Health Education

Preventing Childhood Injuries

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Injury is the leading cause of death and disability during childhood. It is very important parents are knowledgeable about keeping their children safe. The idea of injury control or childproofing can be very overwhelming for parents. Let us break it down for you and discuss what is most important to know for the safety of your child.

What is the difference between an injury and accident?

It is important to distinguish between the terms accident and injury. The term 'accident' conveys a sense of bad luck or helplessness that tends to discourage prevention while the word 'injury' implies a circumstantially predictable occurrence. The goal is to prevent injuries even if we can't always prevent accidents. Children will always bump into things; our job is to prevent them from hurting themselves when they do so.

Choking and Suffocation Injuries

There are approximately 700 deaths each year in children and adolescents from unintentional airway obstruction (choking, strangulation, suffocation, and entrapment).

  • Choking: Although the incidence of choking injuries has declined markedly over the past few decades, the association of choking with rapid eating, improper chewing, laughing or running with food in the mouth, and holding a foreign object in the mouth has remained valid. Small toys should be kept from small children. Food and nonfood items are approximately equally responsible for choking deaths in children. Fortunately, the majority of choking episodes do not result in death. To improve your family’s chances of survival, know the basic first aid for choking.
  • Strangulation: Unintentional strangulation often is caused by clothing or strings around a child’s neck catching on other objects, bus doors, slides, etc. Other products of concern include: window blind cords, lids of toy chests, and crib and bunk bed bars that are too far apart.
  • Suffocation: The most “popular” culprit in suffocation is the plastic bag, especially dry cleaning bags. Babies can also suffocate under large pillows and heavy blankets, or wedged between an ill-fitting mattress and crib frame.
  • Entrapment: This lesser discussed phenomenon occurs when children become closed into a space with inadequate ventilation. Common household items which are a risk: refrigerators, ice chests, clothes dryers, and old toy chests.

What is first aid for a choking victim?

First you must determine if the child is truly choking or is just gagging a little. If the child is coughing and is able to speak or cry, leave him alone. Attempts to stop the natural cough reflex under such circumstances are unnecessary and potentially dangerous. If the child is not making any sound, then spring into action. According to the American Red Cross, the following approaches are almost universally helpful (>95%) and so, it is usually more helpful to just do it, rather than spending the time to call for help.

  • Infants (< 1 year)
    1. Back blows: Place infant face down over one arm (with head lower than waist) and administer five back blows between the shoulder blades with the heel of the hand
    2. Chest thrust: If there is no improvement, turn the infant over on his back and compress his chest five times, with two fingers, on the breastbone. To correctly position your fingers, draw an imaginary line between the nipples, in the center of the chest place your fingers one finger width below the line.
    3. Mouth-check: if there is still no improvement, open the mouth with the thumb over the tongue and lift the jaw forward and up to see if there is a visible object. If a foreign body can be seen, try to extract it with your fingers. If not, do not try a blind finger sweep because you may force the object further down the food-pipe.
    4. Rescue breaths: If there is still no improvement, try to give two puffs of air either mouth to mouth (with the nose clamped) or with mouth over mouth and nose (in a younger child) and then repeat steps 1–4.
  • Small child or adolescent (> 1 year)
  • Heimlich maneuver: Encircle the abdomen with your arms, placing fist between the belly button and ribs. Apply a series of five rapid, inward and upward, abdominal thrusts.
  • Mouth sweep: If there is no improvement, check the mouth by using the tongue/jaw lift. Do not use a blind finger sweep for fear of impacting the item further.
  • Rescue breaths: If there is still no improvement, call 911 and then give two puffs of air mouth to mouth (with the nose clamped) and then repeat steps 1–4.
  • If the victim is unconscious: Call 911, and lay him on his back. Straddle the victim and place one hand on top of the other just above the naval and perform abdominal thrust five times. If it is an infant, after calling 911, continue with back blows and chest thrusts. Alternate rescue breaths and mouth checks with abdominal thrusts until help arrives.

Fire and Burn Injuries

Burns are the 3rd leading cause overall of childhood injury-related deaths, outranked by automobiles and falls. There are six basic types of fire and burn injuries.

