Kids and hot cars: a dangerous combination.

Have you ever driven somewhere and not remembered how you got there? We all have… it’s called automatic pilot.

We are used to our routines; We don’t even have to think about it. However, it is important that we turn off that automatic pilot and try to be present as much as possible, especially when our routine involves transporting kids. Every summer children die because they are forgotten and left behind in the car. Summer is in full swing, and across the country temperatures are rising.

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A few concerning facts you must know about:

  • A child can die of heat stroke very quickly if left in a hot car.
  • Heat stroke is the principal cause of non-crash, vehicle-related deaths in children younger than 15 years old.
  • Cars heat up rapidly. In about 10 minutes, a car can heat up 20 degrees F.
  • Temperatures inside a car can reach as high as 130 degrees, even when external temperatures are in the 60’s or 70’s, turning the car literally in an oven.
  • July and August are typically the deadliest months for children in cars.
  • In the last 20 years, around 800 children died in hot cars.
  • In 2018, 52 children were killed in hot cars.
  • So far this year, 16 children have died as a result of being left behind in a hot car. Sadly, by the time you read this blog post the number will have probably increased.

What is heat stroke?

Heat stroke happens when someone’s body gets too hot. You have probably heard of heat stroke in association with athletes passing out or dying after strenuous exercise in hot and humid climate while not drinking enough water to keep hydrated. Heat stroke can also happen to people who are exposed to extreme heat even if they are not exercising.

Heat stroke is described as a core body temperature of 104 to 105°F along with neurologic changes such as trouble thinking clearly, hallucinations, trouble walking, passing out, and seizures. Once the body’s temperature reaches 104 degrees, its natural cooling methods, such as sweating, begin to fail and the internal organs begin to shut down. Death is likely to occur at 107 degrees.

Heat stroke is a true medical emergency!

Why are children at risk when left in a hot car?

Several reasons:

  • Children’s bodies heat up three to five times faster than adult’s bodies.
  • As is expected, infants and young children, don’t know how to operate car door locks to free themselves from the hot car.
  • Typically, young children are restrained in car seats and booster seats from which they can’t easily get out of.

Three children in car safety seat

You might wonder…how in the world can a child be left in the car: 

Parents always try their best to keep their children safe, but having a change in routine or being busy, overworked, tired, and distracted can increase the risk of accidentally forgetting your child in the car. More than 50% of cases involving a child dying in a hot car is the result of a parent or caregiver who unfortunately forgot their kid in the car.

Other situations leading to deaths of children in hot cars are related to children gaining access to the vehicle (around 25% of cases) and caregivers knowingly leaving children in the vehicle (around 18% of cases).

What can you do as a parent to prevent this tragedy?

Prevent forgetting your child in the vehicle:

  • Avoid distractions while driving, especially talking on the phone and texting.
  • If there is a change in routine, set an alarm to remind you to drop off your child at daycare. Make sure this alarm has a unique ring tone and you only use it for this purpose.
  • Arrange for your child’s day care or pre-school to call or text you if your child is not there at the usual time.
  • Always place your handbag, wallet, or any other item you absolutely need on the back seat of the car. This will force you to literally inspect the back seat every single time you leave your car. Be present and purposeful when leaving your car. Always look at the back seat before locking up the car.
  • If a different care giver is driving your child to daycare or preschool, request a text or phone call confirming they delivered your child safely. If you didn’t receive the requested call, make a point of calling them and verify your child is where he/she is supposed to be at.
  • Keep a stuffed animal or some other reminder in the child’s car seat. When your child is in the car seat, put the stuffed animal on the front passenger seat. This should remind you your child is in the back seat.

Never deliberately leave your child inside the vehicle, not even if it is for a few minutes:

As I discussed earlier, cars can get extremely hot very quickly. Keep in mind that opening a window does little to keep the car cool once it is turned off, so never ever leave your child or pet inside the car.

Prevent your child from entering the car while unnoticed:

  • When at home, keep your car locked to stop a wondering toddler or young child from entering the car and accidentally locking themselves inside.
  • Always keep the car keys out of the reach of children.
  • If a child goes missing, please check the inside and trunk of all cars in the household.
  • As kids get more understanding, teach them how to work the car horn and explain to them to always hunk the horn if they get stuck inside a car.
  • Establish clear and specific rules for older children…cars are not a safe place to play at.

