Author: Vincent Iannelli, MD

Keep Your Kids Safe from These Hidden Dangers

Did you know that you could break your child's leg while going down a slide together?
Did you know that you could break your child’s leg while going down a slide together?

Accidents are the leading cause of death for kids, with drownings, car accidents, fires, shootings, and poisonings at the top of the list.

But that doesn’t mean that you should ignore all of the other less common causes of accidents.

Did you know that riding down a slide with your kid on your lap is a common way to break their ankle or leg?

If you did, would you still ride down with them?

You can see Meadow’s leg breaking (her foot is going in the wrong direction) as she is going down the slide with her mom. Few people know this can happen and we are lucky that Meadow’s mom continues to tell her story, so that we don’t have to worry about unintentionally hurting our kids.

A few weeks later, another mom posted a video of her son’s leg breaking as they went down a slide in the UK.

Surprisingly, the AAP has actually already warned parents that “going down a slide on a parent’s lap can lead to a broken leg for small children.”

Did you know about that warning?

Keep Your Kids Safe from These Hidden Dangers

Tragically, there are other parents out there that have stories to tell about all of the other hazards listed below.

You can’t raise your kids in a bubble, but just remember that the more risks that you take, then the more likely it is that your kids will eventually get hurt.

Be careful and be mindful of these often overlooked dangers:

  • TV and furniture tip-oversanchor furniture and TVs so that they don’t tip over and hurt your kids
  • ATVs – as injuries and deaths continue, the AAP continues to say that children and teens under age 16 years should not ride on all-terrain vehicles
  • hands, feet, untied shoes, or sandals that get trapped in escalators – tie shoes, stand in the center of the step, and hold the rail
  • elevators
  • falls from shopping carts – kids are frequently hurt in shopping cart falls and tip over incidents, which is why you shouldn’t let your kids ride in  or on a shopping cart
  • inflatable slides and bounce houses – videos of bounce houses flying away are certainly rare examples of safety hazards, but as the use of these inflatables because more common, so do the injuries
  • glass-topped tables – avoid if not made with tempered glass
  • inflatable air mattresses – suffocation danger for infants and younger toddlers if put to sleep on an air mattress
  • bunk beds – should have a guardrail on the top bunk, which should be restricted to kids who are at least 6-years-old
  • high water – don’t drive through high water – Turn Around Don’t Drown – and watch for hazards, like downed power lines, during flooding after storms
  • parade floats – falls from parade floats and kids getting run over near parade floats makes planning and supervision important
  • portable pools
  • recalled or broken toys – a toy that has broken might reveal small parts that can be a choking hazard, lead paint that can be ingested, or sharp edges
  • home exercise equipment – young kids can get injured on your stair climber, treadmill, or stationary bike
  • toys with small parts – choking hazard, which makes it important to buy your kids age-appropriate toys
  • lawn mowerslawn mowers are dangerous and cause a lot of injuries, often when you run over a younger child that you didn’t know was there. Keep in mind that the AAP recommends minimum ages of 12 years to use a push mower and 16 to use a riding mower.
  • magnets – can lead to serious intestinal injuries if two or more magnets are swallowed
  • hoverboards – can overheat while be charged, causing fires
  • clothing – hood and neck drawstrings are a safety hazard and should be cut from young children’s clothing
  • paper shredders
  • window blind cords – kids still die after getting strangled in window blind cords
  • balloons – it is important to remember that balloons are a choking hazard for young kids, as they can choke or suffocate on uninflated or broken balloons.
  • pool, spa, and hot tub drains – faulty drain covers can lead to drownings if a child gets stuck to a hot tub drain. Teach your kids to stay away from drains and make sure drain grates or covers meet the latest safety standards.
  • liquid nicotine for e-cigarettes – can be ingested by young children if not stored in a secure place
  • laundry detergent pods – don’t let your kids eat them
  • poisons – household products and medications commonly poison kids and should be stored properly
  • home trampolines – should not be used and can lead to injuries, even when you think you are using them safely
  • BB guns – non-powder guns can serious injure kids and shouldn’t be used by younger kids or without adult supervision
  • loud toys – listen to toys before you let your kids play with them, as some toys with sirens, etc., can get very loud, especially if your child holds it up to their ear
  • windows – install window guards and stops to prevent falls from windows above the first floor because kids can’t fly
  • digging in the sand – playing in the sand is great fun and still safe, as long your kids don’t try to build deep holes that are deeper than their knees, cave-like structures, or tunnels that they crawl into, as these can suddenly collapse on top of them
  • cedar chests – kids have suffocated in cedar chests that lock automatically when closed
  • playgrounds – too little shock-absorbing surface, ropes on playground equipment (strangulation hazard), sharp edges, tripping hazards, and uncoated metal that can get hot and burn in the summer

Keep your kids safe.

