October 3, 2014

Poll Shows Gaps in Parents’ Knowledge About Concussions

Before their children are allowed to participate in sports, many parents must sign a document acknowledging that they understand concussions and their risks for brain injury. But a new poll on children’s health suggests that even if they know about the risk of concussion, they’re not necessarily capable of handling it properly.

According to the C.S. Mott Children’s Hospital National Poll on Children’s Health, about half of the 912 parents of middle- and high-school children surveyed said they had participated in some kind of concussion education.

  • Nearly 1 in 4 had read a brochure or online information.

  • Seventeen in 100 had watched a video or attended a presentation.

  • Eleven in 100 had signed a waiver form, but had no other educational information.

  • Nearly half had received no concussion education at all.

As you might expect, it was more common for parents of children who play sports to have gotten some kind of concussion education than for parents of nonsports kids (58% vs. 31%).

Some education is better than none, but, according to Sarah J. Clark, associate director of the Mott national poll, “The way the concussion information is delivered is linked to the parents' confidence about managing their child's injury." Clark is also a research scientist at the University of Michigan Department of Pediatrics/University of Michigan Medical School.

"Many schools mandate that a waiver form … be signed, but the danger is that parents will skip over information to get to that required signature line," she said in a news release.

More than 6 in 10 parents who watched a video or a presentation rated it as very useful. About 4 in 10 parents who read a brochure or online information rated that as very useful. Only 11 in 100 parents whose only concussion education was signing a waiver form reported that was very useful.

Parents lacking sufficient information about concussion, and its potential for brain injury, won’t know what to do if their child is injured.

According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 175,000 children are treated every year in U.S. emergency rooms for concussions related to sports or recreational activities, including bicycling, football, playground activities, basketball and soccer.

Although it’s never a minor event, a concussion affects children differently from adults. The healing process is different, and getting more than one concussion in a short period is particularly dangerous for kids.

All parents, but especially those with sports-playing youngsters, should get become informed about what is concussion, how to monitor its symptoms and when to seek medical attention. Until symptoms have subsided, parents should limit the child’s physical activity, and maybe mental activity including homework, to allow the brain to heal. (See our blog, “Getting Back Into the Game After Suffering a Concussion.”) Watch the video from the C.S. Mott Children’s Hospital here.

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May 24, 2013

Danger Lurks on Innocent-Looking Mall Rides

Sometimes it’s a mechanical pony. Sometimes it’s a small-scale race car. It might be at the mall or outside the supermarket—any prime territory to amuse and divert little ones while mom or dad needs to get the errands done.

Usually, it’s mission accomplished, but sometimes someone gets hurt.

As reported by CBSnews.com, between 1990 and 2010 nearly 93,000 children were treated in U.S. emergency rooms because of ride-related injuries. More than 7 in 10 such injuries occurred from May through September; about 20 injuries occurred daily during the summer months.

The study, published in Clinical Pediatrics, analyzed child injuries on rides found in amusement parks, fairs, festivals, arcades, restaurants, stores and malls. More than 4,400 ride-related injuries send kids to the ER every year, many of which occurred outside of traditional amusement park settings.

Researchers found that kids who use "mall rides" might face a higher risk of head, neck or face injuries or concussions.

In a news release, study author Gary Smith, professor of pediatrics at The Ohio State University College of Medicine said, "Injuries from smaller amusement rides located in malls, stores, restaurants and arcades are typically given less attention by legal and public health professionals than injuries from larger amusement park rides, yet our study showed that in the U.S. a child is treated in an emergency department, on average, every day for an injury from an amusement ride located in a mall, store, restaurant or arcade. We need to raise awareness of this issue and determine the best way to prevent injuries from these types of rides."

Amusement parks feature "fixed-site rides"; fairs or festivals feature "mobile rides"; those at an arcade, strip mall or restaurant are "mall rides." They’re subject to different oversight.

The U.S. Consumer Product Safety Commission oversees mobile rides at fairs, but state or local governments regulate fixed-rides at amusement parks (see our blog about amusement park ride safety). The study found that 1 in 3 injuries occurred on a fixed-site ride; 29 in 100 on mobile rides and 12 in 100 on mall rides. Although they represent the smallest percentage of injuries, they are under the most direct control of parents, so probably are the easiest injuries to avoid.

Most injuries were caused by a fall—nearly 1 in 3 injuries reported over the 20-year span; 18 in 100 were caused by being hit by something while riding or by hitting a part of the body on the ride.

Head and neck injuries accounted for 28 in 100 injuries; nearly 1 in 4 injuries involved arms; the face was involved in18 in 100, and legs accounted for 17 in 100. Soft-tissue injuries, such as bruises, were common, as were sprains, cuts and broken bones.

Although injuries serious enough to require hospitalization were relatively rare, they are more common during the summer—one occurs about every three days.

Because nearly 3 in 4 mall ride injuries occur when a child falls, parents should ensure that these rides have restraints, especially if they are located on hard surfaces, which they invariably are. In addition:

  • Follow all posted height, age, weight and health restrictions.

  • Follow any special seating order and/or loading instructions.

  • Use safety equipment such as seat belts and safety bars.

  • Keep the hands and feet inside the ride at all times.

  • Know your child: If you don't think he or she will follow the rules, give that ride a pass.

  • Follow your instincts: If you don’t trust the ride, stay away.

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January 25, 2013

Don’t Let a Bouncy House Fling You Into the Emergency Room

Bouncy houses have become a go-to activity for childrens’ birthday parties and other outdoor celebrations that include kids. But, as a recent study in the journal Pediatrics finds, they’re not without risk.