  • Flame Burns
    • Deaths from fires occur more frequently during the winter months, when unsafe heating and electrical equipment are used to a greater extent and in the eastern US when heating systems are used for a longer period of time. A disproportionately high number of house fire victims are poor and disadvantaged (5x greater) who simply cannot afford safe heating and electrical items. The major causes of burn related deaths include:
      1. Careless smoking produces a smoldering type of fire that is particularly pernicious because it usually erupts after everyone has fallen asleep.
      2. Kerosene and gas heaters
      3. Faulty electrical wiring 4) Gasoline storage containers. The ignition of one gallon of gasoline has the explosive force of 20 sticks of dynamite.
    • Prevention and Treatment: From 1980 to 1993 there was a 30% drop in deaths from house-fires. This improvement is attributed to the greater numbers of smoke detectors in homes, safer products, stricter building and fire codes, and a decrease in smoking and alcohol abuse. So what can you do to prevent fatal house fires?
      1. If you smoke, stop smoking. If you can’t stop, never smoke in bed or when very tired.
      2. Install a smoke detector on every floor and change the batteries annually at the same time of year (when you change the clock). It is estimated that 1 in 5 homes have a smoke detector that does not work; therefore recommendations are to test your detector once a month.
      3. Have periodic checks of your electrical system. This can usually be done when you have your HVAC serviced.
      4. When purchasing a new heater, make sure that it is certified for safety by the Underwriters Laboratory, make sure it automatically turns off when it tips over and avoid kerosene or gas heaters if at all possible.
      5. Avoid using cigarette lighters. Annually, these account for $60 million in property damage, some states mandate child resistant lighters. Avoid lighters, but also be very careful with matches, children start house fires with those, too.
  • Scald Burns
    • These account for most non-fatal burn injuries and 95% occur under five years. 60% of scald burns in children are in the kitchen, from liquids spilled from the stove, counter, or table. Microwave scalds have become more prevalent. If the microwave is used to heat a bottle, the container remains cool while the liquid at the center can cause mouth or splatter burns. Until 1980, all electrical water heaters were preset at 150 degrees Fahrenheit and gas heaters at 140 degrees. In the 140–150° range, adult skin takes 2–5 seconds to receive a 2nd or 3rd degree burn. Children’s skin burns 3–4 times faster than adults. The heater industry installs new units preset to 120°F. This reduction increases the margin of safety by 2–10 minutes, sufficient time to remove a child from the water. When burns occur in clothed parts of the body, the clothes act as insulators and even shorter periods of exposure may cause significant damage. Each year there are about 34 deaths and 5,000 ER visits attributed to hot tap water.
    • Prevention and Treatment
      1. Please check your hot water heater and make sure it is turned down to 120 degrees. If your heater is not calibrated in degrees, turn it down to the 1/3 mark.
      2. Never hold a baby while drinking coffee, tea or soup. If the baby cries and the pot is burning, turn off the stove and then pick up the baby.
      3. If your child is accidentally scalded, apply cool water as quickly as possible. If the burn covers more than a small area, call for advice on what to do next. Avoid micro waving baby’s bottles. Any foods or drinks from the microwave should be well mixed, and then the temperature checked again before serving.
  • Contact Burns
    • The most common culprits are irons, frying pans, toasters, coffee pots, and curling irons. Floor furnaces can produce a severe burn in a short period if the child comes in contact with the grating.
    • Prevention and Treatment
      1. Remove irons from view as soon as they are no longer being used.
      2. Hot curling irons should never be plugged in within reach of a child.
      3. Test the heat radiance from any vent or grating. If it is excessively hot, you may want to speak to your HVAC serviceman or, with steam heat, you may need to better protect your radiators.
      4. If your child sustains a burn over a small area and begins blistering, cover the blister and allow the new skin to form under the blister. Place petroleum jelly impregnated gauze (all pharmacies) over the burn so that when it begins to ooze, it does not stick to the gauze. When the scab forms, leave the gauze on during the day and remove it at night to allow it to dry out. If the blistered area is larger than a half dollar, please call and we will be happy to evaluate the burn and make recommendations.
  • Electrical Burns
    • Typically, the toddler puts a live cord (plugged in) in his mouth and the saliva then conducts the electricity. The temperature can reach as high as 2500 degrees Fahrenheit, enough to melt metal, and certainly sufficient to severely damage the mouth and lips.
    • Prevention and Treatment
      1. Place outlet covers over all exposed outlets. Special covers for creative children are available in many mail order catalogs.
      2. Unplug all appliances not being used and tape the cords to the wall of all appliances in use with exposed cords.
      3. Call about any electrical burns or shocks.
  • Chemical Burns
    • The most dangerous burns are caused by the ingestion of strong alkalis, like lye, since they eat through the wall of the esophagus (food-pipe), or strong acids, which destroy both the esophagus and stomach. The release of alkali from a swallowed disc battery can be devastating if it becomes lodged in the esophagus.
    • Prevention and Treatment
      1. Put all poisons out of harm’s way.
      2. Put childproof locks on all cabinets that occasionally contain poisons.
      3. Avoid drain cleaners. They are caustic to your pipes anyway and a single drink of any of these agents may maim your child for life.
      4. If your child swallows any strong acid or alkali, call Poison Control 1-800-222-1222 immediately. Do not induce vomiting, as it will only make the damage more intense as it comes back up.
  • Ultraviolet Burns (Sun Burn)
    • UV burns from excessive sun exposure can certainly be harmful with side effects that are generally more serious (i.e. skin cancer) and long term (30-40 years). One severe burn during childhood, doubles the incidence of malignant skin cancer later on in life.
    • Prevention and Treatment
      1. Sunscreen
      2. Sun avoidance
      3. Common sense.

