Your Toddler

Post-Tonsillectomy Codeine May Pose Dangers

A new report warns about the potentially deadly dangers of giving codeine to children after a tonsillectomy.  The report appears in the New England Journal of Medicine. It follows the death of an otherwise health two-year-old boy who was prescribed codeine to relieve pain from having his tonsils removed. The child, who had a history of snoring and sleep apnea, had the surgery in an outpatient clinic and was sent home, the researchers said.

Doctors prescribed codeine syrup and told the boy's mother to give it to him for pain, but two nights later, the child developed a fever and wheezing. He was found dead the next morning, according to the report. Toxicology tests showed that the mother had given the child the proper dosage, but the coroner found that the child had high levels of morphine in his system. Further investigation determined that the child had an ultra-rapid metabolism genotype, which causes the body to metabolize codeine at a faster rate than the norm. Codeine, is a narcotic used to treat mild to moderate pain and is metabolized by the body to morphine. In children with the ultra-rapid genotype, morphine can build to deadly concentrations. "The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," said Dr. Gideon Koren, a pediatrics professor at the University of Western Ontario and University of Toronto and author of the report. "And more and more of them are done on an outpatient basis, with the child going home the same day." The gene is present in slightly more than 1 percent of whites, but as many as 30 percent of people of African origin could have it. Enlarged tonsils are usually treated with antibiotics, but tonsillectomies are still used to treat sleep apnea, the study authors noted. Parents whose children are prescribed codeine should also be aware that codeine can suppress breathing, which is potentially dangerous if the tonsillectomy doesn't cure the sleep apnea. "This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists," Koren said.

A new report warns about the potentially deadly dangers of giving codeine to children after a tonsillectomy.  The report appears in the New England Journal of Medicine. It follows the death of an otherwise health two-year-old boy who was prescribed codeine to relieve pain from having his tonsils removed. The child, who had a history of snoring and sleep apnea, had the surgery in an outpatient clinic and was sent home, the researchers said.

Doctors prescribed codeine syrup and told the boy's mother to give it to him for pain, but two nights later, the child developed a fever and wheezing. He was found dead the next morning, according to the report. Toxicology tests showed that the mother had given the child the proper dosage, but the coroner found that the child had high levels of morphine in his system. Further investigation determined that the child had an ultra-rapid metabolism genotype, which causes the body to metabolize codeine at a faster rate than the norm. Codeine, is a narcotic used to treat mild to moderate pain and is metabolized by the body to morphine. In children with the ultra-rapid genotype, morphine can build to deadly concentrations. "The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," said Dr. Gideon Koren, a pediatrics professor at the University of Western Ontario and University of Toronto and author of the report. "And more and more of them are done on an outpatient basis, with the child going home the same day." The gene is present in slightly more than 1 percent of whites, but as many as 30 percent of people of African origin could have it. Enlarged tonsils are usually treated with antibiotics, but tonsillectomies are still used to treat sleep apnea, the study authors noted. Parents whose children are prescribed codeine should also be aware that codeine can suppress breathing, which is potentially dangerous if the tonsillectomy doesn't cure the sleep apnea. "This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists," Koren said.

Your Toddler

Preschool Lunch Isn’t Always Nutritious

Parents may be sacrificing nutrition by giving their children the food they like when packing their preschoolers lunch. That's one of the conclusions of a new study in the January 2009 issue of the Journal of the American Dietetic Association. The study found that 71 percent of packed lunches didn't have enough fruits and vegetables and that one in four preschoolers didn't get enough milk with lunch.

