot of bike rodeos that go on across the state. A lot of organizations come and provide helmets to children who don't have them.

Mike Patrick: There's also some -there's a government agency the U.S. Consumer Product Safety Commission and they have standards that they've come up with in terms of which activities and which helmet is the best one, and then it will give a certification number.

18:06

And there is a website that we're going to put in the show notes where parents can find that, so they can look at what activity they're going to be involved in and then find the helmet that has the right safety standards. Safety standards have changed over the years.

Sarah Denny: This is true, right. So, if you have a helmet that's made before 1999, it's time to get rid of that one and purchase a new one because this safety standards have changed. And getting rid of it really means throwing it in the garbage, don't turn,sell it to the garage sale or give it away because we really want to keep all the helmets out there to be safe. Also if helmet has gotten dented, has gotten cracked, then it's time to get rid of it, and also helmets that don't fit, need to be replaced as well.

Mike Patrick: So, this is something that parent should check probably a couple of times during -I mean, in terms of fit because kids grow rapidly.

19:01

You know during the summer time. This is definitely the beginning of the season, but sometime in the middle probably too.

Sarah Denny: Absolutely.

Mike Patrick: And then there's the Snell Memorial Foundation we see Snell stickers on helmets. What's with that?

Sarah Denny: They regulate more of the multi sport kind of helmets and so they provide standards for the multi sport helmets.

Mike Patrick: Yeah. I'm always interested in -I'm kind of a history buff, and so you hear something like Snell. How did that get started? So I had to research this, and I don't know if you're -and I didn't know this until I researched it for the show.

But Snell was named after Pete William Snell who was an auto -a popular sports car racer back in the 1950's. And he wasn't wearing a helmet, had a bad accident, had a head injury and died in 1956. And he had a good friend who was a physician, Dr. George Snively.

20:01

And a group of sports enthusiasts and some scientists, and physicians got together and established this in his honor. And so that's how we have the Snell standards now.

Sarah Denny: Oh, there you go.

Mike Patrick: So, I mean that's one of them too, and we'll put a link to the show notes, because you can go to Snell's website and again you can put your activity and it will tell you which kind of helmet you need and with certification criteria, and then you can make sure whatever helmet you're getting is appropriate for that. What kind of price are we looking at if you had to go out and buy appropriate one on your own.

Sarah Denny: Yeah. I mean, they can range, you can spend as little as $10.00, and you can go all the way up to for bike helmets, you know, 45.50, the sometimes the multi sport helmets can run you a little bit more.

Mike Patrick: Yeah.

Sarah Denny: But you can get them inexpensively.

Mike Patrick: And so the more expensive ones are -as long as it meets whatever safety standard by the Consumer Product Safety folks or Snell, you can -even if it's a cheaper one, you can feel comfortable that it meets what you need?

21:06

Sarah Denny: Absolutely. So, you want to look for that sticker certification for me to consider Consumer Product Safety Commission or from Snell on the outside packaging.

Mike Patrick: OK. Yup. And again we'll have links to both of those places in the show notes so people can find exactly what they're looking for. So, the more expensive ones are -you're just paying for cosmetics at that point?

Sarah Denny: Absolutely.

Mike Patrick: Which should maybe important to a lot of kids.

Sarah Denny: And you know, we'll talk a little bit more about that when we get to picking out a helmet.

Mike Patrick: Yup. I also want to mention this, it will be in the show notes as well. And this is a subscription site, but everybody has heard of consumer reports and they have done their own independent testing of bike helmets and so we'll put a link to their site too and just to be helpful to folks. So, how do parents then check proper fit you know, when they're picking a helmet. How do they know that it fits right?

Sarah Denny: OK. That's a great question. First of all, you should bring your child with you when you go to pick a helmet for your child so that they can pick out the helmet.

22:03

They are going to be much more likely to wear their helmet if they like it. So, number one, the child should pick it out, and then you need to try it on the child and it should be snug on their head, but not too tight. And then when they're actually wearing their helmet, the helmet should be on their head straight.