    Carbon Monoxide — The Silent Killer

    Carbon Monoxide leaks often go undetected until someone is either near death or dead. No person, and no dwelling, is immune to this risk. Have your heating and cooling systems checked at least every year, and take 2 minutes to install Carbon Monoxide detectors. Your life, and your child’s life, may depend on it.

    Motor Vehicle Accidents

    The number of adolescent deaths from motor vehicle accidents far exceeds the number of American soldiers killed in all of our wars combined. But once again, it is important to distinguish between accident and injury. For just because a mistake occurs and your car ends up crashing into another vehicle or object, does not mean that you or your child has to be hurt. Indeed, in every crash, there are two collisions. The first involves the car and does not injure the occupants. Invariably a second collision occurs however, when the occupants strike the car's interior or are ejected from the car and strike the road. It is this latter collision which is the usual cause of death and whose consequences can often be prevented.

    There are two types of prevention for automobile accidents, behavior modification of the driving offender and passive protection of the occupants. This discussion shall deal exclusively with restraint systems that provide injury control in the event of an accident. Safety restraints (harnesses or seat belts) reduce the chance of death by 75%. Using both a harness and a seat belt adds another 10% advantage. Pregnant women are more likely to survive if they are wearing restraining devices and fetal loss is unchanged by the presence or absence of such restraints. Children reap an even greater benefit from the use of restraints. So buckling up is a wise idea at any age and besides, it's the law!

    An infant should be transported in a specially designed, federally approved infant carrier that, depending on the model, may ultimately be converted into a car seat, as the child grows older. The infant is held in the carrier using the carrier's restraints and rides in a semi reclining position facing the rear of the car. If the carrier is too wide, rolled blankets can be used to support the child. Toddlers more than 1 year and 20 pounds who can sit without support can ride in a true car seat. Children more than 35 pounds may use high backed belt positioning booster seats. These raise the child so that lap and shoulder harnesses fit more securely. Shield booster seats should only be used in children over 40 pounds. Products such as Safefit will pull the shoulder harness into a more secure location so that it does not cross the younger child’s neck.

    Air bags may save adult lives, but they are very dangerous for children. DO NOT place a car seat, or children less than 12, in the front seat of a car with a passenger side air bag. There are NO EXCEPTIONS. Do not have the guilt of your child’s death because it was inconvenient to place the car seat in the back seat! Remember, too, small women have also suffered injuries from air bags. Therefore, age requirements for sitting in the front seat should be tempered by common sense. A very small 12 year old is still at risk!

