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No one knows the commitment and responsibility it takes to care for your child more than you do. Yet, so many parents of injured children who come to our Emergency Department respond in the face of tragedy, "Oh, I should have paid more attention," or "If only…," "Why did this happen to me?" Injury is the leading cause of death in school-aged children, more than all diseases combined, and is a significant cause of disability. Injuries are predictable and preventable, not random or "freak accidents."
Your five- to eight-year-old child is learning to do many things that can potentially cause serious injury, such as riding bicycles, skateboards, or scooters; crossing the street; playing with fire, electricity, or firearms; participating in sports; or taking unreasonable chances or risks. Your child is becoming more independent and attempting to prove that he or she is grown up. Their judgment of sound, distance, or speed with regard to an approaching car, for example, is not reliable and therefore may place them in dangerous situations. Similarly, children in this age range cannot fully understand causal relationships. For example, they might try to jump down an entire flight of stairs, seeing the jump only as a faster and more daring way to get from one place to another. It is essential that you put yourself in charge of your child's safety. A child's ability to formulate moral judgments and to follow rules develops gradually over time. School-aged children frequently view rules as "good" or "bad" solely on the basis of physical consequences. For instance, if a child helps develop the rule of no playing ball in street because he or she might get hit by a car, the child is more likely to abide by it. That is a "good" rule.
Scope of Problem
From a public health perspective, school-aged children, between five and eight years, are at significant risk for injury. The single largest cause of traumatic death in childhood is motor-vehicle-related accidents. Motor vehicle fatalities occur in three main categories:
- Motor vehicle/occupant
- Motor vehicle/bicycle
- Motor vehicle/pedestrian
It is felt that 90 percent of these fatalities could be prevented with the appropriate use of safety belts and restraints and close supervision. Motor vehicle/bicycle injuries represent one of the most common causes of injury severe enough to require treatment in an emergency department. Fatal bicycle crashes are typically due to severe head injury and/or multi-system trauma. Although bicycle helmets have significantly decreased the number of head injuries, noncompliance with bicycle helmet regulations and inefficient enforcement have precluded the number of injuries from dropping further.
Motor vehicle/pedestrian injuries reach a peak incidence among five- to eight-year-olds and cause death two-and-one-half times more frequently than motor vehicle/occupant deaths. Approximately one-half of pedestrian injuries occur at night and/or are related to children playing in inappropriate, hazardous areas such as streets, parking lots, or driveways.
Falls
Each year, falls and heavy objects falling on children cause a substantial number of injuries, disability, or death. Falls typically occur from windows or upper-level apartment balconies. Children between five and eight years represent the most highly impacted group. The problem, in many cases, is related to inadequate supervision, windows without screens or locks, and nearby furniture that provides an enticing playground for children to jump around on. In addition, every year our emergency department sees a large number of injuries related to unsecured heavy objects, such as falling televisions, cabinets, entertainment centers, air conditioners, microwave ovens, etc.
Drowning
Death due to drowning ranks second only to motor vehicle trauma in this age group. Near-drowning or deaths from water-related accidents occur in bathtubs, Jacuzzis, pools, rivers, lakes, and oceans. Many of these injuries or deaths occur because of inadequate swimming instruction, inadequate use of personal flotation devices, or gaps in supervision. It is not an infrequent occurrence to hear a parent say, "I only left for a minute," "I just left to get a towel," or "I wasn't on the phone for more than a few minutes."
Firearms
Firearm injuries tragically affect a substantial number of children each year. A gun bought for "protection" is more likely to kill or injure a family member, often an innocent child. Each year my colleagues and I face the unfortunate task of informing a parent that their child just died of a gunshot injury. Children in this age range are curious and inquisitive and an accessible gun stored inappropriately in an open cabinet, on a table, unlocked and loaded, is clearly asking for heartache. As a parent, your best protection is to avoid purchasing a gun. If you feel a gun is essential, speaking to your child about the dangers of guns, or taking the necessary precautions, is the next best safety measure.
Safe Environment
Your child is passing through the stage referred to as the "window of vulnerability" or more simply, "injury prone." Your child may not understand that certain activities necessitate following certain rules of safety. Some of these rules include playing in a well lit, age-appropriate setting. Along with an age-appropriate setting, toys, games, and athletic activities should also be geared toward the age of the child. Using sports equipment for unintended use will invariably cause injury and harm.
Swimming pools should be well maintained, free of debris, and gated to regional specifications. Designated play areas should be well groomed and free of soil, gravel, rocks, or glass. By performing dangerous tasks on a jungle gym in order to engage competition among his or her peer group, your child changes a normally safe environment into a dangerous one by not following the safety rules. Peer pressure and noncompliance of rules will undoubtedly cause problems. However, you must develop and enforce rules of safety in order to protect your son or daughter. Be strong, consistent, and expect resistance.
Supervision
As an emergency physician working in a large, urban children's hospital, I see many injuries as a result of improper or inadequate supervision. I've seen injuries as a result of kids riding on bicycles at night, falling from windows or balconies, or playing in the street. I also see playground accidents, fireworks injuries, near drownings, traffic accidents, and a variety of household injuries, ranging from ingestions to scald burns. Most of these injuries could have been prevented had there been sufficient and immediate supervision. Children in the five-to-eight range do not have the knowledge, maturity, and foresight to understand the consequences of their actions. It is up to parents to develop rules, instruct your child, be a role model, and set the necessary boundaries in order to ensure your child's safety.
Education
Use the following guidelines to help keep injuries to a minimum:
Athletic activities
- Wear age-appropriate protective gear (helmet, wrist guards, elbow and knee pads, etc.).
- Be sure all gear fits the child and is properly secured.
- Take lessons, especially for new activities.
- Follow the "rules of the game" and designated safety guidelines.
Falls, crashes, and violent impacts
- Maintain all window locks.
- Keep all furniture away from open windows and off balconies.
- Wear appropriately secured car-safety belts at all times.
- Avoid play in areas designated for motor vehicles.
- Secure heavy items such as televisions and microwave ovens to avoid crush injuries.
Household dangers
- Keep all medicines locked, out of the reach of children and in childproof containers.
- Maintain a safe distance between all stovetops and hot items.
- Cover and protect all electrical cords and outlets.
- Keep all firearms unloaded and locked or remove them from the home.
- Put all lighters and matches in a safe, unreachable location.
Despite all precautions, accidents may happen. In the face of significant injury, stay calm and call 911. If it is needed and you know how, start cardiopulmonary resuscitation (CPR). In addition, the American Academy of Pediatrics has published the following guidelines that should help you determine if your child needs emergency medical care. The warning signs include:
- Any significant alteration in behavior
- Persistent breathing problems
- Bleeding that does not stop
- Skin or lips that look blue or purple
- Rhythmical jerking (seizure)
- Unconsciousness or change in responsiveness
- Very loose or knocked out teeth
- A cut or burn that is large or deep
- Headache or vomiting after a head injury
- Major injury to a body part
As a parent, the best way to keep your child safe is to provide examples thorough explanations and age-appropriate rules. In addition, children will become less prone to injury if you take an active role in injury prevention strategies. Educate family, friends, and neighbors. You can take an active stance by involving yourself in safety organizations such as the PTA, hospitals, and health departments. Write legislative officials and provide your opinion to neighborhood newspapers, watch programs, radio stations, and police departments.
Summary
You, as a parent, are your child's best advocate. Provide and implement the necessary safety precautions to avoid needless injuries. Always supervise your son or daughter and follow established safety guidelines. Be a role model for your child and maintain a safe environment. This will assuredly decrease the number of children with significant injuries.
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