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.

Bookmark and Share

June 6, 2014

Dangerous Flame Retardant Chemicals Are Everywhere

Parents of small children know that day care centers and preschools are notorious providers of germs the whole family can share, but what they might not be aware of is that they also pose a danger because their furnishings often are treated with flame retardants.

The chemicals in flame retardants, polybrominated diphenyl ethers (PBDEs) and tris phosphate compounds, have been linked to hormone disruption and lower IQs in children. According to a study published in the journal Chemosphere, they were found in 100% of the dust samples collected from 40 child care centers serving more than 1,760 children in Northern California.

As reported by the San Francisco Chronicle, the study was conducted by researchers from the University of California, Berkeley’s Center for Environmental Research and Children’s Health. They said that the results were representative of what's found in many homes and other environments because the chemicals have been widely used for decades in the polyurethane foam inside upholstered furniture.

In the early 1970s, California imposed requirements that upholstered furniture be manufactured with flame retardant chemicals. Those measures became standard elsewhere as well. But they were changed to enable flammability standards to be met without the use of the chemicals. As we noted earlier this week in our Patient Safety blog, “Burn Surgeon’s Testimony Tainted by Conflict of Interest,” chemical industry interests have tried to promote these dangerous substances using unsavory and misleading means.

Although PBDEs have been banned in California for almost a decade, they’re still found in older furniture and other products. And in many cases, their replacement was chlorinated tris, never mind that it had been removed from children's pajamas in 1977, according to The Chronicle, after it was found to mutate the DNA of people exposed to it. In California, it’s considered a carcinogen, or cancer-causing substance.

The Chemosphere study found levels of PBDEs in the child-care facilities to be somewhat lower than what previous studies found in residences. But the amounts of chlorinated tris were similar or higher than household levels found in other reports.

The authors said that the higher tris levels probably were found in the mats children use for napping, as well as in furniture. Of the facilities studied, 29 had upholstered furniture and 17 had napping mats made of foam.

To minimize your child’s exposure to these chemicals:

  • Choose natural fiber wall coverings instead of paint.

  • Use cleaning supplies without harsh chemicals.

  • Maintain a low level of dust.

  • Cover childrens' mats with cotton sheets.

And don’t despair: Despite the study's results, Asa Bradman, its lead author and an environmental health scientist, told The Chronicle, "People shouldn't panic and feel like child care is toxic for children."

Bookmark and Share

January 17, 2014

Should Age Should Determine When Kids Start School?

There’s been a lot of chatter in recent years about the wisdom of holding kids back from entering school if they are among the youngest members of their class. Dr. Roy Benaroch, a pediatrician and author of “Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide,” recently weighed in on the topic at KevinMD.com.

Benaroch has been skeptical of the trend of “holding back” children with late birthdays. They’re the ones who were born in the summer and are just a few months short of the next grade cut-off. Even “60 Minutes” did a segment about parents who think it’s wise to hold their later-born kids back so that they end up as one of the oldest instead of the youngest kids in their class.

The practice might seem to be advantageous in terms of maturity, academic ability and physical ability. As Benaroch points out, because children generally progress yearly, without later switching grades, kids “held back” in kindergarten should end up bigger and stronger and faster when trying out for teams in high school.

“A good idea?” he asks.

“Recent research has shown some stark differences in children who end up as the youngest versus the oldest kids in a classroom, which gives support to the idea of reconsidering firm birthday-based rules for choosing when to start kids in school,” he says.

One study he likes looked at about 12,000 Icelandic children, grouping them by both birthdate and grade in school. The study found:

  • Mean test scores were lowest among the youngest children, especially in early grades. This gap lessened by middle school, but was still significant.

  • Children in the youngest third of a class were about 50% more likely to be prescribed medication for Attention Deficit Hyperactivity Disorder (ADHD) than kids in the oldest third of the class.

We’ve been wary of overprescribing ADHD drugs (see our blog, “Boom in ADHD Diagnoses Can Lead to Overmedicating and Drug Abuse”), but this study examined a different population from the one we generally write about.