So, you want to put one finger above the eyebrow, there should no more than one or two finger widths between the eyebrow and the top of the helmet. The helmet shouldn't be tipped forward or as I see a lot of children in my neighborhood, it should not be tipped back. That does not give you adequate protection, so you want it straight across the head, and then the straps around the ear should make a V or a Y going around each side of the ear.

And then the chin strap needs to be buckled, the helmet's not going to work well if it's not buckled on. And you should only be able to get one or two fingers between the chin and the straps. So, it should be snug, but obviously not choking the child.

Mike Patrick: Choking.

Sarah Denny: Exactly.

Mike Patrick: And I think probably folks that work in bike stores are usually pretty safety kind. I mean, I can't say that for -I'm sure there's some folks who aren't, but I mean as a group.

23:08

Sarah Denny: Right.

Mike Patrick: Would probably be trustworthy in terms of hopefully letting you take the helmet out of the box and trying it on.

Sarah Denny: Right.

Mike Patrick: You know what I mean really making sure it's a good fit before you leave the store.

Sarah Denny: Absolutely.

Mike Patrick: And if you can't, certainly your local fire station, there's probably someone there that would be more than willing to double check it to make sure that the helmet is right of you didn't feel comfortable with it.

Sarah Denny: That's right. And if you do have some kind of in your community around biking and bike safety, there's many people there who are able to fit helmets.

Mike Patrick: And one of the things that I've noticed a lot of safety stuff here lately is things come with expiration dates like car seats for instance. Now, come with an expiration date that you shouldn't use after that. Do bike helmets expire?

Sarah Denny: They don't you know. We kind of touch on reasons to replace your helmet one; if it is made before 1999, and then the other things would be dents, cracks, obvious malfunctions in the equipment and then helmets that don't fit anymore.

24:06

Mike Patrick: And as you said, garage sales is not a good place to get a helmet because you don't know how old it is.

Sarah Denny: Right.

Mike Patrick: Or if it was involved in an accident.

Sarah Denny: Absolutely. So garage sales, secondhand stores are not a place where you want to buy any kind of safety equipment like a bike helmet or car seat.

Mike Patrick: Plus as we've talked about before never share what touches the hair, so that's another reason.

Sarah Denny: Right.

Mike Patrick: Let's actually change gears. Anything else on helmets that we didn't cover that is important?

Sarah Denny: I just wanted to just mention, if a child is in a bicycle accident, and you look at the helmet and you don't see any kind of obvious signs, the helmet really does still need to be replaced because you cannot tell if the protective function of the helmet is still intact. So if the child is in a bike accident throw that helmet away and get a new one because you just want to be on the safe side.

Mike Patrick: Yup. Because the foam stuff in the inside maybe collapsed, and you would know it because the plastic shell still looks OK, but it's not going to protect their heads.

25:02

Sarah Denny: Exactly.

Mike Patrick: All right. Let's change gears and talk about swimming. What dangers lurk around residential and community pools?

Sarah Denny: Well, the obvious danger that unfortunately we started seeing a lot of this time of the year is drownings. Drowning is the leading cause of death in children from ages on to four, and like I said we started seeing a lot of increase in this time of the year with drownings, but really it's something to be mindful of all year round.

Little kids should not be left alone near any standing water, this means bath tubs, toilets, buckets of water, anything where they could drown. And then other causes of injury around pools this time of the year that are really significant would be the head and neck injuries related to diving into pools that are too shallow for diving.

Mike Patrick: And kids like to run.

Sarah Denny: Right.

Mike Patrick: So you don't want then to run on the pool decks and when we see cuts and scrapes, and broken bones from that too.

Sarah Denny: Right.

Mike Patrick: It's kind of a slippery surface and don't want them to run. We talked about over confidence and how important supervision is, and of course those are things that are really important around the pool too.

26:04

Sarah Denny: That's right. I mean, supervision is absolutely the most important thing you can do, and adult supervision we shouldn't have a seven year old watching the two year old at the pool, that's just a recipe for disaster.

Mike Patrick: Even sometimes the 14 year old watching the kids.

Sarah Denny: Right. They get caught up in texting or whatever, and it's just not a good idea.

Mike Patrick: Yeah. So, what are some ways that parents can prevent pool related injuries and drowning.