"What we found primarily was that parents weren't sending in as many fruits and vegetables and whole grains as they should, and the number of milk servings was low, too," said study author Sara J. Sweitzer, a registered dietician and a doctoral candidate at the University of Texas at Austin. The study was triggered by a recent change in Texas day-care regulations that allow day-care programs to stop providing meals and snacks. A subsequent survey found that about half of child-care centers in two Texas counties had chosen to do just that. But they survey also reported that directors of those centers said that children were being given chips, prepackaged lunches and "junk food" by their parents. Vegetables, fruits and whole grains were rarely included. To determine whether or not these results were true, Sweitzer and her colleagues interviewed the parents of 74 children from five day-care centers. All of the children were between three and five years old and most were white and from families headed by two adults. The children's lunches were observed for a three-day period so the researchers could accurately assess the nutritional content. 67 percent of the parents interviewed said they packed nutritious food, even though they thought their child probably wouldn't eat them. 63 percent said they packed foods they knew their child would eat. Milk was available at the child-care center, but the child had to request it. According to the study, only 29 percent of the packed lunches contained adequate fruits and vegetables and only 20 percent of the children had a milk serving at lunch. 11 percent didn't get enough whole grains. "Fruits and vegetables and whole grains need to be presented on a regular basis," said Sweitzer, adding, "With chronic disease issues such as type 2 diabetes on the rise, this becomes a very key time to educate this child about nutrition." The easiest thing to do, she suggested, is to pack up some of the previous night's dinner to be reheated in a microwave, which is usually available at child-care centers.

Tags: 
Your Toddler

Deafness After Mumps More Common Than Thought

New research out shows that mumps-related hearing loss in children may be 20 times more common than previously suggested. "Deafness is rare but important complication of mumps virus infection," the researchers from Japan's Hashimoto Pediatric Clinic in Osaka wrote in a report in The Pediatric Infectious Disease Journal. The researchers determined the incidence of sudden hearing loss in children with mumps based upon a population-based office survey of more than 7,500 patients from 40 pediatric practices in Japan, a country where mumps is constantly present.

Among 7400 children who took hearing tests after the onset of mumps, seven or 0.1 percent had confirmed hearing loss. Hearing loss in the seven children was confined to one ear but was "severe and did not improve over time," the researchers note. None of the 7 children with mump-related hearing loss had been vaccinated against the mumps. In a commentary on the Japanese report, Dr. Stanley A. Plotkin from the University of Pennsylvania, Doylestown, highlights the lack of universal mumps vaccination in Japan. The absence of vaccination against mumps is "surprising for a developed country," Plotkin wrote, "and this regrettable policy must be changed for the sake of Japanese children."

Tags: 
Your Toddler

Magnets in Toys Pose Broad Dangers

Parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets.When giving your child toys this holiday season, parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets. That is the warning from a new study conducted by the Cincinnati Children's Hospital Medical Center. When ingested, multiple magnets can stick together across a bowel wall, leading to infection in the digestive tract, the need for surgery and even death. The study also found that parents often don't seek medical attention for a child who has swallowed a magnet as quickly as necessary.

The findings are based on the analysis of 121 magnet-swallowing cases in 21 counties and were published online in the journal Pediatric Radiology. "The majority of swallowed magnetic objects were components of toy sets, including many well-known brands," study author Dr. Alan Oestreich, a professor of radiology at Cincinnati Children's, said in a hospital news release. "Many of the children represented in the survey were 5 years of age or younger and dependent on their parents or guardians to ensure they do not have access to multiple small magnets." The authors urged parents to pay particular attention when buying toys for small children as written warnings are not mandatory on toys containing magnets. Symptoms of ingested magnets can be mild and flu-like, but nausea, vomiting, cramps or abdominal pain should be given medical attention.