Similar findings, Benaroch says, have been reported by other researchers, so he believes it’s a true effect. “Lumping children together by age creates a disparity in abilities within a classroom, with the youngest children being put at a relative disadvantage. That seems to create a greater likelihood of medical diagnoses and treatment for attention deficit disorder.”

But, it’s important to note, he also concedes, that “It’s not known if holding back these younger kids with ADHD would allow them to become better students without fulfilling an ADHD diagnosis.”

Benaroch isn’t certain what the best approach is. Life, just like school, presents all kinds of diversity everyone must learn to deal with. As he says, “[S]ome kids in any group are going to be the youngest.”

He suggests that maybe smaller classes with a smaller age range of children would be a good idea. Maybe an individualized approach to determining which kids will do best to start sooner versus later would help — that is, not the one-size-fits-all approach of holding back every kid with a certain birthday cut-off. “In the held-back year,” he writes, “children who weren’t ready for school could get extra help with their attention abilities and other skills that will help them advance.”

But Benaroch says this could lead to other problems later on, when kids of greatly varying age, physical ability and sexual maturity are mixed together.

“I don’t have a solution,” Benaroch concludes, “but it seems like this is a genuine problem. We’d better figure out a way to work this out that doesn’t depend on more medications for the youngest kids in a grade.”

On that, we agree.

Bookmark and Share

December 13, 2013

When a Date is a Threat — Violent Romance

A disturbing number of teenagers experience physical violence in their dating relationships, a situation that can lead not only to physical injury, but depression, eating disorders, academic problems and other harms.

As discussed on ScienceDaily.com, a recent study published in the Journal of School Violence reported that 1 in 10 U.S. high-school students reported being hit or otherwise physically harmed by a dating partner within the last year.

The incidence of being hit, slapped or otherwise physically hurt was nearly equal between males and females who participated in the survey. But there were racial differences: There was a statistically significant increased rate of dating-violence among blacks (nearly 13 in 100) and multiracial youths (about 12 in 100) compared with whites and Asians (8 in 100) or Hispanics youth (about 1 in 10).

The study analyzed data from 100,901 students who participated in the Youth Risk Behavior Surveillance System survey (YRBSS) from 1999 to 2011. It concluded that more than 9 in 100 U.S. high school students have been "hit, slapped, or physically hurt on purpose" by a boyfriend or girlfriend in the last year, a rate that has not changed significantly in the last 12 years despite efforts to curb dating violence in the last decade.

The researchers, from Boston University’s School of Public Health (BUSPH), called the incidence of youth hurt by dating partners a serious public health concern because its consequences can include depression, eating disorders, injury and in the most severe cases, death.

"While 9 percent may sound low, this figure puts dating violence on par with many of the other public health issues that we tend to view as serious problems, such as obesity, frequent cigarette smoking or driving after drinking," Emily Rothman, associate professor of community health sciences at BUSPH, said in a news release. "The real concern here is that the rate has not gone down at all in the past 12 years, while the rate of physical fighting with peers has decreased significantly.

"That means that whatever headway we have made in reducing youth violence does not extend to people in dating or sexual relationships."

Malcolm Astley, the father of one girl who was murdered by her boyfriend, said parents, teachers, school counselors and legislators must grasp the extent of the problem of dating abuse and address it. The risk is most extreme during break-ups, and it’s up to adults to help kids understand and handle their feelings.

Which, like bullying, speaks to the necessity of parents knowing what’s going on in their childrens’ lives, even if the kids resist. It can be a matter of life and death.

Bookmark and Share

January 11, 2013

A Profile of Kids at Risk of Being Bullied

It’s no surprise that vulnerable kids are ripe for bullying. Two recent studies found that children who suffer from food allergies and those involved in weight-loss programs reported being bullied by their peers. But it might surprise that those who are victimized because of their weight are sometimes bullied by their parents.

Both studies were published in the journal Pediatrics, here and here.

In one study, nearly one-third of children with food allergies reported bullying or harassment specifically related to their allergy, often involving threats with food. In the weight study, nearly two-thirds of teens at weight-loss camps reported weight-related victimization.

Bullying can cause great harm. See our post about the connection between bullying and suicide. Less dire consequences include social isolation, poor academic performance, depression, anxiety and chronic health problems.