Don’t overlook these hidden dangers.

More on Hidden Risks and Dangers to Kids

History of Car Seat Recommendations

We have come along way since the old days when kids would ride around without seat belts in the front seat of the car. Or a bunch of kids would ride packed into the back of a station wagon, also without seat belts.

In those early days, kids weren’t necessarily safe even if they were strapped in while in the car…

In 1938, Popular Mechanics offered instructions on making your own car seat.
In 1938, Popular Mechanics offered instructions on making your own car seat. Problem solved!

A leash might keep your child from jumping out of the car, but offers absolutely no help if you get in an accident.
A leash might keep your child from jumping out of the car, but offers little help if you get in an accident.

Anyone remember when cars didn’t even have seat belts? It’s hard to imagine, but three-point seat belts, the lap and shoulder harnesses that we use today, didn’t become standard in cars until 1968. Before that, many cars just had optional two-point lap belts.

Latest Car Seat Recommendations

Do your kids ride safely when they are in the car?

According to the latest recommendations from the American Academy of Pediatrics, kids should ride:

  • in a rear-facing car safety seats in the back seat until they are 2 years of age or reach the weight or height limits of their car seat
  • in a forward-facing car safety seat in the back seat for as long as possible and until they reach the weight or height limits of their convertible or forward-facing car seat
  • in a belt-positioning booster seats in the back seat until they are between 8 to 12 years of age and the car’s lap and shoulder seat belts fit properly
  • with lap-and-shoulder seat belts in the back seat once they have outgrown their booster seats and until they are at least 13-years-old, when they might be ready to ride in front seat

In addition to these updated recommendations, we have seen many improvements in car seats and booster seats, including higher weight limits for rear facing car seats and car seats with harness straps.

History of Car Seat Recommendations

With all of these improvements, it is easy to remember that it wasn’t that long ago that kids rode without car seats.

Pediatricians began pushing folks to use car seats as early as 1971.Although the first car seats were invented in 1962, it wasn’t until 1968 that we got a car seat that could actually protect a child in a car accident. Before that, kids might ride in homemade car seats, safety harnesses, or leashes.

Better car seats followed once the National Highway Traffic Safety Administration issued the most minimum of car seat safety standards in 1971 and pediatricians began to push for routine car seat use. It would still take more than a decade, until 1985, that all states actually required young kids to ride in car seats.

Then, in 1996, the American Academy of Pediatrics issued their first major recommendations about car seat safety. Those recommendations included that infants should ride rear facing until they are at least 20lb or 1 year of age and that rear-facing car seats should be placed in the back seat if a car had a passenger side air bag.

Why issue recommendations if states had already passed car seat laws?

It was in response to an increasing number of air bag deaths, as more and more cars began to have passenger side airbags in the 1980s and 90s. In fact, by 1998, front side passenger side air bags were required on all new cars and light trucks sold in the United States. As we now know, a car seat in the front seat, up close to the air bag isn’t a good idea if you are in an accident and the air bag deploys.

The 1996 recommendations also called for the use of convertible car seats that could be used forward facing after a child’s first birthday and through about 40 pounds, and then booster seats until seat belts fit properly.

In 2002, we were introduced to the LATCH system, which made installing car seats easier. And the idea that school age kids needed to stay in car seats or booster seats a lot longer than most parents thought necessary was introduced. The AAP also clarified that infants should ride rear facing until they are 20lb and 1 year of age.

The 2002 car seat guidelines introduced the idea of booster seat for older kids.
The 2002 car seat guidelines introduced the idea of booster seat for older kids.

And then, in 2011, the AAP published the recommendations that we are still following today.

State car seat laws still haven’t kept up with the latest recommendations from the AAP though. Some still just use age based criteria or have criteria for car seats and booster seats that are far lower than AAP recommendations. And South Dakota still doesn’t even have a booster seat law!

Other Car Safety Recommendations

Of course, car safety isn’t all about car seats and seat belts.

