Hair loss Treatment Center

• Poisoning
• Choking
• Falls
• Gun accidents

PARTICIPANTS Calvin G. Lowe, MD, FAAP Childrens Hospital Los Angeles

Joining me to discuss injury prevention for three to four year olds is Dr. Calvin Lowe.  He is an Emergency Department Attending Physician at Children's Hospital Los Angeles.  Thank you, Dr. Lowe, for being with us.

CALVIN G. LOWE, MD, FAAP:  My pleasure.

BONNIE BOSEWELL:  Let's talk about who these little people are.  They're not quite as oblivious as maybe a two year old, but they're not quite as savvy as a five year old.  Describe them for us.

CALVIN G. LOWE, MD, FAAP:  Well I have two children in this age range.  I know firsthand how energetic, how curious they are.  How they're able to ride tricycles, climb stairs, run up and down stairs.  And there are inherent dangers which parents may not know what kind of trouble they can get into.

BONNIE BOSEWELL:  Let's talk about some of those dangers.  What about poisoning.  I know that's come up as an issue sometimes.

CALVIN G. LOWE, MD, FAAP:  Yeah, one of the things is that the kitchen is the most dangerous part of the house because a lot of things are accessible.  The main thing you want to do is be sure to childproof your kitchen, meaning putting latches on the cabinet doors and drawers and so forth.  And try to keep things out of their reach.  Put things up above in the cabinets that are locked.  Using child restraint proof caps, although sometimes children are very curious.  They can still open them.  But the main thing is to just keep them out of their range.

BONNIE BOSEWELL:  Well sometimes children have to take medicine.  What should you do in that case?  Especially if you're dealing with a sitter or something?

CALVIN G. LOWE, MD, FAAP:  That's right.  Just make sure you read the label that your doctor has put, the actual directions, to make sure that you're giving them the correct dose.  A lot of times people have come into my emergency department where the baby-sitter or caretaker has given the wrong dose, either an overdose or an underdose, which could be equally as dangerous.

BONNIE BOSEWELL:  Scary, too.  And should there be an emergency number nearby, say either in the bathroom or in the kitchen?

CALVIN G. LOWE, MD, FAAP:  Absolutely.  Everyone should know 911.  But the other thing is also to have the poison control center at your availability because minutes do count.  So the faster you can get some type of medical attention or some type of consultation, the better.

BONNIE BOSEWELL:  We're talking about some ways that parents can prevent injuries and intervene right away in case of poisoning or something like that.  What about 911 and also the whole business of oxygen—you were talking about oxygen?

CALVIN G. LOWE, MD, FAAP:  Right, absolutely.  The thing is I would recommend every parent to learn CPR at your local Red Cross or American Heart Association.  Something very simple that you can learn.  Remember that interruption of oxygen to the brain, in as little as four to six minutes, which may not be very long if you think about it, but if you sit down and count four to six minutes, it's actually a long time.  And interruption of blood supply with oxygen to the brain for four to six minutes can lead to irreversible brain damage.

BONNIE BOSEWELL:  So learning CPR, dial 911, have poison control—all of these things at the ready.

CALVIN G. LOWE, MD, FAAP:  Absolutely.

BONNIE BOSEWELL:  Okay.  Let's talk about choking, because that's also a problem for this age group.

CALVIN G. LOWE, MD, FAAP:  Yeah, now at this age, children are playing with all different types of toys.  And they learn how to take apart small toys.  They easily grasp, they're very ambidextrous; they're able to use scissors and so forth.  One key, one rule that I use is to, if a toy can fit through the inside of a toilet paper role, it's too small for a child to handle because they like to get it in their hands, put it in their mouth and swallow it and possibly to choke.

BONNIE BOSEWELL:  That's a good guideline.  Because we know that there's problems but oftentimes we don't really have a measure.  So you are really using that toilet paper roll as a guideline is great.  What about balloons?  Because kids go to parties all the time; they're around balloons sometimes; there are broken balloons.

CALVIN G. LOWE, MD, FAAP:  Yeah, it's really hard to deter parents from bringing those nice big latex balloons.  Because what happens is when one pops, it pops in several small pieces.  And kids, again, grab it, put it in their mouths.  And they can inhale it into their windpipe.  I've seen in some of my emergency department cases, these are the worst, we call, aspiration or choking episodes because the balloon adheres to the inside of the windpipe so tightly it's really hard to get out.  And even with specialized instruments, again, you're talking about the four to six minute interval.  If you can't get that out then your child's in serious danger.