As described on MedPageToday.com, surveys of 251 food allergy patients ages 8 to 17 and their parents were analyzed at a single allergy clinic.

Forty-five in 100 of the kids and 36 in 100 of their parents reported bullying or harassment. Eight in 10 bullies were classmates, and 6 in 10 bullying incidents happened at school. Verbal teasing was common, as was waving the allergen in front of the child; 12 in 100 kids had been forced to touch the food to which they were allergic.

Most of the bullied kids said they had reported the bullying, but parents knew in only about half the cases. When the parents did know, the situation improved for the kids.

The weight study included 361 kids ages 14 to 18 surveyed online while they attended two national weight-loss camps. One-third of the respondents were in the normal weight range; nearly one-quarter were overweight and 4 in 10 were obese. The first group represents many kids who previously had lost significant amounts of weight and had returned to the program for maintenance.

The more the kids weighed, the better their chances at being bullied, although many of the normal weight groups remained at risk.

Bullying came in the form of teasing, relational victimization (behavior aimed at damaging relationships or one's social reputation), cyberbullying and physical aggression. The most common bullies were:

  • peers (9 in 10)

  • friends (7 in 10)

  • physical education teachers or sport coaches (4 in 10)

  • parents (nearly 4 in 10)

  • teachers (1 in 4)

The researchers said that some of the adults might have been well-meaning, but made clear that any bullying can be extremely damaging. As MedPageToday summarized, bullying has immediate and long-term effects, both physical and emotional.

The researchers concluded that pediatricians and other caregivers should become front-line interveners when a patient presents with symptoms or stories of bullying. That means helping kids and their parents anticipate and handle incidents, and teaching parents how to recognize bullying clues.

Even if your kid isn’t talking, sometimes you can recognize if he or she has been bullied. Physical clues include unexplained bruises, cuts and scratches; behavioral clues are avoiding school and social events, substance abuse, anxiety and depression. In addition, kids might have chronic headaches or stomach aches.

Simply realizing that if your child suffers from food allergies or excessive weight, he or she is particularly at risk; you can help him or her be prepared for what might occur.

If the bullying occurs at school and at home, the researchers said that "healthcare providers may be among their only remaining allies."

Bookmark and Share

November 16, 2012

Sleep-Deprived Teen Athletes Suffer More Injuries

When you’re sleepy you’re more likely to make mistakes. And, it appears from research presented last month at a conference of the American Academy of Pediatrics, lack of sleep puts adolescent athletes at greater risk of injury.

Researchers studied middle- and high-school athletes in grades 7 to 12 for nearly two years. They found that those who slept eight or more hours every night were significantly less likely—68 percent—to be injured playing their sports than those who regularly slept less.

The study admittedly was small—it surveyed kids at only one California school. And it relied on students remembering and communicating accurately. But the premise, really, is a no-brainer: Insufficient sleep is not good for you, in many ways.

In addition to their sleep habits, students were asked about what sports they played, the time they spent playing sports either at school or in other programs, if they used a private coach, if they participated in strength training and how much they enjoyed their athletic endeavors. Split nearly evenly between boys and girls, 112 of the 160 students completed the survey, which was done in conjunction with Children’s Hospital Los Angeles.

The study’s author, Dr. Matthew Milewski, said, “While other studies have shown that lack of sleep can affect cognitive skills and fine motor skills, nobody has really looked at this subject in terms of the adolescent athletic population.”

In addition to hours of sleep per night being clearly associated with the incidence of injury, results showed that the higher the grade level of the athlete, the higher the likelihood of injury. Each additional grade level was associated with a 2.3 higher chance of getting hurt playing sports. No other element—gender, duration/hours of participation, number of sports played, strength training, private coaching or “fun” factor—showed a significant association with injury.
Milewski said that the association between higher grades/ages and increased chance of injury might reflect the cumulative effect of playing sports for several years as well as the fact that older kids are bigger, faster and stronger.

As reported on MedPage Today, the injuries involved multiple body parts. Most common, however, were injuries to the hand or wrist, knee, shoulder, ankle, back and head.