Resources for parents and caregivers:

The National Safety Council provides a free online course regarding the risks of vehicular heatstroke in children and ways to prevent these accidental deaths. This online course is a great resource. Please check it out and share with your family and friends.

Consider the use and apps such as Kars 4 Kids Safety that can be programmed for reminders. Remember the use of this or other apps is solely an added layer of protection. Ultimately you are responsible for your child.

Consider the use of a car seat monitors like ChildMinder SoftClip or Sense A Life, for example, but remember monitors should be use only as an added layer of protection. Ultimately you are responsible for your child.

Resources:

Up to date: Heat stroke in children

ABC News: record high number hot car deaths

nsc.org: kids in hot cars

Healthychildren.org: Prevent-Child-Deaths-in-Hot-Cars

fatherly.com: best-car-seat-alarms

Drowning Prevention: the basics and beyond

Summer is in full swing. Families are enjoying the longer days, the sunshine, the pool parties, and the much-anticipated summer vacations. Seems like everybody relaxes a bit during this time of the year, but let’s not forget that during summertime children spend more time around water and are therefore more prone to accidental drowning and water related injuries. Please don’t let your guard down!

Last summer, I personally witnessed the indescribable, unfathomable pain and suffering a coworker went through as she experienced the unthinkable and unpredictable loss of her toddler, Kaden, to accidental drowning. He was a lively, happy, funny, sweet 2-year-old boy, who enjoyed his food and cuddling with his mommy more than anything else in this world. He loved ducks, stuff animals, and exploring the world around him. He always had a smile on his face. It was heart wrenching to watch his parents, his family, and the community grieving his death.

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You might wonder why children drown. Whose fault is it? The reality is that parents across the board do the best they can to keep their children safe, but unfortunately this tragedy could happen to even the most responsible and attentive parents out there. It could happen to anyone!

I have always been an advocate for water safety, but this experience opened my eyes to the fact that as a pediatrician, I should be doing more to educate parents on water safety and hopefully prevent another death. It became evident that this is a conversation I should be having with each one of my patient’s parents. Occasionally, when I mention water safety to parents, I can tell by the look in their eyes that they are wondering…Is she doubting my parenting, my abilities, or even my common sense? It is not about doubting parents, it’s about prevention!

Five facts about drowning you must know:

  1. Drowning is the leading cause of injury-related death in children 1 to 4 years old. Toddlers ages 1 to 3 are the age group at highest risk. Most infants drown in bathtubs and buckets, while preschoolers commonly drown in swimming pools.
  2. Teens ages 15–19 are the second age group at highest risk of drowning. Most adolescents drown in open bodies of water like oceans, lakes, and rivers.
  3. Most drownings occur while the child is in the care of one or both parents. In most cases, the child has been out of sight for less than five minutes and they were last seen inside the house.
  4. Around 70% of drownings take place when children are not actively swimming, but when they have unanticipated, unsupervised access to water.
  5. Around 1,000 children under the age of 20 lose their lives to drowning yearly in the United States. That’s way too many!

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Why are toddlers and young children at increased risk for drowning?

Young children, especially toddlers, are inquisitive and curious by nature. They love exploring and discovering their environment. Water is inviting, and it looks particularly attractive if there are toys in it. Most toddlers have the mistaken perception that they can float and swim because that’s exactly what they have done before with floaties or life jackets on. Toddlers are mobile, which grants them access to places they could not get to before, lack the understanding of the dangers of water, and usually lack the swimming skills to save their lives. Toddlers are determined, quick, and fearless …that’s a dangerous combination, especially when there is lack of barriers to prevent them having access to water sources.

Why are adolescents at increased risk for drowning?

This age group for the most part can be described as independent, overconfident, daring and believe that they are unbeatable. Based on that description, it’s easy to understand that they could overestimate their level of swim skill and get involved in risky situations. Also, they might want to impress their peers or as a result of peer pressure, they could engage in dangerous situation. Last, they are likely to use alcohol or drugs while swimming or doing water activities.

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Five common misconceptions you must know about:

  1. I will notice if my child is drowning:

False.

This is a big one. Parents have the mistaken belief that drowning is a loud, splashy, scream for help type of event. Maybe because movies and cartoons depict it as that. But in fact, drowning is usually silent and happens in a matter of seconds (less than one minute).

  1. Most kids drown while swimming:

False.

Like I mentioned earlier, most young children drown during times when they are not actively swimming but when they have unexpected, unnoticed access to water.