Tags: 
Your Toddler

Seven Tips For Toddler Discipline

2.15 to read

Toddler-hood is a particularly vexing time for parents because this is the age at which children start to become more independent and discover themselves as individuals. Yet they still have a limited ability to communicate and reason. "They understand that their actions matter -- they can make things happen," says Claire Lerner, LCSW-C, child development specialist and director of parenting resources for the organization Zero to Three. "This leads them to want to make their imprint on the world and assert themselves in a way they didn't when they were a baby. The problem is they have very little self-control and they're not rational thinkers. It's a very challenging combination." So how do you deal with a child who screams every time you try to give him or her a bath, and whose vocabulary seems to consist of just one word -- "no"? Here are a few simple toddler discipline strategies to help make life easier for both you and your child. Toddler Discipline Secret No. 1: Be Consistent Order and routine give young children a safe haven from what they view as an overwhelming and unpredictable world, says Lerner. "When there's some predictability and routine, it makes children feel much more safe and secure, and they tend to be much more behaved and calm because they know what to expect." Try to keep to the same schedule every day. That means having consistent nap times, mealtimes, and bedtimes, as well as times when your toddler is free to just run around and have fun. When you do have to make a change, it helps to warn your child in advance. Telling your child, "Aunt Jean is going to watch you tonight while Mommy and Daddy go out for a little bit" will prepare her for a slightly different routine, and will hopefully prevent a scene at bedtime. Consistency is also important when it comes to discipline. When you say "no hitting" the first time your child smacks another child on the playground, you also need to say "no hitting" the second, third, and fourth times your child does it. Toddler Discipline Secret No. 2: Avoid Stressful Situations By the time children reach the toddler stage, you've spent enough time with them to know their triggers. The most common ones are hunger, sleepiness, and quick changes of venue. With a little advance planning, you can avoid these potential meltdown scenarios and keep things relatively calm. "You have to anticipate, which means you don't go to the grocery store when your child needs a nap," says Lisa Asta, MD, a pediatrician in Walnut Creek, Calif., and associate clinical professor of pediatrics at the University of California, San Francisco. Try to make sure your child is home at naptimes, bedtimes, and mealtimes. If you are out, always keep food on hand in case of a sudden hunger attack. Keep excursions short (that means finding another restaurant if the one you've chosen has an hour-long wait, or doing your grocery shopping at times when the lines are shortest). Finally, plan ahead so you don't have to rush (particularly when you need to get your child to preschool and yourself to work in the mornings). You can ease transitions by involving your child in the process. That can be as simple as setting an egg timer for five minutes, and saying that when it rings it's time to take a bath or get dressed, or giving your child a choice of whether to wear the red shirt or the blue shirt to school. Toddler Discipline Secret No. 3: Think Like a Toddler Toddlers aren't mini-adults. They have trouble understanding many of the things we take for granted, like how to follow directions and behave appropriately. Seeing the scenario from a toddler's perspective can help prevent a tantrum. "You might say, 'I know, Derek, you don't like getting into the car seat ... but it's what we have to do,'" Lerner explains. "So you're not coddling, but you're validating their feelings. You have to set the limit, but you do it in a way that respects the child and you use it as an opportunity to help them learn to cope with life's frustrations and rules and regulations." Giving choices also shows that you respect your toddler and recognize the child's feelings. Asking your child if he or she wants to bring a favorite book in the car, or take along a snack, can make the child feel as though he or she has some control over the situation while you remain in charge, Lerner says. Toddler Discipline Secret No. 4: Practice the Art of Distraction Make your toddler's short attention span work for you. When your child throws the ball against the dining room wall for the 10th time after you've said to stop, it's pretty easy to redirect your child to a more productive activity, like trading the ball for a favorite book or moving the game outside. "Parents need to create an environment that is most conducive to good toddler behavior," advises Rex Forehand, PhD, the Heinz and Rowena Ansbacher Professor of Psychology at the University of Vermont and author of Parenting the Strong-Willed Child. "If they're into something they're not supposed to do, the idea is not to punish them but to get another activity going or pick them up and put them in another room." Toddler Discipline Secret No. 5: Give Your Child a Break Time-outs are one of the foundations of child discipline, but they may not be the best approach for the toddler stage. The negative implication of being sent away can teach kids that they're bad, rather than promote good behavior. If you do give your child a time-out, limit it to just a minute or two at this age. Instead of calling it a time-out, which can be confusing to children under 3, refer to it as something more positive. Lerner suggests creating a "cozy corner," a safe place, free from distractions and stimulation, where your child can just chill out for a few minutes until he or she can get back in control. That time away can help you regroup, as well. Correct bad behaviors, but also take the time to praise good behaviors. "If you don't tell your child when they're doing the right thing, sometimes they'll do the wrong thing just to get attention," Asta says. When you tell your toddler he or she has done something good, there's a good chance your child will want to do it again. Toddler Discipline Secret No. 6: Stay Calm When you're standing in the middle of the mall, looking down at your child who's screaming on the floor, and trying to ignore the stares of the shoppers around you, it's easy for your blood pressure to reach the boiling point. It's hard to stay calm, but losing control will quickly escalate an already stressful situation. Give yourself some time to cool off, advises Forehand. "Otherwise, you're venting your own anger. In the end that's going to make you as a parent feel worse and guilty, and it's not going to do your child any good." "I call it the "Stepford Wife" approach," Lerner says. As your child screams, say, 'I know, I know,' but stay completely calm as you pick him up. Don't show any emotion. Sometimes the best tactic is to ignore the behavior entirely. "You just literally act like they're not doing what they're doing. You ignore the behavior you want to stop," Lerner says. When your child realizes that his screaming fit is not going to get him a second lollipop or your attention, eventually he'll get tired of yelling. Your child may drive you so close to the breaking point that you're tempted to spank him, but most experts warn against the practice. "When we spank, kids learn that physical punishment is acceptable. And so we are modeling exactly what we don't want our kids to do," says Forehand. At the toddler stage, redirection and brief breaks are far more effective discipline tactics, Forehand says. Toddler Discipline Secret No. 7: Know When to Give In Certain things in a toddler's life are nonnegotiable. She has to eat, brush her teeth, and ride in a car seat. She also has to take baths once in a while. Hitting and biting are never OK. But many other issues aren't worth the headache of an argument. Pick your battles. "You have to decide whether it's worth fighting about, and about half the time it's not worth fighting about," Asta says. That means it's OK to let your son wear his superhero costume to the grocery store, or read The Giving Tree 10 times in a row. Once he gets what he wants, you can gradually get him to shift in another direction -- like wearing another outfit or picking out a different book to read. Finally, know that it's OK to feel stressed out by your toddler sometimes. "Realize that none of us as parents is perfect -- we do the best we can. There are going to be days that we're better at this than other days," Forehand says. "But if we parent consistently and have consistent rules, then we're going to see more good days than bad days."