More than 38 million children participate in organized sports each year, according to MedPage Today. Approximately 1 in 10 is treated for a sports injury. Milewski said about half of all injuries probably are related to overuse, and half of those are probably preventable.

During the school study, nearly 6 in 10 athletes were injured; nearly 4 in 10 were hurt multiple times.

As MedPage reports, the Centers for Disease Control and Prevention and the National Sleep Foundation define insufficient sleep for high schoolers as fewer than eight hours per night. And the eight-hours threshold in this age group, Milewski said, is regularly missed—approximately 7 in 10 high schoolers don’t sleep that much. More than 3 in 4 four students involved in the survey said they slept fewer than eight hours. (See our post about how teenagers’ love of texting contributes to sleep deprivation.)

If parents needed another reason to nag their kids, the greater risk of getting hurt at play is a pretty good one: Tell your kid to log off of Facebook, turn off the smartphone and go to bed.

Bookmark and Share

October 5, 2012

How to Treat Anaphylaxis When Kids Are at School

It might be the result of a bee sting or the ingestion of a peanut, but whatever the cause, when anaphylaxis occurs it can be life-threatening.

Anaphylaxis is an acute allergic reaction to a specific antigen (food, pollen, drugs, etc.); it’s the immune system’s whole-body response to the presence of an allergen it perceives as a threat. Symptoms generally occur immediately after exposure and might include respiratory distress, swelling of the lips, eyes and throat, rash, low blood pressure, bleeding and/or vomiting. It can result in cardiac arrest.

Parents of children with known allergies should ensure that their child’s school authorities are aware of the allergy and have a prescription on file for epinephrine in case of emergency. (Epinephrine is the hormone adrenaline and is the primary treatment for anaphylaxis.)

Epinephrine is generally safe, with few adverse effects, if given even when it is not needed.

But according to a recent story in the New York Times, school nurses can find themselves in a horrifying position if a child without such a prescription develops a sudden reaction to an undiagnosed allergy. If they inject epinephrine, they risk losing their nursing license for dispensing it without a prescription. Their only other option is to call 911 and hope the paramedics arrive in time.

Some states have passed laws to enable school caregivers to have epinephrine injectors on hand and to give a shot to any child with an emergency. Mylan, which markets Pfizer’s EpiPen, the most commonly used injector, is lobbying for such federal legislation. The company has lobbied individual state legislatures and has distributed free EpiPens this year to schools.

Sure, it’s a naked grab for market share, but it also makes medical sense.

As The Times reports, Mylan has spent millions on consumer advertising and has hired scores of sales representatives to help promote the product. It’s estimated that EpiPen sales will total $640 million this year, a 76 percent increase over last year, according to one analyst.

A study last year in the journal Pediatrics found that about 1 in 13 children had a food allergy, and nearly 40 percent of those with allergies had severe reactions.

Efforts to make epinephrine more widely available, The Times says, are an acknowledgment of the rising rates of food allergies among children and the handful of deaths from allergies across the country. Some children with known allergies carry their own epinephrine injectors to use themselves, if they’re old enough, or the devices are kept in their school nurse’s office.

It’s unclear why the rate of food allergies among children appears to be increasing. “I don’t think it’s overdiagnosis,” Dr. Scott H. Sicherer, a researcher at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in Manhattan, told The Times.

A Mylan executive said schools were just the first place to make emergency epinephrine injectors more widely available. The company would like to see them as available as defibrillators—in restaurants, airplanes and other public places.

The Food Allergy and Anaphylaxis Network (FAAN) has not taken a position on placing injectors in public places other than schools, and Sicherer wondered about their suitability in settings such as restaurants, where staff might not be able to tell the difference among choking, a heart attack or anaphylaxis.

Next month, Sanofi plans to introduce a rival epinephrine delivery device, and in 2015, Teva may win approval of a less expensive generic version of the EpiPen, according to The Times. Sanofi’s Auvi-Q features voice instructions and Teva’s product, if approved by the FDA would closely mimic the EpiPen design and, like a generic drug, could be substituted by pharmacists even if doctors prescribed the EpiPen.

To learn about the latest developments in food allergies, visit the NAAN site. To learn about the widespread practice of bogus testing, see our blog about free allergy tests. To learn about the early signs of allergy, see our blog here.