  1. I don’t have a pool, so my kids are safe right?

False.

Bathtubs, hot tubs, spas, toilets, pails, buckets, wading pools, irrigation ditches, ponds, bird baths, garden fountains are all examples of possible sources of danger for young children. Young children can drown in as little as one to two inches of water.

  1. Swimming lessons are not beneficial at a young age.

False.

Swimming lessons can be safely implemented at or around age 1 for most children. Evidence reveals that formal swimming lessons starting at this age are beneficial and can prevent drowning. It would be ideal to find a swimming program that is familiar and comfortable working with this young age group. The most important skill to learn at this very early age is self- rescue or the ability of rolling into their backs to float while waiting for help to arrive.

I personally like the ISR, Infant Swimming Resource, which is a comprehensive swimming program that teaches young children survival skills in conjunction with basic swimming skills. Lessons are taught in a one on one environment daily for 4 to 6 weeks. It teaches young children how to practice self-rescue if they fall into water with clothing and shoes on (both light clothing and winter clothing). As kids mature and get older, this program helps them acquire more water competency and more advance swim skills.

Remember that even if your child has had swimming lessons, there is no substitute for adult supervision.

  1. Installing 4-sided pool fencing is enough to prevent drowning.

False.

Even though the presence of 4-sided pool fencing, that is at least 4 ft tall and has self-closing and self-latching gates, is considered the to be most researched and effective strategy to prevent unanticipated access to water, fences by themselves are simply not enough. Don’t get me wrong, fencing is extremely helpful as it prevents more than 50% of pool drownings in young children, but we should consider doing more. Keep in mind that children like imitating their parents and they are always watching us, so it is probable that they will try to open the gate and sometimes they will be successful. That’s why it is important to implement several other strategies in addition to the fence to provide extra protection for the child. The implementation of in-house safety gates, childproof door locks, doorknob covers, door alarms, gate alarms, pool alarms, and weight-bearing, rigid pool covers are extra physical barriers that will help prevent young children from reaching water when unsupervised.

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 Strategies to prevent injuries and drowning:

  • When young children are in or around water, direct and persistent supervision by and adult with swimming abilities is imperative. The adult should be actively and carefully watching the children, within an arm’s length distance, and not distracted by other adults, his/her phone/electronics, reading, or drinking alcohol.
  • Young children should wear life jackets when they are in or around water.
  • Children should not be allowed to swim alone or under the supervision of another child or sibling.
  • When older children are in or around water, an adult should be present and actively supervising the children, even if the children are considered good swimmers.
  • Establish specific rules and discuss them with your children. For example; no rough play in and around the pool, no head dunking, no diving, no swimming without adult supervision. Establish consequences for not following the rules.
  • During a gathering or party with friends, it is more likely for you to become distracted. So, consider having a rotating designated adult watching the children which could change every 15-20 minutes. In order to make it more intentional, the designated adult could wear a bracelet, badge, or necklace. If there are going to be too many kids or the adults are worried about becoming distracted during the gathering, consider hiring one or more lifeguards to help the designated adult.
  • Consider formal CPR training for you, caregivers, and older children/teens in the house. Having this skill and knowledge could save a life.
  • Prevent young children from having access to water during non-swim times by creating physical barriers like pool fencing, childproof locks, door alarms, pool alarms and weight-bearing, rigid pool covers. If a child is missing, look in the water/pool first.
  • When visiting friends or family, please inspect their house for any potential water dangers. Look for pools, spas, fountains, ponds etc. If the appropriate barriers are not in place, make sure you have direct, constant eyes on your young child at all times during the visit.
  • When vacationing, before renting a house with a pool, please make sure that the pool is properly fenced, and the gates are childproof. Do extensive research of the property and talk to the owner about other possible water dangers that may not have been listed. Once you get there, extensively inspect the surroundings of the property.
  • Young children and toddlers should never be left alone in the bathroom. Toilet locks should be installed, and the bathtub/spa should be emptied immediately after each use.
  • Water from buckets, pails, and other containers should be emptied immediately after each use. Garden features, such as fountains and bird baths, are beautiful, but not appropriate to have if there are young children in the household.
  • Teens crave independence, but remember you are the parent. Establish specific, well defined rules and consequences for not following the rules. Make sure your teen has had formal swimming training. Teens, just like young children, should not swim alone. Remind them of the dangers of swimming under the influence of alcohol and drugs. Encourage them to wear a life jacket when in a boat, jet ski, or on any watercraft. It is important to know the depth of the water before considering diving, as diving in shallow water can be extremely dangerous and cause serious injuries and even death.