Sarah Denny: Right. So, supervision as we already said, and then having their children take swimming lessons. Really studies have shown us that kids who have some kind of history of swimming are much less likely to drown. Things for community pools, pools should have four sided fences which is really important.

And that's a law, but we're starting to see a large number of these inflatable pools. And the law doesn't cover those, but it's really important that even if although the law doesn't cover it the people enclosed those kind of pools because that's a danger for children to wander into the yard.

27:04

If the fences have gates, they should be self closing and self locking. So, if somehow the gate gets opened, and it closes and doesn't stand a jar inviting little guests. Rescue equipment should be kept at the poolside in case there is an emergency.

And parents, caregivers, people who own a pool should know CPR, so that if something happens they know how to intervene and try and help someone who is in trouble.

Mike Patrick: Absolutely. We have talked about this on PediaCast several times. It's so important that parents take a CPR class. And the show notes for the last show, so that would be 209, we did have a link to the American Red Cross. And I'll try to remember to put it in this one as well. So you know, you can find out where your local places where you could get CPR training because that is so important.

Sarah Denny: Yes, I agree.

Mike Patrick: And the other thing too is a lot of kids and some parents will be in tune with this and some won't, but their kids have physical and health limits that could make swimming not safe.

28:01

So, if they have a seizure disorder that's not well controlled, swimming is probably not the best idea. If they even have a well controlled seizure disorder, they probably got to be in the pool with a friend or someone who is very responsible and would know what to do if they started to have a seizure.

We see a lot of kids with ADHD and they have impulse issues and I mean they need, you know of course want to keep a close eye on everybody, but those kids need a little extra attention.

Sarah Denny: That's true. And you know, I take my kids to pool this summer and I just find constant reminding them about safety issues, how to keep themselves safe and just watching them carefully is really the best thing you can do even if there's a lifeguard on duty, they're watching a lot of kids, you know at the same time. So, you really need to be watching your children even though there's a lifeguard on duty.

Mike Patrick: Speaking of lifeguards, I got a great story for you. We had a pool once upon a time in ground pool, and when my daughter for her fifth birthday party, we're going to have a bunch of kids over for our pool party for five year olds.

29:02

So, the parents are going to be there and you know, being a pediatrician we're pretty in tuned safety and my kids will attest to that. So, we decided it would be a good idea to have a lifeguard at the pool party at our home, so that way you know someone was watching the pool, that was their job.

And if parents were socializing they could at least feel a little comfortable that someone, their whole job was watching the pool and we thought a lifeguard would be a good idea. And I had a co-worker who knew a kid who is a certified lifeguard, who is an older teenager. And I think the deal was for $50 bucks they would watch the pool for two or three hours. So, this was 10 years ago or more.

And so this was pretty good, and we thought, my wife and I thought, if he did well and nobody got hurt we'd surprise him and give him 75 bucks. But the deal was for 50, but if he did a good job we're going to tip him and 75 bucks.

Sarah Denny: That's great. Can I lifeguard at your next pool party?

30:01

Mike Patrick: Well, before the party, my wife's going to be upset, but I remember her saying, "Let's just give him the 50 bucks, OK, 75 is a little generous, let's just do the 50 bucks." So the kids arrived, the lifeguard had just gotten there as the kids are getting there.

And he's still in his sweats, he hasn't even down to his trunks yet. And my son who we actually him Mr. Safety because I mean, they won't jump on trampolines, I guess it was just horror stories at home.

And for some reason my son, who at that time was two just jumps in the pool with the other kids and he didn't have floaties on, it was very weird for him. And he just jumps in the pool, goes underwater, lifeguard still in his sweats, jumps in the pool, saves my son. And so we ended up giving him a 100 bucks.

[Laughter]

Sarah Denny: I was going to ask how much he ended up.

Mike Patrick: Yeah. We're not skimping on this guy.

[Laughter]

31:00

Sarah Denny: That's right. Well, you know your story brings out a good point about floaties, that actually those are not life saving devices, and so if kids want to wear them just to play around, that's one thing, but don't put them on your child and hopes that that's going to keep them afloat.