Bookmark and Share

March 6, 2012

How to Help Your Child in the Wake of School Violence

It doesn’t matter that tragedies like the recent school shooting in Ohio are random and nonsensical. If they’re horrifying to an adult, they can be positively terrifying to a school kid.

Even if your child isn’t within three area codes of this or any other school shooting, he or she can be traumatized. Several child violence experts on Psychcentral.com suggest ways to help a child overcome an irrational fear in the wake of such incidents.

Q. What can parents tell their children if they are afraid to go to school after a school shooting?
A. Let children voice their fears and concerns. Open a conversation by saying, “When we hear about something as sad and scary as a school shooting, it makes mommies, daddies and children worry about our children being safe at school.”

If your child expresses concern about safety or violence at his or her school, talk about it and offer to join the child in discussions with the appropriate school personnel.

Shootings can remind children of a previous experience with danger. If it does, discuss these prior experiences and differentiate them from this recent shooting.

For a limited time, accompany your child to school or home. Spend a little extra time with them at bedtime. But make sure your child understands this is temporary help to assist in returning to a normal routine.

Give your child realistic assurances — that while these events can and do happen, they are rare.

Q. What can you do to protect your children?
A. If violence occurs in your home between adults or between adults and children, get help immediately. Violence at home is the primary exposure for children to violence and violent injury.

All parents experience constant tension between allowing children to be independent and setting limitations for their own protection. Most important is to continually educate your children and openly discuss the safety strategies that accompany increased independence. You can renegotiate this balance with your children on a temporary basis because of immediate safety issues within their own communities and schools.

If you must restrict your child from activities because of safety concerns, explain that the restrictions are temporary and that you are looking forward to the time when the child can enjoy more independence. Know their friends and communicate with their friends’ parents and other parents who might have information about your child’s friends and activities.

Q. How can you recognize the potential for a child to be violent?
A. The American Academy of Child and Adolescent Psychiatry says the presence of one or more of the following increases the risk of violent or dangerous behavior:

  • past violent or aggressive behavior (including uncontrollable angry outbursts)

  • access to guns or other weapons

  • bringing a weapon to school

  • past suicide attempts or threats

  • family history of violent behavior or suicide attempts

  • recent experience of humiliation, shame, loss or rejection

  • bullying or intimidating peers or younger children

  • a pattern of threats

  • being a victim of abuse or neglect (physical, sexual or emotional)

  • witnessing abuse or violence in the home

  • themes of death or depression evident in conversation, written expressions, reading selections or artwork

  • preoccupation with themes and acts of violence in TV shows, movies, music, magazines, comics, books, video games and Internet sites

  • mental illness, such as depression, mania, psychosis or biopolar disorder

  • use of alcohol or illicit drugs

  • disciplinary problems at school or in the community (delinquent behavior)

  • past destruction of property or vandalism

  • cruelty to animals

  • fire-setting behavior

  • poor peer relationships and/or social isolation

  • involvement with cults or gangs

  • little or no supervision or support from parents or other caring adult

Communication is key. Encourage your child to express any concerns he or she has about the behavior of others. Be prepared to speak to other parents if your child observes something concerning them about a peer’s behavior. Make sure that your child’s school authorities address any concerns that you bring to their attention.

Schools must have an appropriate procedure to evaluate children of concern to others. Find out if your child’s school has a procedure, and what it is. Find out how it monitors a child’s progress. Parents must impress upon their schools the need to adopt a comprehensive, team approach to ensure one person does not miss the warning signs someone else might see.

Q. What can schools do to prevent violent incidents?
After the recent school shootings, the U.S. Department of Education issued school safety guidelines to every school in the country.

Parents can ask school personnel if they have reviewed and implemented any of the Department of Education recommendations. In addition, parents and schools can refer to the recommendations of the National School Safety Center and the material provided by the National Education Association on its website. In coordination with parents, teachers, community agencies, community law enforcement and mental health professionals, the school should develop a plan for violence prevention and intervention.

Q. What can parents do to ease their own anxiety about sending their children to school?
School shootings challenge our belief that parents or schools can guarantee total protection and make us keenly aware of our children’s vulnerability to harm or injury.

