Hair loss Treatment Center

The Preteen Years
During the preteen years (8 to 12), children become more independent and they start to wander away from their homes to explore their neighborhoods. Children become more adventurous and the number of recreational-type injuries increases during this time. The motor skills in this age group can vary widely and may range from a child who is still learning to ride a two-wheel bicycle to a child who has mastered not only bicycle riding, but who is also adept at using rollerblades, scooters, and/or skateboards.

Parents are often intrigued with their child's development and wonder how well they are maturing during their pre-adolescent years. During this period, parents encourage their child to acquire new motor skills and often compliment them for their physical abilities. Parents may allow adventurous behavior, not fully realizing the potential for serious injury. Parents may also have a false sense of security regarding their child's safety in the home, school, or with recreational activities. On the other end of the spectrum, parents can be overly protective and may restrict their child's activities. After interviewing a mother with two boys in this age group, her solution to injury prevention was to lock her two boys in a padded room. However tempting it is to overprotect our children, it is unrealistic to think we can be at our children's side at all times. Therefore, we need to think of different ways to keep them safe.

Some parents often neglect to go over safety rules with their children, thinking that their child will logically think things through and know the consequences of not following the rules. However, nothing can be further from the truth; children in this age group can often reiterate the safety rules, but they may truly not know how to follow those rules. It is the parent's responsibility to help their children understand how to best prevent injuries and secure their child's safety in the home, school, and recreational activities.

Childhood Injuries in the United States
Injuries are the leading cause of death and disability among children and young adults. Injuries constitute one of the most expensive health problems in the United States. According to a Center for Disease Control nationwide study, injuries account for 16 million Emergency Department visits and result in the hospitalization of 600,000 children annually. The total cost of the injuries is enormous. The cost of a family's or an individual's pain and suffering, however, cannot be measured.

Basic Principles of Injury Prevention
An injury can be defined as an acute exposure to physical agents resulting in the transfer of energy to the human body at levels that exceed the tolerance of human tissue and/or internal organs (e.g., liver, spleen, heart, lungs, brain, etc.)

The types of energy that can damage human tissue may be mechanical energy, heat, electricity, and chemicals. In addition, some injuries result from a sudden lack of essential agents such as oxygen or heat. Generally, about 75 percent of all injuries are caused by mechanical-type energy. Injuries can be subdivided into unintentional and intentional injuries, such as homicide, suicide, abuse, or violence.

Parents may have a perception that the prevention of injuries is beyond an individual's control and there is a common belief that injuries are an inevitable part of childhood. Often, unintentional injuries are referred to as "accidents." However, the word accident implies that the injury is unpredictable or unavoidable. In most cases, injuries result from an interaction of controllable variables, such as inappropriate supervision or failure to use safety equipment (e.g., automobile restraints). Injuries are not accidents. Instead, most injuries can be avoided if proper care is taken to prevent them.

Injury Prevention Strategies
There are many ways to understand and prevent injuries. Research has shown that many serious childhood injuries can be avoided by being aware of commonly occurring injuries to a specific age group and by knowing the risk factors contributing to the injuries. In addition, passing laws that help with the enforcement of safety rules can also impact prevention significantly. And, according to the Academy of Pediatrics, providing automatic protection, such as safer roads or air bags, can eliminate a substantial risk for injury.

Haddon Matrix
The modern science of injury prevention was established in the 1940s and injuries became viewed as a public health problem largely by the efforts of Dr. William Haddon, Jr., a clinician and epidemiologist. Dr. Haddon emphasized that injuries are not the result of a single cause, but instead result from a chain of circumstances and, therefore, present with multiple opportunities to establish prevention countermeasures. Dr. Haddon shifted the injury prevention focus away from changing the behavior of the individual to examining the importance of the object (e.g., trampoline) or vehicle (e.g., bicycle) causing the injury and the physical and social environment surrounding the injury. Dr. Haddon developed a matrix that examines the host, agent, and environmental circumstances before, during, and after the injury.

Let's take, for example, rollerscooter injuries and apply Haddon's matrix for prevention. Rollerscooter injuries are very common in school-age children and constitute an increasing number of emergency department visits each day. The "host" is the child who is inquisitive, somewhat daring, and wanting the thrill of rolling down a hill on a scooter. The "agent" is the scooter, which by design, makes it easy to tip over or lose control. The "environment" is the hill that may present with various bumps and holes in the path of the scooter.

Interventions before the injury for the:

Host: Make sure the child knows how to balance himself on a scooter.
Agent: Make sure the scooter is well built and the brakes work.
Environment: Clear the path of any branches or debris that may cause the scooter to tip over.

Interventions during the injury for the:

Host: Make sure the child wears a helmet and protective padding.
Agent: Make sure the child applies the brake periodically and does not speed out of control.
Environment: Make sure the child is supervised or has a "buddy" with him during the activity.