BONNIE BOSEWELL:  So we can say, don't you think, to avoid these kind of balloons at parties.  Don't you think that would be something that—

CALVIN G. LOWE, MD, FAAP:  --Yeah that would be something I would seriously think about.  You can buy the Mylar balloons, the big silver ones.  Because when they pop, they only pop into one piece.

BONNIE BOSEWELL:  Okay.  Well let's talk about falls because these kids are moving, they're out there.  Should they still be using the gates?  Sometimes they have them when they're younger.

CALVIN G. LOWE, MD, FAAP:  Yes, I believe so, because the running up and down the stairs, you want to inhibit their access to dangerous rooms, such as the kitchen and the bathtub.  So the main thing is at the top of the stairs, use a hardware gate where it's just screwed in.  It needs to be fastened by screws.  And if it's swung open, they can easily, they can't push it over.  There's also the pressure type gate, where if the kids are heavy enough, they can push it over.  And if they topple down the stairs, they can cause severe head injuries.

BONNIE BOSEWELL:  Let's talk about drowning, because sometimes that becomes a problem when you haven't even thought it would be a problem—just a small amount of water.

CALVIN G. LOWE, MD, FAAP:  Right.  It only takes about a couple of inches for kids to drown into.  I'm guilty of this too, where you put the kids into the bathtub, the water's running.  Then you have to get the phone call, goes off, the phone rings.  You go out and get the phone.  You come back and you forget about the child and then the water is rising.  So again, you really have to look after your children.

BONNIE BOSEWELL:  So to follow your own advice, it's hard to put it in place because, as you said, you know the rules.  But then things come up.

CALVIN G. LOWE, MD, FAAP:  Right.  It's easy to be distracted.  The other thing is just the bathroom itself has its inherent dangers.  The bathtub; the toilet.  You lift up the toilet seat, kids look in their.  Their heads are relatively larger than adults.  And what happens is they tip over, and then they go.

BONNIE BOSEWELL:  So that's really—that's definitely something—so you should just keep the toilet lid down?  Is that what you would recommend?

CALVIN G. LOWE, MD, FAAP:  Yeah, I would recommend if you still have—use a latch is fine.  If not—I have a niece who loves to open up the lid of the toilet.  And if you had those special safety latches where you can lock down the lid.

BONNIE BOSEWELL:  And what about slipping, because that's always a problem no matter what age you are.

CALVIN G. LOWE, MD, FAAP:  Right.  That's another thing, too.  You can put a little mat inside the bathtub or outside on the floor outside the bathtub so that as they get in and out they won't slip and hit their head.  The main thing is good parental supervision, holding them out and making sure they have a safe trip out.

BONNIE BOSEWELL:  Well a lot of injuries occur in the bathtub from scalding.  That's a big problem.  What would you suggest for parents in terms of really making sure that doesn't happen?

CALVIN G. LOWE, MD, FAAP:  Yeah, a lot of times in our emergency department we get kids coming in because of the scald burns.  What happens is the parents say, "I didn't check the temperature first."  So the main thing is, use common sense.  Check the water temperature before putting your child in.  And the other hint or rule you can also use is to have the child have his back to the faucet as you're turning on the—as the water is going in so they can't turn around and play with the knobs.  The other thing is the heater.  The factory settings are at 140 to 150 degrees.

BONNIE BOSEWELL:  They're hot.

CALVIN G. LOWE, MD, FAAP:  They're very hot.  It only takes a couple of seconds at 150 degrees to cause a third degree burn, which is a very severe.  If you can turn it down to 120 degrees, that lengthens the time to 30 seconds.

BONNIE BOSEWELL:  And if you're in earthquake country you have to secure that as well, right?

CALVIN G. LOWE, MD, FAAP:  Right, absolutely.

BONNIE BOSEWELL:  So also there's been a lot of attention in recent years about guns in the homes.  Can you speak about that?  Children at this age are a little bit more mobile now.

CALVIN G. LOWE, MD, FAAP:  Right.  If you don't need a gun in the house, I would recommend not having a gun.  But there are some people who need the guns, law enforcement and so forth.  So the main thing is to keep the gun in a locked container.  And if you have ammunition, of course, to have that in a separate site as well.  Kids are, what I've found in my emergency department experience, where kids have come in at this age not because of a shot by an intruder, they were shot by a friend or family member.  Or they were self-inflicted because they were looking at this gun, and curious, and pulled the trigger on themselves.

BONNIE BOSEWELL:  Well you're in that emergency room a lot.  And I know that this experience you're giving us comes from firsthand exposure.  So we really thank you for all of your comments here.

CALVIN G. LOWE, MD, FAAP:  My pleasure.  Thank you.