    Other aspects of car safety include:

    1. Never leave children unattended in a parked car with the windows closed. In the summer, the temperature reaches 150 degrees within 15–20 minutes and the seat belt buckles can cause second and third degree burns. In the winter, temperatures rapidly cool down and frostbite can easily ensue.
    2. Never drink and drive. Parents should set an example for children. The concept of a designated driver should be openly discussed and encouraged. Teens need to know they can call their parents in the middle of the night for a safe ride home. Contract with your teen that if they are in need, they will call you to pick them up at any time, and agree in advance that you will not hassle them that night. This could save your child’s life, and possibly the lives of others. Acknowledge that your teen may not be the one drinking, but if the person driving has anything to drink, you should want your child to call you for help.
    3. Always lock the door with a small child in the car. Ejection from the car increases the likelihood of death by 25x. It's true that there will be some cases where rapid exit from the car may save a life, but such situations are few and far between.

    Bicycle and Recreational Vehicle Injuries

    Every year more than 900 bicyclists are killed, 20,000 are admitted to the hospital, and 500,000 are treated in the ER. The head is the most commonly injured part of the body, and arms are the most common sites of fractures. Saddle injuries to boys and girls can provide lifelong discomfort and crush injuries due to bicycle spokes can require skin grafting. Most injuries are the bike rider's fault, including:

    1. Ride-out: the child rides down the driveway into the street
    2. Wrong way riding: the child rides on the wrong side of the street
    3. Double riding: more than one person rides on the bicycle at the same time
    4. Poor bicycle maintenance: it is critical that before a child is allowed to ride a bicycle he/she knows the rules of the road. This means stopping at all intersections, using hand signals, riding with the traffic (you ride with the traffic, and walk against it) and obeying all signs.

    Helmets dramatically decrease the incidence of severe head trauma in bicycle related accidents; in fact, in municipalities with helmet wearing laws and parental fines, the incidence of injury has dropped over 50%. Parents should be wearing helmets, modeling safe behavior for their children. The rule should be: no helmet, no bike. Riding at night should be forbidden in younger children and only permitted in older children with appropriate headlights and taillights (or reflectors), as well as with the use of reflective clothing. Headphones should not be worn while riding, they block out traffic sounds and warnings of impending dangers. Finally, bicycles should be maintained and serviced by an experienced individual at least annually. Just as you change the oil and lubricate your car at least once a year in order to keep it riding smoothly, so too, you should grease and inspect your bicycle on a similar schedule.

    For those adults who wish to transport their child on a bicycle, the following recommendations are made by the American Academy of Pediatrics. Children with adequate back and neck support (approx. 12 months old) may ride in a rear-mounted carrier seat that shields the child from the spokes, and a helmet must be worn. Usually by around age 4, preschoolers are too large for safe handling of the bicycle. Remember, a passenger makes the bike less stable and increases braking time. If a child is unable to cooperate and sit still, he should not be a passenger. The AAP feels infant-packs are unsafe for taking infants on bike rides.

    Motorized cycle injuries (mini-bikes, mopeds and mini-cycles) are becoming more common as their popularity grows. According to the Consumer Product Safety Commission, there are approximately 33,000 injuries per year in drivers of these vehicles. Any vehicle not labeled for on-road use (off-road vehicles) is even more dangerous when used illegally on public roads. A helmet must be worn at all times. Young drivers should never take mopeds on large or busy roads. All-terrain vehicles (ATVs) are responsible for approximately 60,000 ER visits each year, including 200–250 deaths. These vehicles are very unstable, have a high center of gravity and poor suspension systems, and reach speeds of 30-50 mph. combine this with little driving experience and the perceived immortality of teens and you have an extremely dangerous vehicle. No child or teenager should be allowed to ride an ATV. Adults would be wise not to use them either.

    Inline Skating (Rollerblading) and Skateboarding Injuries

    A few years ago there were 53,000 reported injuries in people under 21 related to inline skating. It is sad to say there were thousands more unreported. Trends show an ever-increasing number of injuries, so the most recent statistics are likely quite a bit higher. Skateboarding was also quoted as responsible for 23,000 emergency room visits, 21% of these were fractures. Again, this is only the top of the iceberg for the actual total injuries. Does this mean your children should be banned from these activities? No! But it does mean they should be well protected and have limits placed on where and when they participate.

    The wrist (and lower arm) is the most commonly injured site for inline skaters. The next most popular areas of injury are the knees, face, and elbows. Skateboarders most commonly injure their ankles, followed by the face, wrists, and elbows.

