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With the warm weather upon us, it is no surprise that our children are spending more time outdoors—in the playground, on their bicycles, or in a car heading towards a fun destination. Unfortunately, the majority of childhood injuries occur during the months of May through August.

Playground Safety
Play is an essential aspect of childhood, and playgrounds provide the environment for children to develop motor, cognitive, and social skills.

The facts

• Annually, approximately 200,000 children are treated in U.S. hospital emergency rooms for playground equipment-related injuries.
• According to the U.S. Consumer Product Safety Commission, children younger than 14 years of age suffer a playground injury every two-and-one-half minutes.
• One-third of all playground injuries are severe.
• Falls account for 90 percent of the most severe playground equipment-related injuries.
• Playground injuries are the leading cause of injury to children in the day care setting, and to children ages 5 to 14 in the school environment.
• Lack of supervision is associated with 40 percent of playground injuries.
• In a 1998 survey, U.S. playgrounds received an overall grade of C- when rated on aspects such as physical hazards and behavioral elements, including supervision and age appropriate design.

Soft surfaces
For example, 60 percent of all injuries are caused by falls to the ground, making protective surfacing under and around all playground equipment the most critical safety factor. Asphalt and concrete are unacceptable. They do not have shock-absorbing properties. Certain loose-fill surfacing materials (e.g., double-shredded bark mulch, wood chips, fine sand, and fine gravel) are acceptable. Grass and turf should also not be used. Platforms more than 30 inches above the ground should have guardrails to prevent falls. Make certain your playground adheres to these standards.

An area free of equipment and obstacles is essential under and around playground equipment where children may fall. Remove all buckets, balls, etc. Additionally, to prevent injuries from the impact of moving swings, the swinging apparatus should not be too close together or too close to support structures. The appropriate horizontal distance between adjacent swing seats is at least 24 inches, and between swing seat and adjacent structural component is at least 30 inches.

Entrapment and entanglement
Other safety hazards are potential head entrapment and entanglement hazards. Openings within playground equipment should be less than three-and-one-half inches or greater than nine inches. Openings that are between three-and-one-half and nine inches are head entrapment hazards because they are large enough to permit a child's body to go through, but are too small for the head to pass. Although you may not have a ruler or tape measure available, the width of an average hand across the knuckles (fist) is approximately three to four inches. Open "S" hooks, especially on swings, may act as hooks or catch-points for children's clothing and can cause strangulation incidents. Close "S" hooks as tightly as possible and eliminate protrusions or catch-points on playground equipment.

A key component to preventing playground accidents is proper playground maintenance. Playgrounds should be inspected on a regular basis (at least annually). If any of the following conditions are noted, they should be removed or repaired immediately to prevent injuries:

• Hardware that is loose or worn, or that has protrusions or projections
• Scattered debris, litter, rocks, or tree roots
• Rust and chipped paint on metal components
• Splinters, large cracks, and decayed wood components
• Deterioration and corrosion on structural components which connect to the ground
• Missing or damaged equipment components, such as handholds, guardrails and swing sets

Car Safety
During the summer, more families are traveling by car to their vacation spot, weekend getaway or family and friends. Alarmingly, motor vehicle crashes remain the leading cause of unintentional injury-related death among children.

The facts

• In 1998, more than 274,000 children ages 14 and younger were injured as occupants in motor vehicle related crashes according to the National Safe Kids Campaign. Children ages four and younger accounted for nearly 30 percent of these injuries.
• Seventy-five percent of motor vehicle crashes occur within 25 miles of home. In addition, 60 percent of crashes occur on roads with posted speed limits of 40 miles per hour or less.
• Riding unrestrained is the greatest risk factor for death and injury among child occupants of motor vehicles. Unbelievably, approximately 29 percent of children ages four and younger ride unrestrained.
• Child-safety seat misuse is commonplace. It is estimated that 85 percent of children placed in safety seats and booster seats are improperly restrained.
• Child-safety seats are extremely effective when correctly installed and used. Proper use of child-safety seats reduces the death risk by 71 percent for infants, and 54 percent for children between the ages of one and four.
• In 1998, child-restraint use saved approximately 300 lives for children ages four and younger.
• Driver safety-belt use is positively associated with child restraint use. In a study of car crashes, a restrained driver was three times more likely to restrain a child.