Your Toddler

Babies, Toddlers and Discipline

2.00 to read

In a previous article we looked at the results of a study on whether spanking your child creates more disobedience instead of controlling bad behavior.  According to the research in this particular study, spanking is not an effective form of discipline; in fact, it’s not discipline at all. It only creates more problems down the road.

So, what are some better alternatives to getting your child to behave? 

The first step is to understand what discipline is and how it works. Discipline is not punishment.

Punishment, defined by the Merriam-Webster dictionary is: suffering, pain or loss that serves as retribution or a severe, rough or disastrous treatment.

That’s not the goal of loving parents who are trying to stop a child’s unacceptable behavior.

Discipline, on the other hand, is about teaching. It helps a child learn what is expected and to gradually learn how to control their behavior.  Children learn best when they feel safe and secure and their “good behavior” is encouraged.  The key is to have a good relationship with your child as well as clear and realistic expectations.

There is no one discipline tool that fits all, but there are some guidelines for different age groups. As children mature, techniques need to change to fit your child’s mental and physical growth.

Ages 0-1 years of age (Infants):

Infants should never be disciplined. They are not capable of understanding the meaning of words or able to remember what you’ve asked of them. You’d think that this would be obvious, and to most parents or caregivers it is. But there are some people who don’t get it and not only try to discipline their baby, but get angry when the infant doesn’t do what they want.  Babies are not little adults who have an agenda. They are merely babies and depend entirely on their parents or caregivers for survival.