    With these injury patterns, it is no wonder the In-line Skating Association, American Academy of Pediatrics, and several other sources recommend the use of full protective gear-wrist guards, helmets, and knee and elbow pads. The wrist is undisputedly the most vulnerable area of the body during a fall. Arms shoot out to try to break a fall, or prevent it, leaving the wrist vulnerable to sudden hyperextension, sprains, strains, lacerations, and fractures. One study showed a greater than six-fold decrease in wrist injury with wrist guards.

    Children should go to parks, trails, and other protected areas to learn these sports. Watch an inexperienced in-line skater try to stop suddenly, or how distracted skate-boarders get, even around traffic, and you will understand why. Children must have protective gear that fits and is in good shape. Teach your children common sense, set limits and rules, and enforce consequences when rules are broken. This will help everyone to enjoy very fun activities, without the trips to the hospital.

    Drowning and Water Accidents

    Drowning is defined as a death occurring within 24 hours of immersion in fluid. Near drowning is when that person survives more than 24 hours. In addition to immersion injuries, water accidents and injuries are from a wide variety of sources: diving, jet-skiing, water-skiing, boating, water slides, “chicken fights”…the list is endless.

    Drowning is one of the top causes of accidental death in children. About 70% of swimming pool drownings occur in the child’s own backyard, and 20% are at a relative’s house. It is vital to remember it only takes an inch of water to drown. The Consumer Product Safety Commission (CPSC) estimates approximately one infant drowns in a bucket each week. And approximately 8% of childhood drownings occur in the bathtub!

    The likelihood that a child will survive an immersion event neurologically is largely determined by events that occur within the first 10 minutes. Consciousness is usually lost after 2 minutes and irreversible brain damage occurs after an additional 4 minutes. Thus, for a favorable outcome to occur, effective CPR resuscitation must occur immediately. Because of the seriousness of drowning and immersion accidents, the following pointers should be followed:

    1. Any amount of water is a hazard. Statistically, many more infants die each year in bathtubs than in pools. Indeed, an infant can drown in just a few inches of bathwater or in a mud puddle, particularly if he has fallen and lost consciousness. Every year, there are reports of children in walkers who lean over the toilet, tip in face down and drown. Never leave a cleaning bucket or full bathtub unattended, and empty immediately when you are done with them.
    2. Children can drown in less time than it takes to answer the phone. Please never leave your child unattended in the bathtub or near a pool, ever. Other children have proven themselves inadequate supervision; there is no substitute for an attentive adult.
    3. Young children who know how to swim should not be considered water safe. Swimming instruction for children under 3 years of age is not recommended for the purpose of preventing drowning. It is unreasonable to expect a child who suddenly finds himself in the pool, likely still fully clothed, to calmly swim to the side. There is great concern that too much familiarity with the pool at an early age makes parents less vigilant and children less careful.
    4. Pool fencing should be mandatory for all in-ground pools. It is estimated that universal adoption of this rule would reduce drownings and near drownings by almost 80%. Fences should be at least 48 inches high, and have no more than 4 inches between the slats. Additional security can be obtained with childproof pool covers, which are so secure a child can walk across them without falling in.
    5. CPR certification for adults and older children in households with pools should be mandatory. Rescue equipment (rings and a pole) should be visible and accessible at all times. Children must be taught what to do if there is an emergency (depending on their age and abilities)
    6. Pools are not the same as lakes and oceans. Adults need to assess each natural swimming situation for undertow, wave strength, and hidden underwater objects. Also, be aware of who lives in that water: fish, snakes, crabs, urchins, etc.

    Firearm Accidents

    The undeniable prevalence of firearms in our country should cause everyone great concern. It is estimated that half of all homes have a firearm of some sort in them. Parents used to ask whether there would be a parent home where their kids are playing, the better question is, “will there be an unlocked firearm at home?” A child has a greater chance of being killed by an unintentional shooting in this country than in any other country in the world. Over 5,000 children die annually from gunshot wounds. Many firearm deaths and injuries in young children are either self-inflicted or are from a playmate. National and international studies have consistently shown a strong correlation between accessibility of a firearm and both homicide and suicide. Suicide with a gun is almost always successful, over 3 times the success rate as without a gun. A firearm kept in the home for self-defense is 37 times more likely to be used in a suicide, and 5 times more likely to be used in a homicide, than it is to be used in self-defense. Consider those facts when your lawmakers bow to special interest lobbies and again vote down tough handgun legislation.

