Summer Safety Tips from St. Louis Children's Hospital

Hoping to stay out of the emergency department this summer? Research revealing general patterns of injury in children can help focus prevention efforts on high risk activities. An overlying pattern is that most play related injuries happen at or near home during common activities. Just like wearing seat belts, prevention strategies work best if they are employed each and every time a potentially risky activity is undertaken. In addition, injuries occur in boys at more than twice the rate that they occur in girls. Following are common summertime activities, related injuries, and means of prevention.

Bicycling
Careful studies in Seattle and elsewhere have found wearing a helmet during a bicycle crash reduces the likelihood of the rider having a serious brain injury by 90 percent. Other injuries may be more common, but brain injuries tend to result in lifelong difficulties with learning and daily activities. Helmets must be worn properly. Chin straps should be tight enough to allow only one finger between the strap and chin and should be adjusted to keep the helmet over the forehead. More children are wearing bicycle helmets as parents set examples and enforce their children’s usage.

Rollerblading/Skateboarding
Helmet safety is of prime importance as with bicycling. In addition, wrist fractures are especially common with these sports and often result in needing to wear a cast for 4-6 weeks. These fractures can be reduced or prevented by wearing rigid wrist guards. Elbow guards and knee guards also help prevent scrapes and cuts, especially in beginner skaters.

Trampolines
Although often described as fun for kids and a great way to get exercise, serious injuries from home trampoline play are so common that the American Academy of Pediatrics recommends that trampolines never be used at home, in routine gym classes, or on playgrounds. Common injuries include broken bones (often needing surgery), concussions and other head injuries, and neck and spinal injuries in addition to minor sprains, bruises, and cuts. Unfortunately, adult supervision does not appear to be sufficient to prevent these injuries.

ATVs (all-terrain vehicles)
Despite statements by the American Academy of Pediatrics and the US Consumer Product Safety Commission against the use of ATVs by children, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in children under the age of 16 years. In a report from Cincinnati on 109 children admitted for ATV-related injuries, the average age was 11 years. In half of those injured the ATV was owned by the family and 70% had received safety information at purchase. However, only 14% of riders had received any formal training before driving the vehicle. Falls off the ATVs, collisions with stationary objects, and roll-over crashes were the most common mechanisms of injury. These vehicles enable children to gain easily speeds of 20-40 m.p.h. at which collisions with fixed objects such as a trees, rocks, or fence posts cause devastating and often fatal injuries. Although sale of 3 wheel ATVs have been banned, severe injuries continue to occur with significant frequency on the 4 wheeled versions. Children and young teenagers have neither an understanding of the risks and potential consequences of riding these vehicles nor the skills and experience to safely operate them at speed. Therefore, children should not be allowed to operate ATVs.

Fireworks
Serious injuries from celebratory fireworks are most frequently seen around the July 4th holiday and include permanent loss of vision, scaring from severe burns, and disfigured fingers. These injuries tend to occur when adults allow children to ignite the fireworks, but in one Missouri study, the child was a bystander in one-fourth of injuries. In that study, firecrackers caused almost half of the injuries followed by bottle rockets, Roman candles, and fountains. Even seemingly innocuous sparklers burn at more than 1000º F and can cause severe burns. Because an adult was present in half of the injuries above, adult supervision does not appear to be an effective means to prevent firework related injuries. Many believe lighting of fireworks is best left to professionals.

Burns
Those luscious hamburgers, hot dogs, and pork steaks on the grill can draw hungry rambunctious kids from far and near! Many young children do not understand the outside of the grill can instantly sear their hands as well. Older children, typically fascinated by fire, should not be allowed to feed the fire with sticks, paper, lighter fluid, plastic, or other objects after the cooking is finished; grills can be easily turned over and clothing can quickly catch fire.

Swimming
Drownings occur most frequently between 2-3 years of age and during mid to older teenage years. Because of their natural curiosity, toddlers are great explorers; backyard or park pools are like magnets during these years. The toddler who falls into a pool, even if he or she can float or dog-paddle, typically is unable to pull him or herself out of the water up onto the pool side. Chain link fences offer simple footholds to climbers of this age; fences that prevent access to pools should have vertical bars or other design that does not allow youngsters to scale them. Furthermore, fences should enclose all 4 sides of the pool. Using a house as one side of the ‘fencing’ is not safe if doors from the house allow ready access to the pool.

Lawn Mowing
One of every 5 deaths caused by a lawnmower involves a child. The US Consumer Product Safety Commission estimates that most of the deaths to children occur when the child falls off or runs up to the riding mower and is run over. Other common mower-related injuries include permanent loss of vision from objects thrown by the mower and loss of fingers and toes when reaching or sliding under a running mower. Children should be kept out of the yard and in the house while mowing. Young children should not be allowed to mow the lawn. Older children must be taught how to safely mow and initially be supervised by adults. Children should never be allowed to ride as passengers on riding mowers. Sturdy shoes with slip-resistant soles should be worn along with eye protection and long pants. Grass should not be cut while it is wet as it is slippery and tends to clog the discharge chute. Finally, mowers with automatic blade cut-off switches on the handle should be used.

Summertime play can be great fun. Prevention strategies can also make it safe.