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Safety Alert!

Most parents have childproofed their homes, are strict about securing their kids in car seats, and stand ready with a well-stocked first-aid kit in case of an emergency. But that may not be enough.

"To really protect their children, parents have to recognize the less obvious hazards around them and, in the event of an emergency, know what to do until medical help arrives," says paramedic Alexander Butman, executive director of the Emergency Training Institute of Akron, OH.

This year, 14 million children  -- one out of four kids  -- will suffer injuries serious enough to require medical attention. Of those, 120,000 will be permanently disabled from accidents, including poisoning, choking, falls, burns, and drowning.

Would you know what to do if your son or daughter were knocked unconscious on the playground or began to choke at dinner? Have you done everything you can to make sure your baby doesn't suffocate or drown?

For starters, "one of the most important things parents and caregivers can do is take a first-aid class through the American Red Cross or their local YMCA to learn cardiopulmonary resuscitation (CPR)," says Peter Silver, M.D., a critical-care pediatrician at Schneider Children's Hospital, in New Hyde Park, NY. "Seconds count when a child is starved for oxygen."

Here are some of the leading childhood accidents, how to avoid them, and steps to take should a crisis occur.

Donna Haupt is an award-winning medical writer and a volunteer emergency medical technician in Westport, CT.

Bike Injuries

Although bicycle helmets have been shown to reduce the risk of head and brain injury by almost 90 percent, only an estimated 15 percent of kids age 14 and under actually wear them. Bicycles are associated with more childhood injuries than any other consumer product, except the automobile, according to the National Safe Kids Campaign, in Washington, DC. "Kids can get bad cuts and bruises, broken bones, and severe internal injuries from bike accidents," says Joan Shook, M.D., chief of pediatric emergency medicine at Texas Children's Hospital, in Houston. "But it's the head injuries doctors worry about the most  -- they're the hardest to treat. That's why parents have got to stand firm and insist that a helmet be worn for biking, as well as for skiing, horseback riding, skateboarding, and sledding."

As the parent of three young children, Dr. Shook knows how difficult it can be to argue constantly with your kids about safety. But she has also seen the aftermath when tragedy strikes. "Last week, a nine-year-old boy was brought in who was hit by a car while riding a bike," Dr. Shook recalls. "He ended up with inoperable brain damage and will be in a persistent vegetative state for the rest of his life. His mom kept saying, ‘But he has a helmet,' and all I could think was, He wasn't wearing it when he should have been." If he had, says Dr. Shook, it's likely that the boy would have ended up with just lacerations, bruises, and other treatable injuries.

Choking

Children 3 years old and under are at the greatest risk of choking, since they have smaller airways, use their mouths to explore the world, and are still learning how to chew foods thoroughly. Common choking hazards include balloons, hot dogs, raw carrots, popcorn, and nuts.

If an object or piece of food becomes lodged in your child's trachea (windpipe), she'll probably cough, wheeze, gag, or drool. If the obstruction is completely blocking her airway and she can't breathe, she won't be able to talk (or, if she's a baby, make normal sounds or cry) and her face will likely turn blue.

"Only if you can see the object or food in the mouth should you try to pull it out," advises Rebecca Smith-Coggins, M.D., assistant professor of emergency medicine/surgery at Stanford University Medical Center, in California. "Making a blind sweep with your fingers in an infant's or child's mouth might only push something farther down the airway."

If you suspect your child is choking, call 911 (or your local emergency number) immediately and begin first aid only if the child cannot breathe, cough, or cry. To try to remove the object, the American Academy of Pediatrics recommends the following, broken down by age.

1 Year and Under

 

 

  • Hold the baby's face and head down over your arm, with his head lower than his body. Then, with the heel of your hand, strike him firmly between the shoulder blades up to five times. If the infant doesn't respond by coughing vigorously or crying, carefully support his head and neck and turn him over.

     

  • Supporting him on your lap or forearm, with the head lower than his trunk, use your middle and ring fingers to give five quick downward thrusts just below the middle of the breastbone. Repeat each of these steps, alternating back blows and chest thrusts, until the object becomes dislodged.

