Accidents Involving Cars And Kids

In summertime, the risk for accidents increases and many of these accidents occur in and around the car.  A wonderful tool for parents is available online at: www.safercar.gov/parents/home.htm. This site has a wealth of information for parents about how to avoid common accidents.

            One section deals with the danger of leaving a child in a parked car. Every summer, there are reports of children dying of heatstroke because they were either intentionally or accidently left in a hot car. A study of 1000 parents early this year done by Public Opinion Strategies revealed that 7 out of 10 parents said that they had heard about the danger of leaving a child in a car, but 14% of those parents reported having intentionally leaving a child aged 6 or younger alone in a parked, locked car. 6% said that they were comfortable leaving their young children in a parked vehicle for longer than 15 minutes. It is common to think that these parents are neglectful, but in cases of a child dying from heat stroke in a car, only 8% were found to be negligent – meaning there were drugs, alcohol or a previous report of negligence to Child Protection. In 52% of the cases, the parent simply forgot that the child was in the car. In 30% of the deaths, children were left playing in the car and in 18% the child was left intentionally. These were not “bad parents”. They just made a bad decision (“I’ll only go into the store for a minute”) or simply forgot the child was with them – often because they were not used to traveling with the child. The website reminds parents to never leave a child in the car, even if the window is cracked open. Don’t let children play in the car and always check before leaving the car – “Look before you lock”.

            The site also discusses power window accidents, including strangulation caused by a rising power window. These accidents are common in vehicles that have push button power window controls (newer vehicles have “lift” controls rather than “push down” controls). Parents need to teach their children not to play with or around the door armrests. The parents should never leave a key in the ignition or have the key turned to “on” or “accessory”.

            Leaving the key in the ignition can also result in the child moving the car’s gearshift out of park and the car being set in motion with the child in it.

            Earlier this year, there were news reports of a toddler “going missing” at a family gathering and, after a prolonged search, the child was found dead in the trunk of the family car parked right in the driveway. The site talks about how to avoid trunk entrapment and also talks about how to avoid back-over accidents where a driver drives over a child while backing up out of a driveway or parking space.

            Finally, the site gives excellent information about car seats, and all manner of child restraints to keep children safe in cars. It also has articles about bicycle safety and safe teen driving.

The handouts are printable and all the information is free.

An Unusual Cure For Bedwetting

     A recent study of children who wet the bed showed an interesting problem: all of the bedwetting children were found to be constipated. Constipation causes stool to build up in an area behind the urinary bladder. This puts pressure on the bladder and causes the child to have problems holding urine, especially at night.

     When the children in the study were treated for the constipation, 83% of them stopped bedwetting within three months.

     Constipation is a very frequent problem for children. It is by far the most common cause of recurrent abdominal pain, especially after meals. It can cause loss of appetite and even cause recurrent vomiting. When a child is constipated, his stools are usually hard and large, but some stools can also be liquid and explosive and the child can have recurring stooling “accidents” in his pants.

     Constipation is usually a long-term problem for children and even after it has resolved, it frequently reoccurs because it results from habitual stool withholding.

     If a child has severe pain from constipation, enemas can give immediate relief. Children’s enemas can be found in any pharmacy. But constipated children need long-term treatment with daily laxatives. There is a commercial product that is a powder parents can dissolve in water or other liquids. This has no real taste and can be given every day. Parents should give larger doses until stools are very soft and the child has no complaints of cramping. After that, the dose can be lowered, but the child needs to stay on a daily dose that keeps the stool soft and keeps the child pain-free. If the child begins to complain of pain again, the dose should be increased.

     Abdominal pain has many possible causes and a child with severe or recurrent abdominal pain needs to be evaluated by his caregiver before any course of treatment is attempted, but, for children with both problems – bedwetting and constipation – curing the constipation could also cure the bedwetting.

Sugar,Fluoride And Teeth

     The June issue of Pediatrics has a detailed report from the United States Preventive Services Task Force about preventing dental cavities in children. It mentions the importance of fluoridation in drinking water and discusses the benefits of the fluoride treatments given by doctors and dentists. It also discusses problems that can occur with too much fluoride such as staining and pitting of the tooth enamel. It is important for parents to be aware of the different sources of fluoride that their children are exposed to (tooth paste, mouth wash, drops, tablets) and to discuss them with their child’s caregiver to be sure the child is receiving the proper amount of fluoride.