Safety tips for car safety
Children should always be properly restrained regardless of the length of the trip. It may be tempting not to make an issue of proper restraint if you are just going around the block to the grocery store, but according to recent statistics, most crashes occur close to home. There can be no exceptions to this rule. Infants in automobiles are extremely vulnerable. Infants (until at least one year old and 20 pounds) should be placed in rear-facing child safety seats. NEVER put a rear-facing infant or convertible safety seat in the front passenger seat of a vehicle with an active passenger air bag. In a collision in which an air bag is activated, the pressure from the air bag can cause an infant to be suffocated against the front seat.

Children older than one year old and between 20 and 40 pounds should be in forward-facing child-safety seats. Children ages four to eight (approximately 40 to 80 pounds) should be in a car booster seat and restrained with a lap/shoulder belt. Toddlers can be difficult to restrain; nevertheless, you may want to purchase an attachment for the car seat (e.g., a steering wheel with sound effects). Make a game of it: baby seat belt on—check; big-brother seat belt on—check; mommy/daddy seat belt on—check. Because most children are improperly restrained, read your child-safety seat instruction manual and your motor vehicle owner's manual for directions on proper installation. Additionally, call the National Highway Traffic Safety Administration's Auto Safety Hotline (see resources) to inquire about any recalls or safety notices on your child's safety seat.

Bicycle Injury
Bicycles remain associated with more childhood injuries than any other consumer product except the automobile.

The facts (According to the National Safe Kids Campaign)

• More than 70 percent of children ages 5 to 14 (equal to 27.7 million children) ride bicycles.
• This age group accounts for 24 percent of all bicycle-related deaths, and more than 50 percent of all bicycle-related injuries.
• In 1998, nearly 362,000 children ages 14 and younger were treated in hospital emergency rooms for bicycle-related injuries.
• Head injury is the leading cause of death in bicycle crashes.
• The most effective safety device available to reduce head injury and death from bicycle crashes is a helmet.
• Unfortunately, national estimates report that bicycle helmet use among children ranges from 15 to 25 percent.
• Children are more likely to die from bicycle crashes at non-intersection locations (66 percent), between the months of May and August (55 percent), and between 3 p.m. and 6 p.m. (39 percent).
• The typical bicycle/motor vehicle crash occurs within one mile of the bicyclist's home.
• Non-helmeted riders are 14 times more likely to be involved in a fatal crash than helmeted riders.
• Correct fit and positioning of the helmet is essential for its effectiveness. One study found that children whose helmets fit poorly are at twice the risk of head injury in a crash compared to children whose helmets fit appropriately.
• It is estimated that 75 percent of bicycle-related fatalities among children could be prevented with a bicycle helmet.
• Universal use of bicycle helmets by children ages 4 to 15 could prevent between 135 and 155 deaths, between 39,000 and 45,000 head injuries, and between 18,000 and 55,000 scalp injuries.

Other bicycle safety precautions
Other precautions can be taken to minimize bicycle accidents. Children up to 10 years of age should ride with adult supervision. Bicyclists should ride with the flow of traffic, not against it. According to experts' estimates, as many as 23 percent of all car/bicycle collisions occur as a result of riding against the flow of traffic. As a means to see rear traffic, a bicyclist should use mirrors attached to the handlebars or helmet. Proper clothing can be a safety benefit, especially when riding at dusk or at night. To ensure that children wear bright colors and reflective strips, allow them to choose "cool" bicycle clothing.

Finally, children should be taught to respect all traffic signals—stop at all stop signs and traffic lights; and look both ways before entering a street.

Picnic/Barbecue Safety
Summer means picnics and barbecues. Here are a few basic safety rules to help ensure an injury-free day.