These concerns are appropriate if they prompt parents to constructively review issues of safety within the family, neighborhood and school community. Taking constructive actions is an important way to alleviate anxieties that result from real-life events. If an act of violence exposes parents to a realistic concern, they must take practical steps to address this concern.

A parent might be experiencing severe anxiety if the shooting brings back previous memories of danger or loss. It can be helpful for parents to talk over these issues with other parents, school personnel and community or religious leaders.

Bookmark and Share

August 8, 2011

Top 5 Ilnesses for School-Age Children

The information and advocacy outfit KidsHealth has issued a list of the top five illnesses parents should look out for during the school year, and how to address them. They are:

  • 1. Pinkeye: Also known as conjunctivitis, pinkeye is very contagious when caused by viruses or bacteria. To prevent spreading it, kids should wash their hands often with warm water and soap; not touch their eyes; and avoid sharing eye drops, makeup, pillowcases, washcloths, and towels.

  • 2. Strep Throat: It spreads through close contact, unwashed hands and airborne droplets from sneezing or coughing. Anyone can get strep throat, but it’s most common in school-age kids and teens. To prevent the spread of it: keep a sick child’s eating utensils separate and wash them in hot, soapy water or a dishwasher; the child shouldn’t share food, drinks, napkins or towels; teach kids to sneeze or cough into a shirtsleeve, not their hands.

  • 3. Head Lice: The critters are common among kids 3-12 (affecting girls more often than boys), but anyone can get this infection. It’s not a sign of poor hygiene and lice do not spread disease. To prevent the spread of lice, discourage sharing combs, brushes, hats and helmets.

  • 4. Molluscum Contagiosum: This skin rash is common among kids 1-12, yet many parents are not familiar with molluscum contagiosum. It spreads easily, most commonly through skin-to-skin contact, but kids can get it by touching objects bearing the virus such as toys, clothing, towels and bedding. To prevents the spread of the virus, wash hands frequently with soap and warm water and avoid sharing towels, clothing or other personal items.

  • 5. Walking Pneumonia: The leading type of pneumonia in school-age kids and young adults spreads through person-to-person contact or breathing in airborne particles from sneezing or coughing. Walking pneumonia usually develops gradually and can be successfully treated with antibiotics. To prevent the spread, encourage kids to wash their hands thoroughly and frequently.

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.

Bookmark and Share

January 27, 2011

Cities safer for kids than suburbs, researcher says

The traditional family dream home -- a large house on a big lot in a quiet suburb -- may actually be more dangerous for children than many inner-city neighborhoods, according to a growing body of research.

Although many parents worry that city living could mean their children will be abducted or caught in the crossfire of a gang shooting, it is exceedingly rare for children to be harmed or murdered by strangers, says William Lucy, a University of Virginia urban planning professor who has led several studies on safe communities. The greatest risk to children, he notes, is car crashes, which are more likely to occur in the suburbs, where children spend more time in cars or playing next to busy roads. The ratio of traffic fatalities versus homicides by strangers is 13-1, he says.

All of Lucy's studies on this subject indicate that lower-density areas are the most dangerous, while the safest communities, for the most part, are high-density cities. Not only do low-density communities have more traffic fatalities, they also are the most dangerous places for stranger homicides.

Mass school shootings most often occur in the suburbs, where the student population is less diverse, making it harder for some to fit in. Unfortunately, he notes, car crashes and schoolyard bullies, both of which usually involve older children, are not things parents often think of when they are first looking for a safe place to raise their young families.

Source: National Post

Bookmark and Share

October 12, 2010

Florida child safety advocates ponder vehicle alarm law after death of infant in daycare van

Some child safety advocates in Florida are calling for special vehicle alarms following the death of a 2-year-old strapped and forgotten in her car seat for nearly 6 hours in the back of a Delray Beach daycare center van.

A few other states already have laws mandating that all vehicles from childcare providers that transport six or seven (depending on the state) or more passengers have a child safety alarm system that prompts the driver to inspect all seats before leaving. Mary Sachs, a state representative, said she will sponsor a bill next spring requiring the alarms in Florida.