     The prevention guidelines listed in the report discuss the importance of avoiding excess sugar and specifically mentions inappropriate use of the bottle.

     Too often, toddlers carry around a bottle of juice or milk through the day and take a sip anytime they want to. This continuous exposure of their teeth to sugar is a common cause of severe dental cavities. Going to bed with a bottle of milk or juice is another cause.

     Up until an infant is one year old, he can have bottles of formula. After six months of age, he should be given milk in a sippi-cup at mealtime but still given a bottle of formula whenever he wants it. At this age, there is no need for (and certainly no benefit in) juice. When a child hits his first birthday, all bottles should magically become water and, after that time, parents should never put anything but water in bottles, daytime or nighttime. This eliminates the debate about when to stop using bottles because, as long as the only thing in the bottle is water, the child can have a bottle whenever he wants it for as long as he wants to use it (in fact, lots of adults suck from a water bottle with a nipple on it). Milk is always given in a cup, and only given at mealtime.

      A recent documentary film (“Fed Up”) and a book (“The Omnivore’s Dilemma”) both outline the problems our society has with our addiction to sugar. That addiction starts early in life with juice, snacks with sugar and processed foods. When infants begin eating solid foods, parents should give them fresh fruit and vegetables ground up to a proper consistency.  Juice is nothing more than water and sugar and when the package says, “100% fruit juice”, it doesn’t mean “100 fruit”, it means “100% fruit sugar”.  The same is true for the many kinds of processed “fruit snacks”. Fiber and other components of fresh fruit help our bodies digest and process the fruit sugar and, without them, the sugar easily turns into fat.

     When our kids are thirsty, we should give them water between meals and milk at meals. When our kids want a snack, we shouldn’t give them apple juice, we should give them an apple.

Should Baby Cry Herself To Sleep?

          One of the most touchy topics in Pediatrics is whether or not to allow babies to cry themselves to sleep.  A visiting granddaughter recently showed me that sometimes it is not a question of “whether or not” but it is an issue of “need to”.

     Our granddaughter is 9 months old and is a quiet, easy-going baby who hasn’t ever much needed to cry herself to sleep because she clearly advertises when she is tired - suddenly crabby, rubbing ears, rubbing eyes, not wet and not hungry – and goes down with a minimal amount of rocking and singing. Like most 9 month-olds, she needs both a morning and an afternoon nap.

     On the day in question, she went down for her morning nap in the guest bedroom and after she was asleep, her father joined her for a nap. After she had been asleep for only an hour, his cell phone rang and woke them both up.  Because she was in an unfamiliar environment, she woke up totally and wanted to play.

     Later, she again got tired at the time for her afternoon nap. But her parents were going to a wedding that afternoon. I put granddaughter in the car seat knowing that she was so tired that she would be asleep by the time the car reached the end of the driveway. She was. But when we returned home after dropping off her parents, she woke up again when I took her out of the car seat. Once again, she wanted to be up and play.

     When bed-time rolled around, she was beside herself. She had been awakened halfway through each of her daytime naps and she was beyond exhausted. She cried when we gave her her pacifier, when we tried to rock her, when we picked her up and when we laid her down. She was rubbing eyes and ears and yet could not settle herself – crying and screaming no matter what two frustrated grandparents could come up with. All she knew was that she was miserable and nothing was helping her feel better.

     Finally, even though her parents agree with the “no-crying-to-sleep” school, we put her into the portable crib and closed the door. After ten minutes of loud, tearful protest, all was quiet and she was gratefully asleep. She slept through the entire night and well beyond her normal time to wake up. When she did awaken, she was her happy, normal self.

     When you know a baby is tired, it is time to let them go to sleep. If you find that what you are doing (rocking, holding, walking, etc.) is keeping them awake, it is time to give baby a chance to cry off the extra bit of energy that is keeping them awake and let everyone get some much-needed sleep.