    Non-powder firearms, such as air guns, air rifles, BB guns, and pellet guns, can cause some severe injuries, too. Most commonly, we think of eye injuries, but you should know that fatal chest, head, neck, and facial injuries also occur. The overwhelming majority of injuries are in boys under age 15. The muzzle velocities of many of these guns are enough to penetrate eyes, skin, and bone. Unfortunately these are designed to look and function like guns. Not only does their use endanger children, but police have also shot kids because they were believed to be carrying bullet-firing weapons. This is a largely unregulated industry; do not think that just because you can go to the store and buy something it is safe!

    A few rules must be followed by anyone with a license to own a gun:

    • Never keep a loaded gun in the house or car. It is just too easy for your adventurous child to find the weapon. Studies have shown that even children, who are taught never to touch a gun, and to get an adult if one is found, will pick up and play with a real gun if they find it.
    • Keep guns and ammunition locked in separate places. This makes it even more difficult for an accidental firing.
    • Always treat a gun as if it were loaded and ready to fire. Teach this to your children. Never point a gun at anyone, even in jest.
    • Make sure all antique or souvenir guns are not loaded and then fix them so that they cannot be loaded.

    Falls

    One study estimated that 80% of all children under a year of age will have experienced at least one fall from an elevated surface and that 2% will require medical attention. We believe these statistics. The most common culprit is the crib, accounting for 11,000 fall injuries annually. High chairs are another household fall hazard. Also, beware the infant walker! It is just plain dangerous. Almost 15,000 children suffer walker related injuries each year all of which could be easily prevented. Stationary exersaucers are safe although if a child spends too much time in this device, walking can be delayed. Falls from beds are also relatively common. Invariably, the placid 3-month-old child will choose to roll over (and tumble to the ground) in the one moment that you run to answer the phone or turn off the stove. For this reason, any child 6 weeks or older should be watched carefully when placed on a bed, changing table or other elevated surface.

    There is no excuse for a child falling out of a window, yet these injuries continue to occur. Remember to place secure screens or guards on any upstairs window and to identify and move any furniture from which a child can easily reach an open window.

    Poisonings

    It is estimated that more than 2 million accidental poisoning episodes occur each year in the United States although less than 10% are reported to Poison Control Centers. Although almost 60% occur in children under five years, the biggest killers occur in older children and adolescents. Fortunately, the total incidence of poisoning events as well as the incidence of serious poisonings has dropped dramatically in the last decade. Yet, we have a long way to go before we eliminate this scourge of childhood. The most common agents involved in pediatric poisonings are: medications (40%), cleaning and polishing agents (15%), plants (12%) and cosmetics (11%). With older children, we tend to deal with medication ingestion, whereas with younger children, cleaning agents tend to be of more significant concern.

    Why do children ingest poisons?

    In general, anyone who has had to care for a child in the latter part of the first year knows that oral exploration, the putting of everything within reach into the mouth, is a major driving force for accidental poisoning. Curiosity and a desire for play are other contributing factors. Couple the curious, mouth fixated child with a breakdown in the usual family structure (i.e. moving, cleaning, vacation, holiday, illness or death) and you are in for real trouble.

    How do you prevent accidental poisoning?

    Keep all potential poisons out of reach. Try to identify the poison that isn't so obvious. Take that ornamental bottle of perfume for example. Do you know what's in it? One patient drank some 20-year-old French perfume that was serving as a decorative accessory. If you don't know what it is, find out what it is or throw it out!

    1. Make sure you've memorized the Poison Control number 1-800-222-1222 and leave it on all phones for other caregivers. And if your child eats something, call the Poison Control center first! They have the resources to find out the antidote and can provide you with critical answers far quicker than we can.
    2. Identify all plants in and around your house. If you aren't sure about the berries call a florist, before your child eats the plant.
    3. Never transfer toxic materials to cups or other containers. Parents have been known to use a cup to transfer drain cleaner, and then a child may come upon the same cup and uses it for a drink of water. There’s an emergency department visit that can be easily avoided!

    What happens if there is an ingestion?