Mike Patrick: Yeah. Absolutely. And the other thing too is then our kids did take swimming lessons, but even if your kids take swimming lessons and they're doing great, they're getting a little stickers and going up to the next class, to the next class, even though that is important, and there's less chance for drowning, by doing that parents still shouldn't have overconfidence because when their kid suddenly struggle, they may forget their skills.

Sarah Denny: That's absolutely true. Having swimming lessons is great, but it does never replace adult supervision.

Mike Patrick: Yup. What about playgrounds, I kind of joked in the introduction about the 20 foot tall metal slides with concrete which is not an exaggeration, that's really was -that's what we had.

Sarah Denny: I know. Absolutely.

Mike Patrick: And they were hot. Do you remember that? They were like baking in the sun.

Sarah Denny: That's right. We're actually going to talk about that in just a second.

[Laughter]

32:01

Mike Patrick: So, what about the playgrounds?

Sarah Denny: Well, since you brought up this cement thing, you know, obviously we want playgrounds to have a soft surface, so molds or that new rubberized material and is much better than the concrete that we've all encountered at some point in our childhood.

You know some of the dangers at the playground would include falls. Also pedestrian safety, we got a lot of kids running around, worry about our kids running out in the road. Dog bites which is not something that you might think of, but you know, people are walking their dogs or may or may not be on a leash and you have a lot of small kids.

So, we've seen several dog bites that takes place at parks. And then other children modeling risky behavior, you talked about kids seeing older kids on TV doing this and that, and the same things happens at parks, kids doing stunts that five year old probably is not able to do, but things that looks neat so give it a try.

Mike Patrick: Yeah. Absolutely. And strangers.

Sarah Denny: Right.

Mike Patrick: Got to watch out for them too.

33:01

And how can parents prevent playground injuries? What some things that they should be on the lookout for?

Sarah Denny: Well, we talked a lot about bike helmets and bike helmets absolutely are essential if you're going to the park and your kids running their bike, they need to put the bike helmet on. But when they get to the park, they need to take the bike helmet off.

So, you know, bike helmets, straps can be strangulation risk as well as anything whether tying, jump ropes, leashes, anything to equipment, that's just not a good idea that's all present strangling risks to kids. Other things keeping their shoes on, you never know what's going to be on the ground or especially if there's mould on the ground, they can get a lot of splinter, so keeping shoes on.

The parents needs to just take a look at the equipment making sure it's in good repair, there's nothing sharp poking out, the swings are secure, that sort of thing. And then as we've been talking about really during this entire interview adult supervision and then making sure that a child is playing on a piece of equipment that they are developmentally and at an appropriate skill level to manage that piece of equipment.

34:00

Mike Patrick: You see a lot of parents chatting it up with other parents, and are reading their emails, or texting and really they just have their eyes off of their kids for a significant amount of time when they're at playgrounds, and that's not good.

Sarah Denny: I know. You know, and it's hard you get caught up in a conversation and then all of a sudden you know, you realize your kids are doing something they shouldn't be doing. So, yeah it is important t have your priority is keeping your child safe at the park.

Mike Patrick: Yeah. I mean it's tough because as a parent you know, I mean a lot of times you re isolated during the day and so you know, having other adults to talk to is important you just have to be you know, talk where you're looking.

Sarah Denny: Absolutely, yeah. It's easy to say you know, realize your kids are similar ages and you start talking about preschools and this and that, and right you just got to keep one eye on the child as you are chatting.

Mike Patrick: Yup. And play with your kids.

Sarah Denny: Right.

Mike Patrick: I love playing on the playground.

[Laughter]

35:00

Mike Patrick: And then we talked about how play equipment is different that it used to be, you know a long time ago. But there are in some states there are laws that they have to change to new safety standards. But we have an international audience, and there maybe places that still have unsafe slides that are 20 feet tall. And so, parents should avoid those places.

Sarah Denny: That's true. And even on the new parks and playgrounds that we have that are up the code, there are still areas that are very high up where for example uphold might be. And for a five year old that's fine, but if you have a two year old or an infant, crawling around up there, they don't understand that there's a drop off there.

So, you know just being really vigilant especially when the children are higher up. And even this plastic swing or plastic slides that they have in the parks, still get hot in the sun and can burn the skin. So, you just want to be careful especially now that the temperature are starting to warm up that you're checking for those kinds of things as well.

