DC Child Accident & Safety Blog

For 26 years the California Public Interest Research Group (CALPIRG) has issued a report about toy safety. We wrote about it last year, and this year’s summary, “Trouble in Toyland,” was released earlier this week. It identifies hazardous toys and offers safety guidelines for consumers. Specific toys are listed in the complete report.

CALPIRG’s work has resulted in 150-some recalls of toys that posed hazards for a range of reasons, including strangulation, choking, toxins, noise and sharp edges. But as a consumer watchdog, the organization knows the work isn’t done. Although championing the Consumer Product Safety Improvement Act (CPSIA) of 2008 for its advances in toy safety, CALPIRG also notes that this year, “policymakers delayed implementation of its most stringent lead standard rules and enacted some narrow exceptions,” and we concur.

That said, here’s what you need to know as you embark on the toy-buying season.

Lead
Lead is especially problematic for the central nervous system; childrens’ developing brains are particularly at risk. Seven toys exceed levels CALPIRG finds excessive (the organization’s threshold is much lower than the CPSIA standard).

Phthalates
Phthalates are of concern particularly for premature delivery and reproductive defects. The CPSIA has banned toys containing three phthalates and set temporary limits on three others, while tests continue. CALPIRG found two toys that laboratory testing showed to exceed limits allowed by the CPSIA by 42 and 77 times, respectively.

Choking
Choking is a major cause of toy-related deaths and injuries. CALPIRG found several toys that violated standard intended for children younger than 3, and several others that support its call for the small parts test to be made less permissive. Some toys intended for older children failed to provide choking hazards warnings required for small parts or small balls.

Noise
One-third of Americans with hearing loss can attribute it in part to noise. One in 5 U.S. children will have some degree of hearing loss by the time they are 12. CALPIRG found three toys it considers too noisy.

Among CALPIRG’s suggestions for improving toy safety are:

• The Consumer Product Safety Commission (CPSC) should review and, if necessary, expand its definition of a “small part” or “small toy” to include parts and toys that are larger than the current standard, but have been shown to pose a choking hazard to children.


• Cadmium should be limited in children’s jewelry. See our recent post about the dangers of this toxic chemical.


• Lead and phthalate standards in toys should be vigorously enforced, and lead standards should be lowered.


• The CPSC must ensure that its product incident database it provides the information consumers need to make informed choices in the marketplace.

Consumers must realize that not all toys are tested, and not all toys on store shelves meet CPSC standards. There is no comprehensive list of potentially hazardous toys. Examine toys carefully for potential dangers before you make a purchase.

It's also a good idea to screen all children for exposure to lead via a simple and inexpensive blood test at a physician’s office or public health agency.

Report unsafe toys or toy-related injuries to the CPSC at www.cpsc.gov and to www.saferproducts.gov or call the CPSC at 1-800-504-7923.

Last week, Johnson & Johnson surrendered. After sustained pressure from consumer watchdog groups, the manufacturer has decided to eliminate from its baby products any preservatives that might release even trace amounts of formaldehyde.

In a letter to the Campaign for Safe Cosmetics, the company’s vice president for product stewardship & toxicology reiterated the safety of all of its products, and called the reformulation a response to consumers. Two weeks before the company’s announcement, the Campaign had called for a boycott of Johnson & Johnson baby shampoo.

The removal of the offending ingredients—quaternium-15 and 1,4-dioxane—from all products worldwide will take about two years, but the baby shampoo will be reformulated first. Quaternium kills bacteria, but releases formaldehyde, a known human carcinogen. Dioxane is a suspected carcinogen.

In addition to the Campaign for Safe Cosmetics, the Breast Cancer Fund and the Environmental Working Group lobbied Johnson & Johnson to make the switch.

Here's something about children that most of us don't know, which is connected to some facts that most of us do know.

Most people know that America is an increasingly obese nation. Most people know that obesity is a risk factor for heart disease, stroke, diabetes, osteoarthritis and lots of other threats to health and life. Most people know that obesity can raise blood cholesterol levels, and that adults often have cholesterol tests to determine if their levels are dangerous.

For the first time, medical experts are recommending that all children also have their cholesterol checked.

It’s not just a sound health-care practice, it’s a sad reflection that kids are getting fatter right along with the rest of us. And that the seeds of heart disease, diabetes and strokes are sown early in life.

Approximately one-third of U.S. children are overweight or obese. And although being overweight doesn’t always result in high cholesterol, it’s always a reason to check.

As described in the Los Angeles Times, although kid cholesterol tests have become an unfortunate necessity, the recommended procedure is not the same as the one for adults. Tests should be given at least once when kids are between 9 and 11, and again when they’re between 17 and 21. They’re not usually necessary every year.

And the kid cholesterol test doesn’t require fasting, as the adult test does. It involves either a blood draw or maybe just a finger prick in the doctor's office. If the first test suggests abnormal cholesterol levels, a fasting cholesterol test would be the next step.

The panel’s recommendations were published in the journal Pediatrics.