    In general, the most important principle is to call the Poison Control Center 1-800-222-1222, no matter how trivial the ingestion. There are some poisons that seem to have no side effects until many hours later. So always make sure to call! Syrup of ipecac is no longer recommended for ingestions. If the poison was splashed in the eye, make sure to wash the eye with large amounts of water. The biggest mistake in eye exposures is washing the eye for too short a period. 10 minutes of washing under the faucet is the minimum. If acid or lye has splashed in the eye, an ophthalmologist must see the child. If the poison contaminates the skin, wash carefully, but do not scrub. In most cases, the only thing preventing excessive skin absorption is the thick outer layer of skin, which can be easily scrubbed off.

    Animal Bites

    It is now estimated that there are over 100 million cats and dogs kept as pets in the United States as well as 20 million birds and an array of other, more exotic pets. The increasing number of pet animals has led to a rise in the number of human injuries. Annually, almost a million Americans seek emergency care for animal bites or scratches with more than 60,000 leading to loss of sight, facial disfigurement or more serious physical problems. Sadly enough, 75% of these injuries occur in children.

    What animals are most likely to bite?

    In general, beware of sick, injured or hungry animals. Also, high-strung animals tend to become testy when kept in cramped corners or deprived of sufficient exercise. Vicious dogs are species of dogs, such as pit bulls, that have been bred to be aggressive and they pose serious problems for children. Any breed of dog may become vicious with improper handling. Contrary to popular opinion, most severe dog attacks come from animals known to the victim and most occur in the victim's house or yard. Furthermore, reproductively intact (non-spayed) male dogs under 5 years account for almost 100% of vicious attacks and frequently have a history of aggression before seriously harming or killing a child. Be an advocate for your child and be very vocal about removing such menaces from the neighborhood.

    Teach your child not to harass the local animals. Unfortunately, children who are too young to know the consequences of their behavior are the most likely to be bitten. Although 5 to 14 year olds are only 20% of the population, they make up half of all injuries from pets. So just as you teach your child not to run in front of moving cars, you should teach him not to run after or harass animals. This is not to say that pets are taboo. On the contrary, caring for a pet can provide a child a wonderful sense of mastery and enhance his self-confidence. However, pets should not be used to 'teach' responsibility; indeed, children must demonstrate the maturity necessary to handle and care for animals before they are purchased. This maturity is unusual in children under 6 years of age. Additionally, younger children do not understand what behaviors may be threatening to an animal, provoking an attack. The family should also decide who is responsible for feeding, walking, grooming and cleaning up after the animal prior to the purchase of a new pet. Read books and speak with vets to choose the pet appropriate for your family. Remember, many pets are a 10-15 year commitment! A note on ferrets, they are popular and can be wonderful pets. They are also a lot of responsibility and are dangerous in homes with infants. Ferret-proofing a home is more difficult than toddler proofing.

    In summary, the American Academy of Pediatrics has suggested the following rules for animal-person relationships:

    1. Notify the local health department about any sick or injured animal.
    2. Never permit a child to break up an animal fight, even if his pet is involved.
    3. Teach children not to mistreat animals by setting a good example yourself.
    4. Do not keep an animal confined with short ropes or chains. It is cruel and serves to heighten the aggressiveness of the animal.
    5. Teach your child how to make friends with the local animals if there is the possibility of casual contact even if it means you have to overcome your own fears of that particular animal. They should always ask before petting a dog, and then offer the back of their hand to sniff first. Dogs should not be pet on the top of the head by children; this is a sign of dominance and may not be well received.
    6. Teach your child to avoid unknown animals, especially ones that look sick, in the same way you teach him to avoid strange humans.
    7. Do not allow a child to overly excite, tease, or pull the tail of any animal. Teach them not to touch a dog’s bone or food.
    8. Do not allow a child to place his face close to an animal.
    9. Teach your child to avoid riding his bicycle in an area where animals are known to run after them.
    10. Teach your child what to do when confronted by a strange and frightening animal. In general, one should stop, stand still and speak softly. “Be a tree!” If the dog circles around you, move slowly and stop when he does. Never turn your back on an approaching dog. Eye to eye contact is considered threatening.

    This education is by no means exhaustive. It attempts to educate, encourage, prod and frighten. But most importantly, it sends the message that teaching safe behavior patterns to a child is one of the most important tasks confronting both parents and pediatricians. Good luck!