Mike Patrick: Yup. If my kids had to tell you their biggest pet peeve with regard to safety, it would be that we have not let them have a trampoline.

[Laughter]

36:09

Sarah Denny: I'm right there with you. For the longest time I tried to keep my kids off the monkey bars too because we see so many broken arms with monkey bars, but I've lost that battle.

Mike Patrick: Yup. But you're still going strong on the trampoline?

Sarah Denny: Oh, yeah absolutely.

Mike Patrick: We did go to one of those indoor places you know, that wasn't very crowded and they have like a huge trampoline area, do you know what I'm talking about? So you don't have the frames and you can't fall off of it. And we went in a time when it wasn't crazy busy and of course my wife and I were there with them and making you know, they weren't doing flips and getting crazy. But I did find out it is a good exercise.

Sarah Denny: Did you get on it?

Mike Patrick: Yeah. And like I was winded and I don't even want to tell you how long it took.

Sarah Denny: We had my son's birthday party at a place where again against my bad adjustment, there were trampolines, so I was a nervous wrecked the whole time.

37:01

But before anyone got there I got on the trampoline and it was pretty fun I have to say.

Mike Patrick: Yeah. Yeah.

Sarah Denny: I was winded too.

Mike Patrick: This is what happen when you get two pediatricians and they were like, "No we're not doing the trampoline", but you know, it was kind of fun.

Sarah Denny: But when the kids showed up.

Mike Patrick: Right. Right exactly. And you know, i probably see as many trampoline injuries that are just caused from two kids being on the trampoline and they run into one another or jump on an arm. I mean, obviously you think about hitting the frame, falling off of it, you know getting injured that way, but really it's one person kind of thing here.

Sarah Denny: Right. So you know, I have always just in my experience, as you said we see so many trampoline injuries and a lot of them are broke bones, and that kind of thing. You do see some of them more severe head and neck injuries, but broken bones are the most significant. And I always have felt like it's often when there's multiple people on the trampoline.

Mike Patrick: Yes.

Sarah Denny: So, I had that theory, but I decided to actually research it.

Mike Patrick: OK.

Sarah Denny: And what I found a group at Salt Lake City Children's Hospital looked at trampoline related injuries. And what they found were that a significant number, actually the majority of the kids that were injured were having multiple children on a trampoline at one time.

38:11

And typically it was the youngest person of the group that got injured. So, people I think get a false sense of security with those nets around the trampoline, but really those have nothing to do with kids getting hurt.

Mike Patrick: Yeah.

Sarah Denny: I mean the majority of injuries aren't from kids falling off trampoline, it's they get double bounced the wrong way, or they get landed on, or something that results in a bone injury.

Mike Patrick: Yup. Yup. I want to stress, and we see everyday.

Sarah Denny: I know.

Mike Patrick: I mean when it's warm outside, It's just everyday.

Sarah Denny: Every time I see one, I think as long as there's trampolines I will always have a job.

[Laughter]

Mike Patrick: This is true. This is true. So, we're not -we're kind of winning the trampoline battle in our own homes, but any drive through a suburban neighborhood and you see trampolines right and left. So, we're not winning the battle of making parents get rid of trampolines.

Sarah Denny: Right.

39:02

Mike Patrick: So what the parents who have trampoline, our first advice would be, get rid of them don't buy them.

Sarah Denny: Right.

Mike Patrick: But if you have them what can parents -other than one kid at a time, what other safety?

Sarah Denny: Really I think that's the biggest one, you know the American Academy of Pediatrics recommends no trampoline, but as you said we're not winning that battle.

Mike Patrick: Yeah.

Sarah Denny: So, I think the biggest rule is one child at a time is the most important thing, and then supervision. Again we keep going back to that.

Mike Patrick: Absolutely. The other thing too is kids want to do more than they think they should and flips, and it's not a good idea. There's too much of a head and neck injury risk with flips.

Sarah Denny: This is true.

Mike Patrick: I do not recommend this at all. We had a neighbor back, this is 10 years ago when we lived or we had our pool. And this kid actually ended up to be an army ranger. But he used to put the trampoline next to the pool, and all that did you imagine, I'll leave that to your imagination exactly what happened.

