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Childhood Injuries and Deaths: An Ounce of Prevention vs. a Pound of Cure

Preventing childhood injuries and diseases means developing good habits early

Buckling Up in the Car Seat
Teaching Car Safety Early
Microsoft Clip Art

Childhood Injuries and Deaths: An Ounce of Prevention vs. a Pound of Cure

When my wife and I had our children, they learned to ride in car seats. As Connor and Alex each reached 40 pounds, they graduated to booster seats, with continual instruction on how to buckle up safely. I regularly taught the lesson of safety in the car, discussing both the laws/rules as well as accidents and boo-boos. Our children became creatures of these habits, refusing to let me put the car in gear if their buckles were not fastened.

So, when a van crashed into us from behind recently, sending us into another car in front of us, our own van suffered thousands of dollars in damage...but the kids and I received only minor injuries. Of course, they sat in booster seats, and all three of us wore our safety belts. Both children traveled by squad to the emergency room at Nationwide Children's Hospital...my son was released later that day, and my daughter the next morning. An ounce of prevention led to minimal harm to my children (and their dad) from a serious car crash.

Sometimes, we parents let our guards down to save a little time, or to have some peach and quiet. We send the kids out to play without checking for a few minutes. We turn on the TV or video game console to occupy them so we can get something else done. But, the truth is clear:  parents have the ultimate job of keeping their children healthy, safe and alive. We teach them the habits of healthy living the moment we start to parent tiny babies.  

According to the American Academy of Pediatrics, injuries kill children more than any other cause (http://www.aap.org/healthtopics/safety.cfm and http://aappolicy.aappublications.org/cgi/reprint/pediatrics;119/1/202.pdf). Unhealthy eating habits in children are a leading cause of childhood, and later adulthood, diseases. We can prevent many common injuries or unhealthy living habits by focusing on 4 areas: Helmets, Car Safety, Drowning Prevention, and Healthy Life Skills.

Helmets and Head Injuries

When children injure their heads, the future may change permanently. If a head injury results in traumatic brain injury, children and teens experience different degrees of emotional and cognitive outcomes-none of which are easy for them or their families. Most head injuries are preventable, particularly those that can lead to the worst outcomes. For example, properly fitted helmets can reduce the chances of serious injuries from bikes, skates, or skate-boards. As parents, the earlier we introduce helmets, the better. Children develop habits early, and use of helmets when riding tricycles or training bikes teaches children to use them without question or peer pressure. When we put the helmets on, parents can also explain that the helmet protects from "ouchies," and provide a good role model by wearing our helmets too. One ounce of prevention is to develop the proper use of helmets, especially on bicycles, at an early age.

Cars, Accidents, and Restraints

According to studies (http://www-nrd.nhtsa.dot.gov/Pubs/811157.pdf), children under 14 years old represent 8% of car crash injuries. As parents, even more shocking is that 15% of the deaths from car accidents are children and teens (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;127/4/e1050#SEC1). Most parents know the resistances children offer to sitting in car seats or boosters-but several strategies can help children learn to sit in safety seats and wear their shoulder/lap belts properly.

Modeling: Parents can show their children the importance of being belted in cars by always wearing their own belts

Teaching the Risks: As children learn to understand cause-and-effect, parents can teach car seats and belts keep them safe from being hurt.

Rules of Behavior: By kindergarten, children understand that they are to follow rules. Parents may use phrases ("Remember, it is a rule that you must sit in your seat and be buckled or I can't drive the car.") that remind children that the rules require using car seats/boosters and belts.

Studies tell us that fatalities in car crashes are reduced by 71% for children under 1 year old, and 54% for ages 1 through 4 years, if restraints are used (http://www-nrd.nhtsa.dot.gov/Pubs/811157.pdf). As a parent, an ounce of prevention to childhood physical injury, traumatic brain injury, and death is the use of car seats/boosters and safety belts.  

Water and Drowning

The Centers for Disease Control says that drowning is the second leading cause of all unintentional injuries under the age of 14 years (http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-factsheet.html). For the youngest of children, prevention of drowning involves close supervision when near water, even in a bucket or toilet. For older children, swimming pools and retaining ponds provide significant risks. We must remember that young children can not fully understand the risks of downing or concepts of death, so we must do more than simply tell them to stay away from pools or ponds.

To prevent many of these accidents, parents can use relatively simple but important steps.