I’m not asking for parents to live in fear, but to be alert, aware, vigilant and present when it comes to their child’s safety around water.

Please help me raise water safety awareness and keep Kaden’s memory alive…share this article with your family and friends.

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Resources:

AAP-Updates Recommendations to Prevent Drowning in Children

AAP publications- Prevention of drowning

Water Safety For Young Children

Healthychildren.org-swim lessons

Healthychildren.org- water safety for teens

Healthychildren.org-Pool-Dangers-Drowning-Prevention-When-Not-Swimming-Time

AAP-prevention of drowning: updated policy

Disclaimer: The content in this blog is not to be considered medical advice and it is not intended to replace the relationship you have with your primary care provider. If you have specific questions, please contact your physician.

Guide for physical activity and screen time for preschoolers.

What’s the right balance between active time and sedentary time for young children? How many hours should your baby or preschooler be sleeping? Is it OK if my baby watches TV? If you don’t know the answers to this questions…keep reading.

Lee En Español

The World Health Organization (WHO) has just released guidelines for children under age 5, proposing the adequate amount of physical activity, sedentary activity (including screen time), and sleep a child must get in any given day.  The reasoning behind these guidelines is that by increasing the overall time a child is being physically active while decreasing sedentary activities we can reduce their risk of developing obesity and improve well being in general. The importance of getting the proper amount and quality of sleep were also well described on the recommendations. This is the first time WHO releases guidelines on these topics for these age groups.

Here are the recommendations at a glance:

Child’s age Sleep Time Recommendations Physical Activity Recommendations  Screen Time Recommendations
Infants- less than 1 year old  

0-3 months:14 to 17 hours; 4-11 months:12 to 16 hours

 

At least 30 minutes

 

No screen time.
1 to 2 years old 11 to 14 hours of good quality sleep At least 180 minutes  

1-year of age:  No screen time; 2 years of age: 1 hour or less

 

3 to 4 years old 10 to 13 hours of good quality sleep At least 180 minutes  

1 hour or less

 

How important is sleep for children?

​​​​​​​​​​Getting the appropriate amount and quality of sleep is tremendously important. Some experts say it is as important as getting the proper nutrition and amount of physical activity. Adequate sleep duration improves a child’s level of alertness, mood, behavior, memory and learning abilities. Shorter sleep duration can affect your child’s safety (more prone to accidents), emotional regulation, growth, and weight. So, establishing healthy sleep habits for your children right from the start seems like a good idea.

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Tell me again…What are the sleep recommendations just released by The World Health Organization (WHO)?

The daily recommendation for good quality sleep, including naps is as follows:

  • Infants younger than 1 year:
    • 0 to 3 months: 14 to 17 hours
    • 4 to 11 months: 12 to 16 hours
  • Children 1 to 2 years old: 11 to 14 hours, should attempt regular schedule of sleep/wake-up times.
  • Children 3–4 years old: 10–13 hours, with regular sleep/wake-up schedules

How do these recommendations compare with the  American Academy of Pediatrics (AAP) sleep recommendations?

They are pretty much the same…The AAP recommends:

  • 12 to 16 hours of sleep for infants younger than 1
  • 11 to 14 hours of sleep for children ages 1 to 2
  • 10 to 13 hours of sleep for children 3 to 5 years old.

These also reflect total of sleep in a 24-hour period and consider naps.

How important is physical activity for children?

Extremely important! We all know this but sometimes its difficult to commit to being physically active. Our schedules are packed with multiple responsibilities, but we must make time to stay active. Here are some facts that might help you make a different choice when it comes to your family.