Even overweight children typically don't suffer heart attacks, but looking for precursors of heart disease is an effort to head that future event off at the pass. "Heart disease is the No. 1 cause of death in our society," said Dr. Stephen R. Daniels, the panel chairman. "We know the process that leads to those deaths begins in childhood. We also know that people who are able to maintain a low risk through childhood and early adulthood have a lower risk.”

The National Heart, Lung and Blood Institute – a branch of the National Institutes of Health (NIH) – developed the guidelines for testing cholesterol in kids, and they were endorsed by the American Academy of Pediatrics. Heart specialists and pediatricians called them long overdue.

The previous guidelines, dating to 1992, said children should be given cholesterol screenings only if their family history included heart disease or high cholesterol.

Experts predict that the most immediate impact of universal cholesterol screening for children will be imparting a sense of urgency among parents and primary caregivers to improve kids’ diets and exercise habits if the test discloses higher than normal cholesterol, whether or not they’re overweight. (Just as overweight people can have normal cholesterol, sometimes cholesterol can be elevated even if you aren’t carrying extra pounds.) They don’t anticipate widespread prescription of medication.

According to one study mentioned in The Times’ story, no one knows how many children have abnormal cholesterol, but more than 28% of children who are overweight may have metabolic syndrome. That’s a cluster of risk factors including high blood pressure and high cholesterol.

In addition to the cholesterol test, the new report suggests other ways to monitor and manage heart risk in children. They include:

• exclusively breast-feeding babies for the first six months of life;


• feeding children a diet low in saturated fat beginning at 1 year;


• counseling children about diet and exercise if they score above the 85th percentile on weight-height charts (that threshold means the child’s weight is higher than 85% of other children at that height).

The guidelines suggest different diets depending on a child's weight and whether he or she has high blood pressure or high cholesterol.

We’ve written often about the misguided, expensive and potentially dangerous medical practice of over-testing. But this isn’t one of those situations. Although some cholesterol tests for kids might signal a need for changes in behavior, changes that might seem overly restrictive as if you can’t let a kid be a kid, parents must realize they’re only making an investment in the future.

And that sometimes doing what’s best for a child brings positive change for the whole family.

It's always disturbing to hear about an adult taking away a child's innocence through inappropriate sexual contact. But even more disturbing is when bystanders look the other way and let the offender repeat the abuse against other children.

The perpetrator has no moral excuse, of course, but at least has the partial explanation of some deep-seated mental illness. The bystanders have neither excuse nor explanation for their own dereliction of duty.

Although this is a story that has played out in multiple settings in recent years, seemingly wherever adults and children come into regular content, today's story comes from Penn State, where Jerry Sandusky, the retired assistant football coach, is the alleged perpetrator, and the university's athletic director, Tim Curley, and vice president for finance Gary Schultz, are the not-so-innocent bystanders.

Curley and Schultz received a report from a graduate assistant who saw Sandusky raping a 10-year-old in the locker room on a Saturday night. This happened in 2002, and the only concrete action to happen to Sandusky then was the loss of his locker room keys. Neither Curley nor Schultz brought in any police agency to investigate. Now they are under indictment for their cover-up along with Sandusky.

You can read the grand jury's report on these troubling allegations here.

Hospitals help us heal. Unfortunately, sometimes they can make us sicker. As a parent concerned about your child’s welfare, use this checklist, courtesy of James’s Project, to successfully navigate your child through his or her hospital stay.

Hospital-acquired infections. Ask – demand, if you must – that every health-care provider from food server to surgeon washes his or her hands on entering your child’s room and/or before touching your child. Ask what infection-control procedures are in effect. For example, are the newest technologies and innovations in reducing catheter-associated infections in use?

Medication mistakes. Reduce the likelihood of a medication error by knowing what your child is being prescribed. Ask the person delivering medicine what it is, why it is being given and what is the dosage amount. Ask to see the medicine’s original container. Write it down.

Broken medical equipment. Ensure that alarm systems are working. Ask when they were last inspected. If the interval seems extreme, request that they be inspected immediately.

Poor communication. Communication in handing off care is vital. The care team should have a prescribed process to communicate all pertinent information from one provider, from one shift, to the next. Ask the hospital’s patient advocate what hand-off measures are taken. As a member of your child’s care team, you’ve a right and an obligation to see this checklist.

Failure to rescue. Sick children and babies need constant care and attention. Every parent should know what a family (or patient) activated rapid response team is, and every hospital serving the pediatric population should share it with you.

Rogue clinicians. Most health-care professionals are ethical and dedicated caregivers. But to protect your child from a bad egg requires transparency. Don’t be shy about asking questions. Expect detailed answers.

You can read more about how to become an effective advocate for a loved one in the hospital in Patrick Malone's book, "The Life You Save."

Later than you might think, according to this guest blog from Beckley Mason, which explores important new safety developments in car seats:

Out here in California, a law was recently (and at long last) passed that raises the size and age requirements children must reach before they can leave their safety car seats. California joins Maryland and about 30 other states in requiring that children be eight years old or at least 4’9’’ (which ever comes first).