The alarms work as follows: After the driver turns off the vehicle, an alarm goes off and continues to sound for one to four minutes, which forces the driver to walk to the back of the van to turn it off. If the driver ignores the alarm, an external car alarm sounds, thereby alerting others that the vehicle hasn’t been checked.

While no one keeps specific data on how many children die from being left in childcare center vehicles, dozens of children die after being left in cars every year. According to Jan Null, an adjunct professor of meterology at the University of San Francisco and author of “Hypothermia death of children in vehicles,” 49 children have died forgotten in cars so far this year.

The driver of the van was charged with negligent manslaughter and the owners of the day care lost their license after losing more than $200,000 in state funds following the incident.

Source: The Palm Beach Post

You'll find more information about deaths of children in vehicles from hypothermia here.

Bookmark and Share

September 2, 2010

Study examines benefits of school bus seat belts for kids

A soon-to-be-completed University of Alabama study of seat belts in school buses notes an increase in positive public perception concerning their installation and use, and growing acceptance among the students using them.

The study, which was commissioned by the state government after a school bus accident in Huntsville, Ala. killed four students and injured 30, assessed the impact of installing lap-shoulder seat belts on Alabama school buses. It includes a review of national experiences and trends, alterations needed in the buses if seat belt use is adopted, analysis of school bus crash data in the state, and a cost-benefit analysis. Detailed results will not be released until the study is completed later this year.

Federal law requires seat belts on small school buses (weighing less than 10,000 lbs.). However, larger buses, which make up about 80% of the nation’s school bus fleet, are governed by state, not federal, guidelines, and only a handful of states – California, Florida, Louisiana, New Jersey, New York and Texas – require seat belts in school buses. According to the National Highway Traffic Safety Association, an average of 19 school-age children die in crashes involving school buses each year.

The school buses used in the study were outfitted with four ceiling-mounted video cameras allowing the research team to gather data on the level of restraint use, review the percentage of students using the belts and the percentage of students using the belts properly, and investigate if using the belts keeps students from moving into the aisle and out of the protective compartment provided by the seats. The camera data will also reveal the benefit of having a bus aide to monitor students and will monitor time devoted to buckling at each stop.

The study is the first to assess the benefits of installing seat belts in school buses, and officials from the National Transportation Safety Board, the National Highway Safety Administration and other national agencies are awaiting final results to determine whether or not the adoption of seat belts in school buses should be instituted across the U.S.

Source: Some of the information in this post came from here.

You’ll find more information about the University of Alabama schoolbus seat-belt study here.

Bookmark and Share

July 29, 2009

Heavy Backpacks Cause Lower Back Pains for Children

Consumer Reports recently conducted a survey in rating the most durable backpacks, and found in the survey that an average 6th grader carries a backpack weighing 18.4 pounds, but some are as heavy as 30 pounds, according to Tara Parker-Pope of the New York Times.

A medical adviser to Consumer Reports and also a board-certified neurologist, Dr. Orly Avitzur says that carrying a heavy backpack can cause low-back pain in children, and carrying the backpack on one shoulder instead of two exacerbates the problem.

Parents can consult some suggestions provided by the American Academy of Pediatrics about how to choose the best-fitting backpack and how to prevent injuries. Consumer Reports has also published its full report and buying guide.

Some of the American Academy of Pediatrics' guidelines include the following:

- Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. Wearing a backpack on one shoulder may increase curvature of the spine.

- Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the waist.

- Pack light. The backpack should never weigh more than 10 to 20 percent of the student's total body weight.

- Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back.

- Stop often at school lockers, if possible. Do not carry all of the books needed for the day.

- Bend using both knees, when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.

- Learn back-strengthening exercises to build up the muscles used to carry a backpack.

- Ask your pediatrician for advice.

Bookmark and Share

December 19, 2008

Parents Fight to Help Diabetic Children Manage The Disease In Schools

Before Kari Christiansen retained a lawyer and threatened to sue the primary school her diabetic son attends, Carter Christiansen, a second-grader, could not bring his medical supplies to school and once fell unconscious in the school hallway. In another school district, 17-year-old Jennifer Schwartz had her insulin pump snatched away – when the needle and tubing were still inserted in her body – by an unwitting teacher who thought the beeping device was a cell phone.