Interventions after the injury for the:

Host: Administer first aid, or cardiopulmonary resuscitation (CPR) if needed.
Agent: Dispose of the scooter.
Environment: Ensure access to a certified trauma hospital or medical specialist to treat the injury. In addition, be aware of rehabilitation services needed to treat serious injuries.

Most Common Injuries
Primary topics on injury prevention to address in the preteen years include pedestrian safety, bicycle safety, swimming safety, and seat-belt use. Additional topics to address include, fire safety, and firearms.

Motor Vehicle Occupant Injuries
All states have child restraint laws, although some are stricter than others. Overall, these laws have been shown to be effective in reducing injury and death, especially in infants. However, there are still problems in getting parents to properly restrain their children. Statistics show that among children involved in serious crashes, only half are restrained.

A major problem insuring passenger safety in this age group is the children may use a safety belt, but they do not properly sit in their seats to get the maximal protection needed. Children tend to be independent and mobile during this age and have a hard time sitting still in the car. SafetyBeltSafeU.S.A., one of the leading nonprofit safety organizations in the United States, provides technical information on all child-passenger safety and advocates that parents apply the five-step test to determine if a child is ready to graduate from a booster seat to using a safety belt:

• The child needs to be able to sit with his back against the seat.
• The knees should bend over the seat cushion.
• The lap belt should rest on the top of the thighs and below the belly.
• The shoulder belt should be centered across the shoulders.
• The child should be able to maintain a sitting position throughout the entire trip.

Proper seat belt use
One of the problems with older children is that they have outgrown their booster seats and they are not well protected compared to adults. A high priority in motor vehicle safety is to provide upper torso protection as well as lower torso protection. Lap and shoulder belts should be used in all cases. Use of a lap belt alone creates a greater likelihood of head injury, abdominal injuries, as well as spinal cord injuries. In the event of a crash, the upper torso is propelled forward as the pelvis is held tight against the seat, resulting in a traction dislocation injury to the lumbar vertebrae. These types of injuries are very serious and in many instances, result in a spinal cord injury and paraplegia.

Air bags
There are potential dangers for children riding in the front seat, especially if the car is equipped with an air bag. Many children riding in the front seat fail to sit properly with their backs against the seat. They will do such things as lean forward to play with the radio or put their feet on the dashboard. A child may suffer trauma to his face or head if he is too close to the dashboard when the air bag is deployed. Most safety experts advocate that children younger than 13 sit in the back seat with the proper safety restraints. If the child does ride in the front seat, then the seat should be pushed backward to the farthest point from the dashboard.

Bicycle-Related Injuries
There are approximately 90 million cyclists in the United States and nearly half of them are younger than age 15. Around 600 children die from bike-related injuries on our streets each year. And each year, more than 400,000 children and adolescents are treated in emergency departments because of bicycle-related injuries. Children ages 5 to 14 are at highest risk for sustaining bicycle-related injuries, accounting for more than half of all the bicycle-related trips to the emergency department. Children in the 9-to-12 age group are often involved in non-traffic-related injuries, resulting from a fall or collision with a fixed object. As children mature, they start to venture out into traffic, resulting in more crashes involving motor vehicles.

Helmet safety
A priority in making sure your children are safe on their bikes is to help your child develop good safety habits. Most important is to make sure your children understand the importance of wearing helmets and promote strict observance of the "rules of the road." Studies have shown that bicycle helmets are extremely effective in reducing bicycle-related head trauma and brain injury. Parents should therefore insist that their children wear bicycle helmets routinely. They should select a helmet that is labeled as meeting the safety standards published by the American National Standards Institute or the Snell Memorial Foundation. Helmets are usually supplied with fitted pads of different thickness that can be changed to accommodate a growing child's head and secures the helmet snugly against the head.

Parents should make sure they and their children understand the rules of the road. Bicyclists should follow the same traffic rules that apply to automobiles. The American Academy of Pediatrics advocates that children riding their bikes on the street follow four important road rules:

• Ride with traffic. Children should ride with traffic—not against traffic. Bicyclists traveling on the left side of the road often confuse oncoming traffic, especially as they are crossing an intersection or have to veer out onto the road to avoid obstacles.
• Stop and look both ways before entering the street. Teach your children not to dart out into the street from a driveway or between parked cars. The same rules for entering the street on foot apply to bicycle riding.
• Stop at all intersections. Young children are less visible to drivers and are not good at judging the speed of an oncoming car. Often, adults set bad examples for their kids by speeding through an intersection without stopping at stop signs or red lights. It is a good safety measure to instruct your child riding a bike to stop at all intersections and check for crossing traffic.
• Use hand signals when turning. The objective of using hand signals is to alert the motorists of your intention to turn. When signaling a left turn, instruct the child to extend the left arm straight out to the side. For a right turn signal, the left arm bends at the elbow with two fingers pointing upward. Hand signals may be difficult to master for a beginning cyclist and children must be able to demonstrate proper signaling before they are allowed to ride their bike on the roadways.