A picnic menu should be chosen carefully. Disease-producing bacteria prefer foods high in protein and moisture. These foods include milk products, poultry, eggs, meats, fish, shellfish, cream pies, and potato salad. The temperatures that prevent bacterial growth are either above 140 degrees or below 45 degrees. Keep hot food hot (use insulated dishes), and keep cold food cold (use an insulated cooler and put ice or frozen gel-packs on top). Store hot foods separately from cold foods. Pack the foods that should be kept the coldest on the bottom. Do not leave a cooler in the hot trunk of a car. Keep it in the shade (i.e. under a tree), and keep the lid on at all times.

Sanitation
To prevent transmission of bacteria, always wash your hands before you handle any food, and immediately after handling raw meat, fish, or poultry. Furthermore, wrap all foods separately, and keep raw meat, poultry and fish well wrapped and separate from precooked foods.

Leftovers need to be handled properly. For example, return leftovers to your cooler as quickly as possible, and keep them packed on ice or frozen gel-packs. When the temperature is 85 degrees or higher, food should not be left outside longer than one hour. No food should be left outside for more than two hours.

As a rule of thumb, "When in doubt, throw it out!"

Sunburn Safety
Most children obtain between 50 and 80 percent of their lifetime sun exposure before age 18; therefore, it is important that parents teach their children how to enjoy fun in the sun safely. Children should be able to enjoy playing outside in the sun, but certain precautions need to be taken.

Sunscreen
Even though it is difficult to avoid being in the sun during peak hours (between 10:00 a.m. and 3:00 p.m.), especially for children attending camp, ensure that protective sunscreen is applied generously. Don't forget about lips, hands, ears, feet, behind the neck, and shoulders. Sunscreen should be applied about 30 minutes before going outside so that a good layer of protection can form, and it should be reapplied often—approximately every two hours. Make sunscreen application fun for kids—use the spray type. Also, sunscreen comes in different colors and textures (some are foamy). Have your child put sunscreen on you, and then you apply it on him or her.

The American Academy of Dermatology recommends that all children wear sunscreen with an SPF of 15 or higher. Sunscreen should not be applied to babies under six months of age; infants should be kept out of the sun as much as possible.

One of the best ways to protect your family is to cover up. It is unrealistic to have your child wear a long-sleeved shirt, long pants, or full-length robe in the sun. But the use of an umbrella or a wide-brimmed hat can minimize sun exposure. Sun exposure damages the eyes as well as the skin. The best way to protect the eyes is to have your child wear sunglasses.

Medications
Some medications (certain antibiotics) increase the skin's sensitivity to UV (ultraviolet) rays. Know your child's medications. Also, ask your doctor or pharmacist whether the prescription and over-the-counter medications your child is taking can increase sun sensitivity.

Sunburn
In the event your child does get sunburned, he or she may experience pain and heat sensation. Some children may also develop chills. To help alleviate pain and heat, give your child a cool (not cold) bath, or apply a cool, wet compresses to the skin. Additionally, a child can be given a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin). DO NOT give aspirin to children or even teenagers. To rehydrate the skin and reduce swelling, apply topical moisturizing cream or one percent hydrocortisone cream. Finally, keep your child in the shade until the sunburn is healed.

First Aid Essentials
In addition to the home, a first aid kit should be kept in the car, and a traveling first aid kit for vacations is recommended. A first aid kit should include:

• Adhesive strip bandages (varying sizes)
• Baby wipes
• Bar of soap
• Children's pain reliever
• Cold pack
• Cotton balls
• Cotton tipped swabs
• Epsom salt
• Hot water bottle or heating pad
• Hydrogen peroxide
• Latex gloves
• Antibiotic ointment
• Petroleum jelly
• Rubbing alcohol
• Thermometer
• Tissues
• Tweezers

Resource List

AAA Foundation for Traffic Safety: http://www.aaafts.org
Bicycle Helmet Safety Institute: http://www.bhsi.org
U.S. Consumer Product Safety Commission: http://www.cpsc.gov
National Highway Traffic Safety Administration: http://www.nhtsa.dot.gov
National Safe Kids Campaign: http://www.safekids.org
National Safety Council: http://www.nsc.org
Centers for Disease Control and Injury Prevention: http://www.cdc.gov
Kids Safe: http://www.kidssafe.com
National Parent Information Network: http://www.npin.org
Be a Safe Kid Inc.: http://www.beeasafekid.com