     

  • If the infant loses consciousness, isn't breathing, or if you can't feel a pulse, begin CPR until help arrives.

     

1 to 3

 

 

  • Place the child on her back, straddle her thighs, and put the heels of your hands (one on top of the other) against her abdomen below the rib cage.

     

  • Firmly thrust upward, up to five times (gently in a small child). Check the mouth and remove any object you can see. If necessary, repeat chest thrusts and check again for any objects.

     

  • If the child loses consciousness, isn't breathing, or if you can't feel a pulse, begin CPR until help arrives.

     

3 and Up

 

 

  • Use the Heimlich maneuver. Stand or kneel behind your child with your arms around his middle.

     

  • Make a fist and press it thumb-side against the child's abdomen. Grasp your fist with your free hand and firmly thrust upward and inward, up to five times. Repeat if necessary.

     

  • If the child loses consciousness, isn't breathing, or if you can't feel a pulse, begin CPR until help arrives.

     

Drowning

No responsible parent would ever leave a toddler unattended by a swimming pool. But something as innocuous as a bucket can also cause drowning. "A bucket left by the garage that ends up filled with water from the last rainstorm could spell disaster for a curious toddler," says Dr. Silver. Because a baby's head and upper torso are heavier than his lower body, he can easily lose his balance while leaning to look inside, then find he's unable to right himself, explains Dr. Silver. According to the U.S. Consumer Product Safety Commission, since 1984 an estimated 300 deaths in the United States have been attributed to bucket accidents.

Store pails, empty flowerpots, and large containers upside down, preferably on a high shelf, so they can't fill up with rainwater. And don't overlook the hazards of toilets, fish tanks, buckets used for cleaning indoors, and even large coolers filled with melted ice.

Whenever your child is near water  -- a pool, the ocean, the bathtub  -- designate an adult whose sole job it is to watch him. Never rely on a bathtub seat or air-filled swimming aids for complete protection. And even if a child has taken swimming lessons, never leave him unsupervised, even for a second. "I've seen kids who knew how to swim but drowned in three feet of water because they got confused and scared," says Dr. Silver.

If you're present at a water-related accident, remember that if CPR is started at poolside, there's a much better chance of recovery. "Brain damage can start to occur after just four to six minutes without oxygen," says Dr. Silver.

Playground Injuries

Children 5 and under don't yet have the ability to properly judge distance, says Dr. Shook. They may reach for a bar on the jungle gym thinking it's closer than it actually is and end up falling off. And until around age 9, children don't have the peripheral vision or ability to accurately gauge speed. "When they're running by the swings," adds Ken Allen, of the Emergency Medical Services for Children National Resource Center, in Washington, DC, "they may not see another child moving toward them until the swing hits them in the jaw."

To help prevent your child from becoming one of the 200,000 treated in emergency rooms for indoor and outdoor playground accidents each year  -- most related to swings, slides, and climbing equipment  -- make sure an adult supervises playground play closely. To determine what equipment is appropriate, check out a playground the same way you'd inspect your home  -- from a child's-eye view, on hands and knees. Check the area for potential hazards, like hot surfaces, broken glass (sandboxes are notorious for hiding such things), wobbly railings, sharp edges, and peeling paint. Most important, check the ground surface. Playground equipment should always be on a soft surface, such as sand, wood chips, or mulch. As for your child, make sure all drawstrings (a strangulation hazard) on coats or sweatshirts are removed. Don't let mittens dangle from elastic hooked to jacket sleeves, and remove scarves, long necklaces, and loose belts, advises Allen.

Should your child strike her head or be knocked unconscious, resist the urge to scoop her up in your arms, says C. Rainy Broomfield, an emergency medical technician in Westport, CT. "It's best not to move a child with a head injury unless there's danger of further injury," she says. "Doing so could cause serious spinal-cord damage and permanent disability."

While another parent calls 911, check for bleeding and any signs of watery fluid from the ears or nose. If you see bleeding, apply pressure to the wound. If the child begins to vomit, gently stabilize her neck by holding it as you roll her on her side to prevent choking. Above all, try to keep her still until helps arrives.