Pedestrian Injuries
These types of injuries, which haven't received adequate attention, represent a significant problem for school-age children. Close to 2,000 children and adolescents are killed annually as a result of automobile/pedestrian injuries. Children up to age ten account for 42 percent of all motor-vehicle-related deaths. These types of deaths, however, occur throughout all age groups. The problem is especially high in urban areas and more than half of the cases are caused by "mid-block dart-outs." At my hospital, I have cared for many children who were hit by a car as they ran out to meet the ice cream truck. Many of these children suffer severe brain injuries, fractured bones, and blunt trauma to the chest and abdomen. Their recovery is long and many are left with both physical and cognitive disabilities. Strategies to prevent these injuries include educating your children to never dart out into the street. Teach your children to cross the street at the corner or marked crosswalks. Before crossing the street, the child needs to stop, look, and listen. Also, a parent can advocate that the city build safe streets with speed limits and speed bumps, or established paths where the pedestrians have the right-of-way.

Preventing Drowning
Drowning is second only to motor vehicle occupant injuries as a result of injury death in 0- to 14-year-olds. Males are almost five times as likely to drown as females. The highest rates of drowning occur in 0- to 5-year-olds. Fewer drownings occur in school-aged children and then the number rises again to the maximum at age 18. Residential swimming pools pose the greatest hazard for drowning. Other common cause of drowning is boat-related accidents. Older children tend to drown during recreational swimming, generally in lakes and rivers.

The American Academy of Pediatrics advocates that prevention efforts in the school-aged child should be focused on the child learning to swim and following appropriate safety rules. People of all ages should follow the rules about never swimming alone or always wearing personal flotation devices when boating. Parents should be aware of local conditions, such as high tide for ocean swimming, thinning ice for ice-skating, or risk of increased water levels in a particular river or creek that children may like to swim in. Again, safety measures should be reviewed with the child.

Epileptic children and swimming
School-aged children with epilepsy deserve special attention. Their risk of drowning is four to ten times that of children without epilepsy. These children are at risk for drowning in a bathtub as well. Children with epilepsy should be encouraged to shower instead of bathing if they prefer their privacy and don't want to be supervised.

Firearms and Violence
Firearm-related violence is a growing source of injury in the preteen age group. The rates of injury have increased dramatically in the teenage years. One must be aware, however, that younger children are also at risk.

You only have to look at the statistics on gun availability to understand why children in the United States are dying and being injured in unprecedented numbers. Gun ownership has proliferated in the United States over the past 30 years. Currently, there is an estimated 200 million civilians that own firearms in the U.S., and more than 60 million of those firearms are handguns. There are guns in at least half of all U.S. households. More than half of the guns are kept loaded, with many of them left unlocked and easily accessible to children. Researchers have documented an even more frightening statistic: Over the past ten years, an increasing number of children are carrying guns to school daily. A 1993 Harris poll of students in grades 6 through 12 showed that 59 percent of them felt they had easy access to a gun.

Firearm-related injuries have become identified as a public health problem. From a public health perspective, crime and violent injuries are recognized as important, but are not the central issues in preventing the problem of firearm-related injuries. The public health approach identifies the handgun and its ammunition as the primary instruments causing the injury. The American Academy of Pediatrics recommends the removal of the firearm from the home as a first priority in prevention. However, if a gun is in the home, we recommend that you separate the ammunition from the gun and keep them under lock and key.

A word of caution on "Firearm Safety" programs—in general, there is no evidence that they work, in part because most gun injuries are intentional. Such programs may make guns more attractive and give parents a false sense of security. There is no such thing as a "safe" gun. Many people have guns in their homes for personal protection and home security. A gun in the home, however, is most likely to injury a family member than an intruder or robber. Many prominent researchers studying firearm injuries have documented an increased risk of suicides, homicides, and unintentional firearm injuries in homes that have guns.

We advise that parents talk to their children about guns. Although you may not own a gun, it is likely that someone in your neighborhood does. You may start by teaching your child that firearms are not toys. The child should be taught that if a gun is found, you should assume it is loaded. Teach them not to touch a gun if found, instead they should get away from the gun and tell an adult.

Conclusion
Preventing childhood injuries requires an understanding of the types of injuries that occur in a specific age group and risk factors associated with the injury. Parents can take an active role by educating their children about the potential danger of injury involved in their day-to-day activities such as riding in a car, crossing the street, riding their bikes, or visiting a friend's house where there is either a swimming pool in the backyard or a gun in a drawer. A significant number of childhood injuries can be reduced if parents make it a priority to ensure that the environment their children play in is safe, they encourage the use of proper safety equipment, and follow simple safety rules.