Hair loss Treatment Center

• Suffocation
• Drowning
• Choking
• Falls

PARTICIPANTS Sajjad Yacoob, MD Children's Hospital of Los Angeles

SAJJAD YACOOB MD: That's true. A lot of parents tend to think, first of all, that their child probably can't do some of the things that they normally can do. They think that they'll never be able to reach that bottle or crawl over there that quickly when, in fact, a lot of their motor skills are developing rapidly and more quickly than they may realize.

The overestimation tends to happen when they think that if I tell my child enough, if I tell him this not to do it, he'll stop doing it. Kids' cognitive skills, their ability to understand, is really limited and immature at this stage. And more importantly, their ability and drive to do things, their innate ability and drive to explore, is very much in control. So talking to them as much as they want, they still probably will not be able to prevent a lot of things they could just by sheer planning

BONNIE BOSEWELL: So parent really has to assume total responsibility. I mean, they—you can't, like you said, plug into their cognitive level because it's just not really fully developed. And they're moving quicker than you think.

SAJJAD YACOOB MD: Exactly. And they move quicker and they think less than we think they actually are doing.

BONNIE BOSEWELL: Let's talk about parents' role in terms of household items that are used every day, and how safe those are, and what parents should do to make sure that they're using them safely.

SAJJAD YACOOB MD: Well certainly one of the things that is by statistics one of the number one injury-related death causing things is choking, suffocation. Suffocation tends to happen in a couple of ways. First, when kids are first born, they don't have the motor skills to be able to move their head very quickly and to move it off of things. So when you put your child to sleep, one of the first things to think about, putting a child to sleep is a very sort of innocuous event. In fact, it can be very important.

So what the American Academy of Pediatrics recommends, and what we recommend our parents to do is put your child on their back. Put them back to sleep. That helps prevent two things. One is the incidence of sudden infant death syndrome, or SIDS. And secondly, as I mentioned, they aren't necessarily able to move their head very quickly. If you put them face down on a soft surface like a water bed or a sheepskin mattress, they may not be able to move their head and they can actually suffocate by having just their mouth and nose covered by that soft, lumpy surface.

BONNIE BOSEWELL: And they can also wedge themselves in somehow between the mattress and the crib. They're very mobile in ways that you may not suspect.

SAJJAD YACOOB MD: Exactly. Even when they're first born they can sort of push against with their feet and arms. But as they get older, going into three, four, five, six months of age, they definitely start to move and roll over even within the crib or the bed. And the important thing there is that when you are in a crib, you want to make sure that, A, not only is the mattress very firm, but the mattress fits very snugly within the crib. Because as you mentioned, one of the leading causes of suffocation is the fact that a child will wedge themselves between, let's say, a mattress and the crib.

Or unfortunately, if they're not in a crib, which is the safest place to be, on a bed they can wedge themselves between, say, a mattress and a backboard or a side table.

BONNIE BOSEWELL: So then what does a parent do specifically?

SAJJAD YACOOB MD: The best thing to do is first to always make sure your child is laid back to sleep on their back in a crib with the side rails up. A crib that has a firm mattress and doesn't have any lumpy pillows or lumpy comforters or anything else that can be very form fitting for the child.

BONNIE BOSEWELL: But to prevent that wedging effect, would that take care of that?

SAJJAD YACOOB MD: Being in a crib with a very snug fitting mattress. And the way to check for that is if you can put two fingers breadth between the mattress and the crib itself, it's already too loose. You check those things, and a child sleeping with the side rails up in the crib, they should be very safe.

BONNIE BOSEWELL: Okay. Well let's talk about where children sleep because that is an important issue. And sleeping in the bed is something that is done from time to time. What about that?

SAJJAD YACOOB MD: Well it's interesting because a lot of cultures outside of our country actually have family beds where kids sleep with parents and other siblings. If you look at the recent literature and look at some of the statistics, unfortunately there are children, usually less than three months of age, who suffer suffocation injury because one parent or caregiver who is asleep, it's usually an adult in the bed with a child, accidentally rolls over on them and doesn't realize it. While the numbers may be small, again, if it happens to your child, that's 100%.

So the recommendation that I usually give my parents is that if at all possible, like I said, keep them in a crib. But more importantly, try not to share a bed with them, especially when they're that age. Because there is that very real possibility of having a suffocation due to rolling over on them.

BONNIE BOSEWELL: That crib can be in the room. Because one of the issues that parents have is that—you know, these are new parents oftentimes—they don't want to get up. I mean the waking and sleeping at night is a real problem. So one of the solutions I've used anyway is having access to the child. What do you think of that?

SAJJAD YACOOB MD: That's perfectly reasonable and fine. In fact, you know, I know with my children I did the same thing. I kept the crib right in the room with us. There's nothing wrong with that; that's fine. The important thing is, again, the use of the crib. That is the safest place to put the child on their back to sleep.

BONNIE BOSEWELL: Okay. Let's turn to another topic. You mentioned before choking. This is an oral phase; they're picking up stuff; they're exploring. What can parents do to make sure that children don't choke?