Loving touches and gentle words are just as important as food and clothing to these little ones.  They need to learn that their world is a safe and nurturing place and that they can trust those around them.  A baby never does anything to deliberately annoy someone. They simply aren’t capable of that kind of manipulation.

Ages 1-3 (Toddlers)

These are the ages when children first sample the world around them through mobility and touch. They are curious, excited and easily frustrated. They learn through touching and moving and oftentimes creating a mess. They get frustrated because they don’t have the skills to accomplish everything they want.  The word “no” can become a part of their limited vocabulary.

Discipline at this age is about setting a few simple boundaries and helping them learn new skills with patience and praise.

Avoid battles, particularly with eating and toilet training. It’s not a war between you and your toddler. Making a mess is normal. This age group demands a lot of attention and patience. Re-directing and praise works better than a constant stream of you saying “no, no, no.” The word no loses its power when repeated constantly.

Toddler-proof your home: The best way to help a toddler stay out of a dangerous situation, or not grab something you don’t want them to have, is to toddler-proof your home. Cover electrical outlets with plastic snap-ons. Move breakable objects to a higher place in the house. Make sure coffee tables don’t have sharp corners.  Secure your TV to the wall and make sure that bookcases are secured. Anything they climb on or pull over needs to be anchored. Make sure that drawers and cabinets cannot be accessed. Put in place kid-safe products designed to block access to these areas.

Toddlerhood is a challenging time, no doubt about it.  They have little self-control and are not rational thinkers. They want to be independent and discover things for themselves but don’t have the communication skills and forethought needed to do so safely so it’s up to you, the parent, to help keep them safe.

Routines, order and consistency: Routines, order and consistency are very important to helping this age feel that the world around them is a safe place. This means regular nap times, meal times and bed times as well as free time to play and explore.  

Since they are just beginning to experience a little independence, toddlers need to know what you expect of them. Terms have to be simple; consequences quick. If your child bites or hits or grabs the cat by the tail, you respond quickly with the appropriate words. “ Do not bite”, “Do not hit,”  “ Do not pull the kitty’s tail”.  Say it every time it happens, and redirect your child to an activity that you can praise. Be consistent in the idea that there are certain actions that are not acceptable and others that are not only acceptable, but also more interesting.

Avoid stressful situations. You’ve spent enough time with your child to know that there are situations that often trigger bad behavior. The most common ones are hunger, sleepiness, and quick changes of venue. Avoid these potential meltdown scenarios with a little advance planning. An example would be that you wouldn’t take your toddler to the grocery store when you know they haven’t had a nap or are hungry. You can pretty well predict how that is going to go.

If you’re taking your child out, keep excursions short unless it’s to the park or playground. Even those trips should have a time limit that you know works well.

Restaurants can be tricky with a toddler. There is a lot of stimulation and not a lot of room for exploring. Find “family friendly” locations and try not to go during the busiest times. If a meltdown occurs, take your child outside, explain the situation in a calm voice and redirect their attention again until he or she calms down. 

Validate their emotions: Let your child know you understand their frustration. Validate their emotions. “I know you don’t like the car-seat, but we have to use it when you ride in the car.” It’s not coddling, it’s validating their feelings but also setting boundaries. When we ride in the car- you’ll be in the car seat. I understand you don’t like it.

You can also bring something your child likes to hold – a stuffed animal, blanket or toy. You can offer a healthy snack or give them a choice between the two, so they feel like they have a measure of control in their life. It’s a learning experience every day for parents as well as toddlers.

Time-outs? A lot has been made of “time-outs.” Time-outs are helpful when used as a discipline tool, but typically they don’t work well for toddlers. They are too young to really understand what it is you’re asking of them and it can be too confusing.  Distraction and redirecting tend to work better for this age.

Praise good behavior: You can correct bad behavior, but don’t forget to praise good behavior.  When a little one only hears what they are doing wrong, they don’t get a sense of the difference between acceptable and unacceptable behavior.  Sometimes re-phrasing in a more positive tone helps. “The puppy likes to be petted, not have her tail pulled. Let’s pet the puppy like this. Look- see the puppy likes that – you’re such a good puppy petter!”