While the law may not be popular with kids eagerly awaiting the day they can sit like an adult, it’s an important step to keep kids safe. Even with advances in technology and awareness of child seat safety fairly high, motor vehicle crashes remain the leading cause of death for children between ages 3 to 14.

The reason that California, which was once the leader in child safety seat laws, fell so behind the times is that former governor Arnold Schwarzenegger twice vetoed similar laws. Schwarzenegger claimed that he would rather spend state money promoting education for parents on how to best use car seats than pass another difficult to enforce law. While it’s difficult to agree with his decision to veto, his reasoning does carry more than a bit of logic. In a state without our budget concerns this policy would be entirely indefensible, but research confirms that many parents all around the U.S. need more education on how to properly use booster and car seats to maximum effect.

In a groundbreaking year-long study of 79,000 car seats and their passengers, Safe Kids USA found that less than a third of all parents were both installing their car seats and strapping their children in properly. The primary issue was a failure to correctly use the top-most tethers that fully secure child seats during a crash. While at rest, these top tethers can seem superfluous, and often inspectors found that they were secured too lowly, or not at all. However when in a collision, the tethers are vital because they keep the passenger child’s head from moving dangerously during crashes.

The same study raised concerns that many parents who do their best to secure their children are not aware of the latest best practices for children of different heights and weights. New research doesn’t always reach the people who need to hear it, as in 2010, when American Academy of Pediatrics changed guidelines. The group now recommends that children under two years old ride in rear-facing seats. However a recent poll showed that barely a quarter of parents were aware of that fact. About three quarters of responding parents turned their kids around before year two, and 30 percent before year one.

It is at that young age that child seats are most vital to preventing serious injury. According to the National Highway and Traffic Safety Administration (NHTSA), properly using a child safety seat decreases the risk of death by 71 percent for infants and 54 percent for toddlers. Even older, less vulnerable children are 59 percent less likely to be injured in a booster seat that ensures the seatbelt fits across the chest instead of the collarbone or neck.

The NHTSA is trying to spread the latest word on child passenger safety by offering free educational resources to parents around the country. There are trained professionals at locations around the country that now offer 20-30 minute “courses” on properly installing car seats and their strapping in their passengers.

You can find a location near you by clicking over to the NHTSA website and searching by state or zipcode. It’s a great opportunity to get the latest information and training to make sure you keep your precious cargo safe.

Beckley Mason writes a Bay Area street safety blog for GJEL Accident Attorneys.

A hot topic in the world of sport safety these days is concussion. It’s not the first time we’ve covered the topic. Thanks to an increasing awareness that concussions can lead to traumatic brain injury (TBI), cognitive decline and other problems, athletes are monitored more closely for signs of head injury.

But greater awareness and better medicine have a concussion traveling companion of a decidedly consumer orientation. So-called “anti-concussion” sports equipment is making its market move. As always, it’s buyer beware.

As reported in the Los Angeles Times, no piece of equipment, no matter how technologically advanced, can indicate the presence of brain damage, or guarantee protection from it.

Testifying a couple of weeks ago at a U.S. Senate hearing, Jeffrey Kutcher, chairman of the American Academy of Neurology's sports section, said, "I wish there was such a product on the market. The simple truth is that no current helmet, mouth guard, headband or other piece of equipment can significantly prevent concussions from occurring."

Parents are a target market for these products, and football is a prime activity.

• Item: a $149 chin strap made by Battle Sports Science called the Impact Indicator that features colored lights to "help" indicate whether a player has a concussion.


• Item: the Brain-Pad LoPro mouth guard, which promises "brain safety space.


• Item: Riddell's Revolution helmet, whose pitch is to reduce the number of concussions by 31%. Kutcher said research showed that the helmet decreased concussions by only 2.6%.

Good equipment is key, whether you’re a 12-year-old middle linebacker or a 47-year-old softball catcher. But the best way to prevent brain damage (or worse) after a head injury is to take the time necessary to recover. Children have relatively heavier heads than adults, and because their brains are still developing, the incidence and severity of their head injuries is higher.

According to the Centers for Disease Control and Prevention (CDC), the number of traumatic brain injuries among young athletes has increased 60% over the last 10 years. In 2001, 153,375 young athletes were admitted to emergency rooms for concussions and other sports-related head injuries. In 2009, that number had climbed to 248,418. Approximately 298 youths per 100,000 suffered a head injury in 2009. Males 10 to 19 had the highest rate of injuries.

Motorcycle and auto accidents account for about 20% of traumatic brain injuries. According to the CDC, the most common sports and games leading to TBI are:

• bicycling


• playground activities


• football


• basketball


• soccer.

It’s difficult to resist the appeals of a kid who can’t wait to get back into the soccer game. But if she was dizzy, nauseous, had vision problems or a headache, even momentarily, she’s done until a doctor examines her. And certainly anyone who has gotten knocked out should be seen by a doctor immediately.