1.      Make sure that pools and ponds have fences around them with child-proof gates.

2.      Remove tempting toys from the ends of pools or ponds.

3.      Never leave children unsupervised near pools or ponds for even 5 minutes.

4.      Teach children to swim at very young ages, but never use water wings or other floatation devices (as these teach children a false sense of security in the water).

5.      When in a boat, always have children and adults wear properly fitted life-jackets.

As children age, parents can reinforce the rules of water safety through explanations. For example, children can remember choking when learning to swim-so reminding them of that experience provides a basis for the rule that others need to be close by when swimming. Adults provide a good example by never dunking others or rough-housing in the pool when children watch them. We teach our children water safety developing safe behaviors early, modeling those behaviors ourselves, and providing reasons for water safety rules.

Healthy Life Skills

Obesity is a major risk of disease and medical illnesses in children, both while they are children and when they grow to be adults. The American Academy of Pediatrics reports that almost 32% of adolescents and children are overweight, and 16% are obese (http://www.aap.org/obesity/about.html). The preventable outcomes from obesity include diabetes, high blood pressure, asthma, emotional problems, and social victimization.

Food Choices: While pediatricians advise parents to do a number of things to prevent obesity in children, perhaps two of the most significant actions we can take are 1) limitation of sugar-based beverages and 2) increase physical activity to at least one hour per day. Parents can seek non-soda alternatives such as water, unsweetened fruit juices, reduced sugar juices, and low-fat milk. In addition, snacks such as high fiber foods or fruits can replace candy or fried foods (like potato chips).

Parents find changing an already developed habit hard, so we effectively teach our children when beginning their eating habits with healthy, low-sugar foods. By offering, during toddlerhood, these kinds of foods as the only options, parents create healthy habits with fewer struggles over donuts and soda. And, if parents show their children the same healthy food choices, parents both teach through habit and example-a powerful one-two punch against the marketing efforts of less healthy food makers.

Activity Levels: Parents can increase activity levels by limiting video game playing to one hour or less per day, setting similar limits on television watching, and participating with their children in active play or sports. Parents' role in increasing activity levels is much greater now, than in the past, considering the reduction or elimination of recess and gym class in many public schools. Again, as with most prevention efforts, parents educate themselves best when consulting experts like their pediatrician, then by teaching through example and development of healthy habits.

A Final Word

Parents teach best when they use three strategies: Setting a good example (modeling), directly teaching healthy habits as early as possible, and setting rules, with explanations, at a young age. We invest, as parents, in our children's life-long health and safety when we use these techniques from the beginning-and save ourselves the time and grief of trying to change bad habits later.

The best advice is to consult your pediatrician about safety and injury prevention, from healthy eating to proper fitting bike helmets. Fire departments regularly teach the proper way to use a car seat, often by simply stopping at the local fire station and asking for help. Psychologists offer behavioral tips on teaching healthy habits, or changing unhealthy ones if necessary. But...consulting your pediatrician is probably the best first step.

Parents can react in unhealthy ways to a child's injury:  driving anxiety or phobias, short-term traumatic stress, excessive guilt about the injury or accident, or over-protectiveness. Healthier reactions include emphasizing safety strategies, confronting anxiety, and advocating preventive habits to others.

Psychologically, if you develop anxieties in response to a child's injury that interfere with your concentration or daily functioning in life, consider seeing a behavioral psychologist. Often, such reactions diminish or disappear within 6 months, but if they do not, treatments like exposure therapies, combined with cognitive therapy, usually overcome the anxieties. As parents, we provide an example to our children about coping with accidents and injuries-we teach them that falling down is just an opportunity to learn to get back up again.

Resources

http://www.abct.org/docs/Members/FactSheets/INJURY%200707.pdf

http://abct.org/docs/Members/FactSheets/PTSD%200707.pdf

http://www.apa.org/helpcenter/anxiety-treatment.aspx

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;127/4/e1050#SEC1

http://www.cdc.gov/safechild/

http://www-nrd.nhtsa.dot.gov/Pubs/811157.pdf

http://www.aap.org/healthtopics/overweight.cfm

http://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

http://www.healthychildren.org/English/safety-prevention/at-play/pages/Bicycle-Helmets-What-Every-Parent-Should-Know.aspx

 

 

Kevin D. Arnold, Ph.D., A.B.P.P., is the Director of the Center for Cognitive and Behavioral Therapy of Greater Columbus and a Clinical Faculty member in the Dept. of Psychiatry at OSU.

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