Claire McCarthy, a primary care physician and medical director of Boston Children’s Hospital’s Martha Eliot Health Center, advises parents on KevinMD.com to be mindful of the potential danger if they’re considering renting a bouncy house, and to take measures to minimize it.

Between 1990 and 2010, about 65,000 children were treated in U.S. emergency rooms for injuries they got in bouncy houses. “That’s about 31 kids a day,” McCarthy writes. According to Pediatrics, the number and rate of injuries increased fifteen-fold during the study’s 20-year period.

Most of the injuries were arm and leg fractures or sprains. Fortunately, only 3 in 100 required hospitalization. More than half of the injured kids were 6 to 12 years old; most of the rest were younger.

A bouncy house seems like a safe, padded environment to horse around in, but it still presents a lot of ways for a kid to get hurt. Most of the injuries documented in the Pediatrics study resulted from falls, many of them falling out of the bouncy house, but kids pushing, pulling and crashing into each other caused a lot of hurt, too.

This isn’t to suggest you reject the idea of a bouncy house for your child’s party—but you should take some precautions. Like wearing helmets when you ride a bike, there are guidelines for using bouncy houses, also known as “inflatable amusement devices.” The Pediatrics researchers suggest that, beyond the manufacturers’ information, rules should be devised similar to those for trampolines, because the injuries are very similar.

The best thing you can do, McCarthy says, is use common sense:

  • Always follow the manufacturer’s directions and safety guidelines.

  • Be especially careful with children younger than 6, or wait until kids are that old to use a bouncy house.

  • Don’t overcrowd the house--keep numbers of kids using it small. Everyone inside should have their own personal space.

  • Make sure kids keep body parts to themselves.

  • No flips or other stunts.

  • Supervise! Make sure there are enough grownups to monitor the bouncy house activity at all times during its use, and make sure they enforce the rules.

  • Have zero tolerance for rough-housing or other dangerous behavior. Consider using a whistle, like a lifeguard.

For more specific, detailed guidelines on bouncy house use, consult the Consumer Products Safety Commission guidelines.

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July 21, 2011

Risky Play on Playgrounds Isn't Always Wrong

The parental instinct to protect one's child is evolutionary. If something isn't safe, the parent's instinct is to remove the child from the danger, or otherwise minimize the threat.

That's a noble instinct, But is it always the best instinct? A recent story in the New York Times suggests that too much protection can stunt growth and inhibit an otherwise healthy desire to try new things and expand horizons.

Parental concern, government regulation, product safety guidelines and the fear of lawsuits have all contributed to the makeover of playgrounds from tall, creaky equipment resting on hard surfaces to kinder, gentler forms of outdoor apparatus. Shorter equipment sited on enclosed platforms underlain with absorbment material unquestionably prevents some injuries. But experts wonder at what cost.

“There is no clear evidence that playground safety measures have lowered the average risk on playgrounds,” said David Ball, a professor of risk management at Middlesex University in London. He noted that the risk of some injuries such as arm fractures increased after the introduction of softer surfaces on playgrounds in Britain and Australia.

“This sounds counterintuitive, but it shouldn’t ...,” Ball told The Times. “If children and parents believe they are in an environment which is safer than it actually is, they will take more risks.”

Playground equipment should be age-appropriate, of course--lower monkey bars will help develop a toddler's physical abilities. But they might impede an older child's psychological development or, because they're insufficiently challenging, encourage her to engage in play somewhere else--goofing around a high bridge over a river--that's too risky.

A study published in Evolutionary Psychology describes the value of risky play in encouraging children to confront their fears in order to overcome them. "[W]e may observe an increased neuroticism or psychopathology in society," the authors suggest, "if children are hindered from partaking in age adequate risky play."

Some researchers aren't convinced that children do suffer fewer physical injuries when their recreational corners are padded, but if so, they contend that such playgrounds may stunt emotional development and leave children anxious and fearful. Isn't that worse than a broken ankle?

As Ellen Sandseter, co-author of the Evolutionary Psychology study, told the New York Times, “I think monkey bars and tall slides are great. As playgrounds become more and more boring, these are some of the few features that still can give children thrilling experiences with heights and high speed.”

Sandseter identified six categories of risky play: exploring heights, experiencing high speed, handling dangerous tools, being near dangerous elements (water, fire), rough-and-tumble play (wrestling) and wandering alone away from adult supervision. The most common is climbing heights.

Children progressively raise their adventure bar, Sandseter, said. And that's the way they learn to accept and master challenge. When they fail, they get hurt, physically or emotionally. But as The Times' story reports, if parents and psychologists worry that a kid who suffers a bad fall will develop a fear of heights, studies have shown the opposite: A child younger than 9 who gets hurt in a fall is less likely as a teenager to have a fear of heights.

The gradual exposure to increasing danger is known as habituation. It's the same technique therapists use to help people overcome phobias. And it's hard-wired into our primordial brains: As The Times summarizes, "While a youthful zest for exploring heights might not seem adaptive — why would natural selection favor children who risk death before they have a chance to reproduce? — the dangers seemed to be outweighed by the benefits of conquering fear and developing a sense of mastery."

“Paradoxically,” the authors write in Evolutionary Psychology, “we posit that our fear of children being harmed by mostly harmless injuries may result in more fearful children and increased levels of psychopathology.”

So, parents, here's your long-term homework assignment. Try to understand that your instinct to keep the kids safe is normal and laudable, but it can overrun your child's need to take risks. You can't soften every blow, and--here's the take-home--you shouldn't try.

On the other hand, efforts to remove safety hazards from playgrounds are still important. When the issue is not just bumps and bruises, but head injury and serious harm, parents have a right to insist that playgrounds conform to safety standards.

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