Suffocation

If you're the parent of a newborn, chances are you've removed suffocation hazards like stuffed animals, bulky comforters, and pillows from the baby's crib. But don't overlook the possible danger of letting your infant sleep beside you in your bed. "Particularly in the first few weeks after birth, new mothers may be so sleep-deprived that they let the child fall asleep at the breast and then inadvertently roll over on top of him," says Angela Mickalide, program director of the National Safe Kids Campaign. "Infants don't have the neck and arm muscle strength to lift their heads or free themselves from tight places."

Experts are divided on the safety of bed sharing. It may be particularly dangerous when a parent has been drinking or is on heavy medication. However, some studies on mother-infant bed sharing and sudden infant death syndrome show that under normal conditions (you're not overtired, haven't been drinking or taking any strong medicine), a mother is aware of her child being in bed with her, and therefore is not likely to suffocate the baby. Whether your infant sleeps with you or in a crib, once the baby is older and able to roll over, usually around 4 to 7 months, the hazards of suffocation will lessen.

Don't assume toddlers and older children aren't at risk of suffocation: In 1996, nearly 2,000 children age 14 and under were treated in emergency rooms for plastic-bag-related injuries. On average, 20 children under 5 die each year after suffocating due to a plastic bag. "Children see them as toys, and parents leave them within reach," says Dr. Silver.

Store plastic bags in a cabinet with a child-resistant latch. When disposing of them  -- especially dry-cleaning bags, which are thinner and easily conform to a child's airway  -- use receptacles that your child can't get into.

Poisoning

Childproof latches on kitchen and medicine cabinets help eliminate many poisoning dangers, but keeping a direct eye on your child is the only way to be really safe. "A curious toddler can get into a stray purse or a bathroom and end up ingesting prescription or over-the-counter drugs," says Brooks Metts, director of the Palmetto Poison Center at the University of South Carolina College of Pharmacy.

Iron supplements, such as those found in prenatal vitamins, are the largest single cause of pediatric poisoning deaths for children under 6 in the United States. "They look like candy. Some taste sweet, and a handful will cause severe intestinal bleeding, which can kill a small child within hours," warns Metts.

A growing source of poisonings are the medication patches used to reduce nicotine cravings or control heart conditions and high blood pressure. "A toddler can get hold of a discarded medication patch left in a bathroom trash can and then suck on it," says Metts.

If your child does ingest a dangerous substance, bring its container or packaging to the phone and immediately call your local poison-control center. Don't give anything by mouth or induce vomiting without checking with poison control first. You may be asked to list the ingredients and will be advised what first-aid steps to take. If you're told to get to a hospital, bring along the container of what your child may have ingested to help the doctors.

Burns

Nearly 28,000 children are treated for burns in hospitals each year. Burns are among the most painful injuries for children because they damage sensitive nerve endings on the surface of the skin. "Children's skin is much thinner than adults', so they get deeper burns at much lower levels of heat," explains Dr. Silver. The seriousness of a burn is judged by how deeply the tissue is affected and how big it is. Small (quarter-size) or superficial burns can usually be treated at home, but see a doctor immediately for a blistering burn that involves the hands, feet, genitals, or face, or one that covers a large area, such as a forearm or leg.

Though burns to children most often occur in the kitchen or bathroom, playgrounds can also be high-risk. On hot days, touch the inside of your wrist to metal handrails, slides, and swings to test the heat level.

Be on the alert for potential scald burns in restaurants, particularly when hot liquids are brought to the table. "I never seat my daughter on the outside of a booth," notes paramedic Butman. "This helps take her out of the risk zone when the waitress swings a tray of hot food over our heads."

Should a burn occur, immediately plunge the injured area into cool water (never use ice) to help alleviate pain and prevent further progression of the burn, experts advise. Then cover the burn with a cold, moistened cloth for about 15 minutes. A small first-degree burn, which causes mild redness, warmth, and discomfort after soaking, can be treated at home, as can small second-degree burns, which cause blistering or oozing. Still, call your doctor and watch for infection. For larger or third-degree burns (white or charred skin, or skin that's very red and weepy-looking), call 911 or your local emergency service.

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