40:02

I mean, I would cringe, you know, like I don't even want to know this is next door.

[Laughter]

Sarah Denny: Oh that's a disaster.

Mike Patrick: Yeah it was bad. And you know, but he's an army ranger now, he shoots a gun. Actually he shoots a gun back then too.

Sarah Denny: Thankfully he survives. Sometimes I wonder how we all survived childhood.

Mike Patrick: Yes. Yes.

Sarah Denny: But thankfully he made it through.

Mike Patrick: Yeah. And we don't recommend that. All right. so we're pretty scaring parents here. We see kids with severe injuries in playgrounds, or on swimming pools, and trampolines or riding your bike. But it is important for kids to be outside and active in the summer. Talk a little bit about why that's important.

Sarah Denny: Sure. Well, you know when you think about your childhood you have so many memories from being on summer break and all the fun thing you do. We want to get kids out, get exercise, enjoy nature, and kids are out of school. So, it's a nice time for families to spend time together and kids to hang out with the kids in their neighborhood and do some different kind of things.

But as you know from working in the emergency department, summers is the time when we see the most number of injuries because kids are kind of doing things that maybe they shouldn't necessarily be doing.

41:06

So we want kids to have fun, and we want kids to be healthy and get exercise, but we want them to do it in a safe way.

Mike Patrick: Yup. What are your most important, if you had the most important take home tips on the safety stuff for the summer. What's the top five kind of thing?

Sarah Denny: OK. Well, I kind of thought of a few things that we had already talked about. Obviously supervise your kids, keep an eye on them, be vigilant and kind of think ahead about you know what dangers could be in this activity and how we can prevent them. And then simple things like don't forget to put sunscreen on your children ages six months and older.

Mike Patrick: Oh yeah.

Sarah Denny: Keep your kids well hydrated, don't have them out doing heavy exertion during the hottest parts of the day. The other thing that we really start seeing a lot of injuries related to this time of the year is lawn mowers. Kids should not be anywhere near lawn mowers. We don't want them to get run over by lawn mowers, we don't want them to get any kind of eye or head injury from something getting flown out from lawn mowers.

42:00

And then they have no business riding on a lawn mower. We see a significant number of injuries where you know, the parent thinks that it's just kind of fun to have their kids sit on their lap at.

Mike Patrick: The toddler. They got the toddler with one arm. Yeah.

Sarah Denny: You know you see funny and all kinds of badness can come to out of that, it's just not a good idea. And then I've seen especially when I was on Seattle, a lot of burns related to fire pits, and camp fires, it's really fun to have a bonfire, roast marshmallows that kind of thing, but you want to keep kids at a safe distance.

And once you put the fire out, you want the child to understand that although the fire is out, those ashes and what not can still be hot. So, you know, fire safety is important. And then one of the big ones during the summer especially around fourth of July is eye injuries. So, you can get a significant numbers of eye injuries related to fireworks around the fourth of July.

Kids shouldn't be setting off fireworks, they're wonderful to enjoy, but at one of those big community settings where professionals are putting them off.

43:00

Mike Patrick: Yeah.

Sarah Denny: Even sparklers, get hotter than 1800 degrees which is hot enough to melt golds. So, putting those in a hand of a seven year old too don't have a lot of impulse control, it's just a recipe for disaster.

Mike Patrick: Absolutely. And they don't have a lot of coordination either.

Sarah Denny: Right. And they don't realize how hot they can be, they probably just have no idea how dangerous those can be with the eyes.

Mike Patrick: Yeah absolutely. Again, my children would just roll their eyes at this. I was trying to think ahead like, "OK, what's the worst case scenario that could happen here and how am I going to prevent that from happening?

And it's funny because even as teenagers you know, we'll be crossing the street and I was like, "Hold on, hold on", and they were like, " Dad, we're not going to run in front of traffic", but they're just something you know, innate that just has to sort of think of, OK what's the worst case scenario, and I have to actually voice it and say it and it annoys my children.

44:00

Sarah Denny: I'm in the same way, and I convince my kids we'll be in therapy for years because I am so safety conscious, just you know because you do see the worst and like we say like injury prevention is the vaccine against this long term injuries. And so we just want to prevent as much as we can so that kids can live long, healthy, happy lives. And they can go out and have fun, do the things they want to do, but just do it in a safe way.