In a Chicago Tribune article, Carolyn Starks reports the difficulties that many diabetic schoolchildren face in managing their disease in schools. Parents are fighting for accommodations and policy changes to help young children with diabetes, which affects one in every 500 people under age 20, according to the article.

In many school districts, glucometers and other supplies that diabetic children need to use several times throughout the day are banned from school zones, or, in cases where they are allowed in schools, have to be locked away in nurses' cabinets. The needles in these devices, which are the smallest needles in the world – are thought to be dangerous.

To help diabetic students manage the disease at school, physicians and lawyers have joined force with parents to make these children’s need known. Dr. Patrick Zeller, endocrinologist, and Ed Kraus, associate professor at Chicago-Kent School of Law, are among such advocates for diabetic children.

Parents should feel comfortable about communicating to teachers and other school workers about their children’s needs. Dr. Zeller said that schools “want to do a good job” and that they are willing to help the students when they are educated about the disease. Jean Sophie, the new superintendent in Carter Christiansen’s school district, was eager to accommodate the Christiansens’ requests because she personally knows children who are diabetic. Teachers will likely be willing to make special arrangements, if notified by parents of diabetic students, such as allowing the kids to bring snacks into classroom in case of low blood sugar.

Bookmark and Share

September 24, 2008

Cheerleader Injuries: The Darker Side of an All-American Sport

A leading sports injury expert says that cheerleading has become one of the riskiest sports for women. Lifelong pain and disability, paralysis and even death are becoming more common consequences of participation in cheerleading.

The expert, Frederick Mueller, points out that most people still think of cheerleaders as mere pompom-waving eye candy and do not realize that cheerleading can involve dangerous gymnastic exercises. Because of this, schools often will not label cheerleading as a sport and choose to class it with non-athletic activities like working on the newspaper or acting in a play. This labeling contributes to the dangers of cheerleading:

The main problem, critics say, is that cheerleading in most states is not considered a sport; it's an "activity" such as chess club and debating. As a result, it is not required to follow uniform safety regulations, such as mandating off-seasons, routine physicals and soft surfaces that would minimize injuries. Coaches are not required to undergo standardized training.

There are obvious ways to minimize this risk. The coaches and administrators of cheerleading organizations quoted in the article point out that approaching cheerleading with the same care schools use in recruiting and training coaches for sports like basketball and football would make the sport much safe. For instance:

Several organizations also offer training programs for coaches, including how to minimize risks, teach stunts properly and respond to medical emergencies.

Among those organizations are the American Association of Cheerleading Coaches and Administrators and the National Federation of State High School Associations.

If your child is or wants to get involved in cheerleading, it is a good idea to talk to the coach first and see what kind of training he or she has had. It would also be wise to ask about safety measures the coach plans to implement to protect the cheerleaders.

Bookmark and Share

July 19, 2008

Bullies and Bullied Both At Risk of Suicide

Tara Parker-Pope discusses a new Yale School of Medicine review of research on bullying from 13 different countries, published in the International Journal of Adolescent Medicine and Health.

The review came up with a new finding: there is a link between being a bully and being suicidal. It was previously known that the victims of bullies had a higher risk of suicide than others, but now it seems that the tormentors are also at risk.

From the article:

Compared to other kids, a child who bullies may be at two to nine times higher risk for suicide, according to the study. Girl bullies appear to be at highest risk. Some researchers have also found a “dose-response” relationship, showing that those who bully more frequently are at highest risk for suicide.

While the studies showed an association with bullying and suicide, it wasn’t clear whether the behavior actually increases risk for suicide or whether kids already at risk for suicide are more likely to become bullies or their victims. The researchers noted that most of the studies failed to take into account the influence of factors like gender, psychiatric problems and a history of suicide attempts.

Please read the full article and the comments section, which is full of people who have been bullied discussing how they were brushed off by parents and teachers and other authority figures as over-sensitive or cowardly. Many of the comments are interesting and insightful in their analysis of what bullying does to children's mental health.

Bookmark and Share