It is well described and researched that physical activity decreases the incidence of obesity in all age groups. Alternatively, physical inactivity is a leading risk factor for global mortality. Kids who are physically active have superior motor skills, fitness, muscular strength, endurance, and bone/skeletal health. In addition to the physical benefits of increased activity, it improves psychosocial wellbeing and cognitive performance, and reduces the risk of depression. So, it seems like a no brainer to encourage not only your child but the whole family to be physically active. Remember, you should be a role model for your children, so stay active.

children wearing pink ball dress

OK! So now that you are on board…Let’s look at the recommendations for physical activity in more detail:

  • Infants younger than 1 year of age: should be active several times a day for a total of 30 minutes…ideally through floor play while interacting with a parent or caregiver.
    • If the infant is not mobile, do tummy time several times a day (WHILE AWAKE) for a total of 30 minutes. Remember infants should NEVER sleep while on tummy time, especially if unsupervised!
  • Children 1 to 2 years old should do 180 minutes of physical activity spread through the day at any intensity (can include moderate to vigorous activity but not required).
  • Children 3 to 4 years old should do 180 minutes of physical activity spread through the day (should include at least 60 minutes of moderate to vigorous intensity activity).

How does these recommendations for physical activity compare with other agencies recommendations?

Both the Centers for Disease Control and Prevention (CDC) and the AAP recommend that school-age children get at least 60 minutes of daily moderate to vigorous physical activity that is age and developmentally appropriate. They currently don’t have formal recommendations for preschool age kids.

Why is sedentary time a big deal?

In the previous section I pointed out that being physically active is essential in order to stay healthy. There’s nothing wrong with allowing children to have some quiet time or resting time; but we must make sure we are not allowing them to spend most of the day being sedentary.

For the purpose of the guidelines, sedentary behavior was defined as any passive behavior which didn’t involve active movement including time spent restrained in car seat, high-chair, stroller, or in a carrying device or on a caregiver’s back ; while screen time was defined as time spent passively watching screen-based entertainment (TV, computer, mobile devices).

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Remind me…what are the recommendations for sedentary behavior?

  • Infants younger than 1 year old:
    • Should not be restrained for more than 1 hour at a time
    • No screen time
    • When sedentary, reading and storytelling with parent or caregiver is preferred
  • Children 1 to 2 years old:
    • Should not be restrained or sit for more than 1 hour at a time
    • No screen time for 1-year old children; 1 hour of screen time for 2-year-old children
    • When sedentary, reading and storytelling with parent or caregiver is preferred
  • Children 3 to 4 years old:
    • Should not be restrained or sit for more than 1 hour at a time
    • Screen time 1 hour or less
    • When sedentary, reading and storytelling with parent or caregiver is preferred

How do these recommendations compare to the American Academy of Pediatrics (AAP) screen time recommendations?

They are very similar to the AAP guidelines on screen time. In general, the AAP similarly recommends avoiding digital media use for children younger than 24 months and to limiting screen time to an hour a day for children 2 to 5.

However, the AAP guidelines are not as strict, for example the use of video-chatting for the 18- 24-month age group is allowed. They highlight that if parents choose to introduce digital media to their 18-24-month children, they should only pick high-quality programming and use the media with their children.

These recommendations are quite strict…how do I put them to practice?

I know!  Remember the recommendations are just a guide to provide parents with some parameters to follow when planning their children’s daily routines and schedules. Sometimes stern rules can produce guilt or frustrations for the parents, but it is ultimately your job to decide what works best for you and your family. Most families are so busy, and over-scheduled that it is easy to overlook how much TV our children watch or for how long they sit around.

I think the key to success is to find a balance that allows your family to function. Ultimately, be kind to yourself …if you must finish dinner, or finish doing homework with one of your older kids, it’s probably OK if your toddler or preschooler gets an extra 15 or 20 minutes of screen time.

Let’s promote healthy habits right from birth!

I like this is a great family media plan  resource for parents…check it out.

Resources:

www.washingtonpost.com-WHO-Infants-under-Year-Old-shouldn ‘ t-be-exposed to-any-Electronic-Screens/

www.nytimes.com-health/screen-time-kids

www.usatoday.com-phone-tv-screen-time-not-healthy-babies-some-toddlers-

https://apnews.com

www.cnn.com-health/child-recommendations-exercise-sleep-screens

www.aap.org

https://slate.com/technology/2019/04/screen-time-world-health-organization-limits.html

WHO guidelines

www.aap.New-Recommendations-for-Childrens-Media-Use.aspx

https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Children-and-Media-Tips.aspx

https://pediatrics.aappublications.org

https://www.healthychildren.org/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need

https://www.uptodate.com/physical-activity-and-strength-training-in-children-and-adolescents-

https://pediatrics.aappublications.org

Disclaimer: The content in this blog is not to be considered medical advice and it is not intended to replace the relationship you have with your primary care provider. If you have specific questions, please contact your physician.