Mike Patrick: And really I was just floored when I saw that statistic, the 30% decrease in accidental deaths from 2000 to 2009. As I was researching for the show, I came across that statistic and that just floored me, I mean, that is just really impressive.

Sarah Denny: Yeah. I mean.

Mike Patrick: We still have work to do.

Sarah Denny: Absolutely.

Mike Patrick: But these efforts are paying off in getting this information out there.

Sarah Denny: That's right.

Mike Patrick: Well, we really appreciate you stopping by. Again we'll have lots of links in the show notes for you. I'll try to remember to add the American Red Cross, if it's not there though in show 209, I know it's there for sure.

45:04

We'll have a link to emergency services here at Nationwide Children's Hospital also the Center for Injury Research, and Policy. Seattle Momma Doc, and U.S. Consumer Product Safety Commission, The Snell Memorial Foundation, Consumer Reports, all those links will be at PediaCast.org for you.

Before we let you go, one of the things we always ask all of our guests here on PediaCast is for your favorite family game. We just like to encourage families to do stuff together that doesn't necessarily involve everybody just staring at the screen and not communication with one another. So, just in your home, what is a favorite game?

Sarah Denny: Well, my kids are pretty little.

Mike Patrick: Yeah.

Sarah Denny: So I have five, three, and one. So board games especially on a one year old just not happening. So, there's two games we like to play in out house. My boys are really into dinosaurs, so I say a dinosaur name and then they have to walk around the house acting like that dinosaur.

46:00

Mike Patrick: Oh, that is cool.

Sarah Denny: That's one. And then one we do in the car because we don't watch DVD or TV in the car. We take turns thinking of an animal and then other people have to ask questions about what animal it is.

Mike Patrick: Kind of like a 20 questions kind of thing.

Sarah Denny: Exactly, but related to animals. So, yeah we're big on dinosaurs and animals in the house. But there's a really.

Mike Patrick: Yeah.

Sarah Denny: Those are the things we do because like I said my kids don't really at the board I mentioned.

Mike Patrick: Yeah. And I want to encourage just right now, I want to put a call up there, a call to action for dads to get involved with doing these kinds of stuff too. I mean, I don't know, moms I think do those kind of creative, interactive spur of the moment kind of games. There's just there's a natural innate ability to do that. And I think a lot of dads aren't comfortable doing those things. And I just want to put a call out there that "Dads, when you run around making dinosaur noises, and I mean you make an impression on your kids.

Sarah Denny: Right.

Mike Patrick: And it creates a bond in a relationship between you and your kids that's very important.

47:01

Sarah Denny: It's true.

Mike Patrick: I got to get off my sofa on that.

Sarah Denny: Well you know what and the thing is too, it's about you know if you're filling the time then the kids aren't bickering, and yelling, and you can teach them things and they don't even realize they're learning. So, it's fun.

Mike Patrick: Absolutely. Absolutely. Well, we really appreciate you stopping by and been a great guest, and we just love having you here.

Sarah Denny: Well, thanks for having me.

Mike Patrick: Want to remind everyone that iTunes reviews are helpful as our links on your webpage and mentions in your blogs, on Facebook, in your tweets, and on Google+. Be sure to join our community by liking PediaCast on Facebook, following us on Twitter, tweeting with # hashtag PediaCast, and hanging out with us on Google+.

And be sure to swing by the show notes at PediaCast.org, add your comments on today's show. We also appreciate you telling your family and friends, and neighbors about PediaCast.

And don't forget to talk us up with your child's doctor at your next check up or sick office visit. We also have posters that you can download, ad hang up wherever moms and dads hang out.

48:00

And you can find them under the resources tab at PediaCast.org. One more time the links to get a hold of us PediaCast.org, just go to the contact link up on the top of the page. And you can get in touch with us very easily. I read everything that comes through. So, of you put a comment or question there, I would definitely see it.

You can also email pediacast@gmail.com, or call the voice line at 347-404-K-I-D-S, again 347-404-KIDS. And until next time. This is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.

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