Stay calm: Toddlers can push your buttons.  It’s important to stay calm and to know when you’re getting too upset to parent well.  Losing control can quickly escalate into yelling, hitting and doing or saying something you regret. If your child is home and having a tantrum or repeating the same behavior over and over, give yourself some time to cool down.

When they are in a safe environment like the home, ignoring the tantrum may work best. Sometimes, you just have to let them exhaust themselves while screaming, lying on the floor and flailing about. It’s part of learning that they won’t always get what they want.

Once they settle down, hug them and let them know that you love them and then find something better to do. 

Toddlers will test your patience, your sanity and your self-control. They’ll also make you find creative ways to teach them. Each child is different and requires an approach tailored to their personality and maturity.

And yes, sometimes you reach a point where the battle is more damaging than giving in. Be flexible and give in, but redirect the behavior towards something that you want them to learn or do.

“Alright, mommy is going to give you this piece of candy, and then you’re going to help me put away your building blocks. That’s the way we’re going to make this moment work for both of us. Sound good?”

Toddlers and babies are precious little beings that can make your heart burst with joy and love. Yes, they can be demanding, but they are so worth the extra effort.

In later posts we’ll look at discipline techniques for older children.

Sources: Stephanie Watson, http://www.webmd.com/parenting/guide/7-secrets-of-toddler-discipline

http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=122&id=2429

Your Toddler

Liquid Nicotine Poisonings up 300 percent!

2.00 to read

Most people are familiar with e-cigarettes. New e-cigarette stores are popping up almost every day. City councils around the country are debating the pros and cons of setting age limits to buy them and banning them in places where smoking cigarettes is already forbidden.

There’s another e-cigarettes related story that’s is much more alarming that is beginning to surface - the potentially deadly liquids that are often bought and used to refill the e-cigarette vaporizer.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

According to an article in The New York Times, e-liquids are being mixed on factory floors and in the back rooms of shops.

Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

Many users, unaware of the toxicity of the ingredients, are casually leaving replacement bottles around the house where children are finding and ingesting them.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Nationwide, the number of poison cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals - triple the previous year’s number.

As two examples, of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year, involved children age 4 and under. That age group is considered typical.

The e-liquids are much more dangerous than tobacco because liquid is absorbed quickly into the skin, even in diluted concentrations. Initially, many of the e-cigarette brands were disposable devices that looked like regular cigarettes. However, many of the newer e-cigarette vaporizers are larger and can be refilled with liquid that is generally nicotine, flavorings and solvents.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The FDA has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue.

Chip Paul, chief executive officer of Palm Beach Vapors, a company that operates 13 e-cigarette franchises, estimates that there will be sales of one to two millions liters of liquid used to refill e-cigarettes.

If you look online, you can buy e-liquids anywhere from a liter to 55 gallon containers with 10 percent nicotine concentration.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

The nicotine levels in e-liquids can vary. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet.

A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

Many people believe that e-cigarettes are a new and valuable tool in the battle to quit smoking. The science isn’t there yet to say whether they actually help or just replace conventional cigarette addiction. But one thing is for sure, if you have e-cigarettes and in particular, e-liquid refill containers in the home, they should be kept out of a child’s eyesight and reach.

Source: Matt Richtel, http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=1

Your Toddler

Parents Ignore New Car Seat Recomendations

1.45 to read

I have been surprised at the number of parents I have seen lately, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.I have been surprised at the number of parents I have seen, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.