SAJJAD YACOOB MD: First and foremost, recognize, as you just said, children go through what's called this oral phase. One of the ways that they interact and explore their environment as they get older, say between three and seven months of age, they will start to pick things in their hand and start to put it in their mouth. Now certainly there are some things that we want them to play with; but there are certainly other things we don't want them to put in their mouth because they can actually swallow it and choke on it.

A simple couple rules of thumb are this. One, if there is an object that you can take that can fit through the cardboard toilet paper roll, if it can fit through that, it can go on down into your child and actually be swallowed or choked.

BONNIE BOSEWELL: What about jewelry. Sometimes that becomes a problem, too. So you should avoid that I would suspect.

SAJJAD YACOOB MD: Definitely. One of the things, again, as parents we want to make our child look good. And having jewelry on them makes them look nice, but it is a hazard. The jewelry, even for a child that can't necessarily reach up and grab things yet, if that jewelry falls off, becomes ensnared in a blanket, that can cause injury. And again, even those children that aren't necessarily reaching and grabbing, they will at some point put their hand in their mouth. And if there's something caught in their hand, they can swallow it as well.

BONNIE BOSEWELL: Well let's talk about drowning, because this is also an issue that occurs, too.

SAJJAD YACOOB MD: Yes. In this age group, when we talk about drowning, most parents think, "Well my child, I don't go near the pool. That's not going to be a problem." In fact, more than half the drowning deaths in this age group are actually in bathtubs. One of the important things that parents need to remember is that it only takes about an inch to a couple of inches of water, basically enough to cover the mouth and nose, to cause a child to drown. So therefore, in the bathtub, places where there's standing water, like toilet bowls or buckets of water that are just standing around, a child could theoretically drown in that.

BONNIE BOSEWELL: What about burns? How do we avoid burns for children that age?

SAJJAD YACOOB MD: Again, there's a couple of ways to do that and it's very important. First and foremost, when we are holding children this age we tend to think, "Well I have good control of them." But again, we mentioned at the very beginning, children are developing very rapidly. They'll start to move around and reach and kick before they even realize it. So never, ever carry a hot object, like a coffee mug or something like hot tea, anything in your hands and the child at the same time.

BONNIE BOSEWELL: What about fire prevention?

SAJJAD YACOOB MD: Fire prevention, the important thing to remember is that when you are at home with a child, always make sure that you have smoke detectors in the home. And as we talked about where a child sleeps, if a child let's say is not sleeping in your room but another room, make sure that there's a smoke detector in the room where the child room. And if you have two floors in the house, make sure there's at least one on the first floor and one on the second floor.

BONNIE BOSEWELL: Well children this age are beginning to walk around. What are some of the problems that you've come across when people begin to use walkers. I know that has been a leading cause of some of the injuries in the past.

SAJJAD YACOOB MD: Right. Walkers, I think, from a parents' perspective, they like to think that they're good because there's a myth that goes around that says walkers will help my child walk faster. Actually that's not true. It actually develops the wrong muscles for walking. But more importantly, parents like it for the most part because it serves as a good baby-sitter.

But the problem is children who, let's say, are not necessarily very mobile at that age, suddenly in a walker, turn into this speed demon and can move very quickly out of a parent's sight. More importantly, they can now get into places they may not be able to. So they will be standing in this walker and pull things on themselves. And because walkers are on wheels, they can go down stairwells, they can tip over. And because they are exposed from basically their chest up, they will suffer injuries to the head and extremities.

BONNIE BOSEWELL: So what's an alternative for parents who want to have some kind of way to contain their children?

SAJJAD YACOOB MD: Right. And baby-sitting is very important because you want to keep an eye on them. There's actually something called a saucer, which is basically like a walker in that your child fits into it; however it has no wheels. So a child can go anywhere. And it's shaped such that it won't tip over. So now you have a child who can sit in this, be observed from a distance and still feel safe because now they're not able to move away very quickly.

BONNIE BOSEWELL: Let's talk about something else that comes up when we handle young children. Is there a proper way to do that that maybe some parents don't know?

SAJJAD YACOOB MD: When children are first born, and specifically up until even three or four months of age, as we mentioned, they're still very immature in a lot of what they can do with their muscles. One of the most important immaturities is the fact that they can't hold their head up very well. And we talked about when they're put down on surfaces in which they could possibly suffocate. Well by the same token, they can't hold their head very well, so you need to support their neck. So that's one thing that parents should always remember. Until the child can actually demonstrate that they can hold their head by themselves, always pick up your child by holding their neck and the rest of their body at the same time.

The second thing is we tend to sometimes bring up or pull up our children by their hands. That also can cause injuries to the shoulder and the muscles and nerves in that area. Always if you're going to pick up a child, pick them up by grasping underneath their armpits; pick them up that way.

One other thing that's very important. We all love to have our child in our hand and sometimes sort of throwing them in the air and hear them giggle and squeal with delight. In fact, even though it seems like a safe activity, there can be problems that can lead to injuries to the eyes as well as the brain. So be very careful. Don't throw your child up into the air. Don't toss them around. Don't even shake them, even in a playful mood, because that can result in some injury.

BONNIE BOSEWELL: Thank you so much for being with us. We appreciate your comments.

SAJJAD YACOOB MD: No problem. Thank you very much.