I try to discuss car seat safety at each check-up appointment, and have always been especially mindful of doing this at the one-year check up. A new policy (April 2011) by colleagues at the American Academy of Pediatrics recommends what I have been discussing for a while now: children up to age two should remain in rear-facing safety seats. The new policy is supported by research that shows children younger than 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing. So how did we get here? Original recommendations (established in 2009), I had followed with my own patients. I discussed turning the car seat to a forward facing position if the child had reached 12 months and 20 pounds. Then in April, an article was published (Inj Prev. 2007;13:398-402), which was the first U.S. data to substantiate the benefits of toddlers riding rear facing until they are two years of age. This study showed that children under the age of two are 75 percent less likely to die or experience a serious injury when they are riding in a rear-facing. That is a fairly compelling statistic to keep that car seat rear-facing for another year! Studies have shown that rear-facing seats are more likely to support the back, neck, head and pelvis because the force of a crash is distributed evenly over the entire body. Toddlers between the ages of 12 and 23 months who ride rear facing are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat. There has also been concern that rear-facing toddlers whose feet reach the back of the seat are more likely to suffer injuries to the lower extremities in a car accident. But a commentary written by Dr. Marilyn Bull in Pediatrics (2008;121:619-620) dispelled the myth with documentation that lower extremity injuries were rare with rear-facing seats. So, it has now been over two years since this data was published and recommended, and parents continue to say, “I just turned the seat around any way” or “I didn’t know.” I did go look at car-seats the other day and I noted that the labeling on the boxes had all been changed to recommend rear facing until two years or until a toddler reaches the maximum height and weight recommendations for the model. I take this to mean that some “small” toddlers could even rear face longer as they do in some European countries. For safety sake, rather than convenience, keep that car seat in the rear facing position. I wonder if they will begin putting DVD players and cup holders facing toward these toddlers, as that seemed to be a concern of many parents. Maybe this will make it “okay” to listen to music or talk while in the car rather than watching TV, at least until a child is older!! If you need references on car seats go to http://www.nhtsa.dot.gov or http://www.seatcheck.org Send your question or comment to Dr. Sue!

Your Toddler

Anchor It!

1:45

The U.S. Consumer Product Safety Commission (CPSC) has launched “Anchor It”, a national public education campaign, to help make people aware of the dangers that free-standing furniture and TVs present, particularly to children.

The annual number of children injured or killed from furniture and TV tip-overs is astounding.

According to CPSC data, unstable and unsecured TVs and large pieces of furniture kill a child every two weeks, on average, in tip-over incidents that are easily preventable.  CPSC also reported that 38,000 Americans go to emergency rooms each year with injuries related to tip-overs of top-heavy furniture or televisions placed on furniture, instead of a TV stand.  Two-thirds of those injuries involved children younger than 5.  Additionally, between 2000 and 2013, 84 percent of the 430 deaths reported to CPSC involved children younger than 10.

A January 2015 CPSC report found that a television tipping over from an average size dresser falls with thousands of pounds of force. 

The impact of a falling TV is like being caught between two NFL linemen colliding at full-speed—10 times. 

“Every 24 minutes in the U.S. a child goes to the emergency room because of a tip-over incident involving furniture or a TV,” said CPSC Commissioners Marietta Robinson and Joseph Mohorovic. “We must take action now. CPSC’s new ‘Anchor It!’ campaign is a call to action for parents and caregivers to ‘get on top of it, before they do.’ If we can prevent one more death, it will be worth it.”

Cards and posters are being distributed parents and caregivers of toddlers at daycare centers and preschools. A list of safety steps parents and caregivers can take are printed on the handouts. They are:

·      Buy and install low-cost anchoring devices to prevent TVs, dressers, bookcases or other furniture from tipping.

·      Avoid leaving items, such as remote controls and toys, in places where kids might be tempted to climb up to reach for them.

·      Store heavier items on lower shelves or in lower drawers.

·      Place TVs on a sturdy, low base and push them as far back as possible, particularly if anchoring is not possible.

·      If purchasing a new TV, consider recycling older ones not currently used. If moving the older TV to another room, be sure it is anchored properly to the wall.

The “Anchor It” campaign’s website (www.Anchorit.gov) shows you how to anchor furniture and television sets properly, with easy to follow instructions. Keep your little one safe and Anchor It!

 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.