Since the first laws and recommendations about car seats and seat belts, we have also learned:

Are you still sure that your kids are safe in the car?

What to Know About the History of Car Seat Recommendations

Car seat safety recommendations have come along way since kids began riding in cars.

More on the History of Car Seat Recommendations

Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Despite what some folks believe, most pediatricians are very interested in breastfeeding and learning as much as they can to help their families breastfeeding effectively for as long as they wish.

They are not looking to push baby formula or bottles to sabotage a mom’s chances of breastfeeding her baby.

It can help you breastfeed if you get ongoing support.
Your pediatrician should give you ongoing support to help you breastfeed effectively.

And they will typically do anything to help the mom breastfeed, as well as make sure the baby is getting enough to eat. At least they will do anything that has some evidence to show that it is effective.

Chiropractic for Breastfeeding Problems

Will they refer their babies to a chiropractor for extra help with breastfeeding?

“Chiropractic manipulation in children who are < age 12 years is considered unproven and not medically necessary as a treatment for any diagnosis as there is insufficient published evidence to assess the safety and/or impact on health outcomes in the pediatric population.”

Chiropractic Spinal Manipulation in Children

Probably not, as there is no real evidence that it would help. Unfortunately, well meaning pediatricians do often refer their patients to lactation consultants who may then recommend further management by a chiropractor.

Why?

“Based on their case studies and the volumes of previous research, these researchers concluded that subluxations and the neurological interference they cause play a major role in Hypolactation. The researchers suggest, “Chiropractic evaluation for subluxations would be a key element in the holistic assessment of the failure to establish milk supply in the post partum patient.””

icpa on Chiropractic Helps New Mothers Produce Milk

Maybe it is because they don’t understand that when chiropractors use the term subluxations, they are not referring to something you can see on an xray, but rather something they think they can feel, and when manipulated, unblocks the flow of energy that prevents your body’s innate ability to heal itself.

“DD Palmer, an American magnetic healer, believed that diseases are often caused by subluxations of the vertebrae, which, in turn, lead to an interruption of nervous impulses; and that the correction of these subluxations allows the body to heal itself. This is still a central tenet of chiropractic.”

Chiropractic care for children: Controversies and issues

Is that why your baby is having trouble breastfeeding? An invisible subluxation is blocking the flow of energy in your body?

Or is that why your baby has reflux or colic?

I doubled checked my copy of Gray's Anatomy, and our nervous system and the things it supplies don't look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.
I doubled checked my copy of Gray’s Anatomy, and our nervous system and the things it supplies does’t look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.

What about the “research” chiropractors talk about?

They are case studies, which is basically a chiropractor telling a story (glorified anecdote) about what happened to their patient, without any evidence of why it happened or how it could have happened.

“High-quality evidence supporting effectiveness of spinal manipulation for nonmusculoskeletal concerns is lacking, especially in infants and children, for whom the risks of adverse events may be the highest because of immature stability of the spine.”

AAP on Pediatric Integrative Medicine

The American Academy of Pediatrics Section on Integrative Medicine even warns parents about taking their kids to a chiropractor. And that’s saying something, as they promote some other holistic therapies that aren’t actually all that evidence based.

Craniosacral Therapy for Breastfeeding Problems

What about craniosacral therapy?

Similar to chiropractic, it has to do with has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate by massaging your baby’s head.

Is that why your baby isn’t breastfeeding well? The tides and rhythms of his cerebrospinal fluid are off?

“When a baby is unable to nurse or nurses so poorly that he causes pain to his mother, he presents a true challenge. A mother who experiences pain or who perceives that her baby is not breastfeeding effectively is a mother who is at risk of prematurely weaning this baby.

After working through all of the usual avenues of information and resources that can help in this kind of situation, some Leaders have found a new therapy, called CranioSacral Therapy (CST), can be helpful. CST is a light-touch manual therapy used to encourage the body’s self-correcting mechanisms.”

La Leche League on Considering CranioSacral Therapy in Difficult Situations

Not surprisingly, there is no real evidence that craniosacral therapy helps breastfeeding or anything else.

It is very surprising that some parents are willing to pay $600 or more for a few craniosacral therapy sessions.

And it is disappointing that a lactation consultant would refer their patients for this kind of therapy, since there is no evidence that it will work.

What to Know About Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Parents looking for breastfeeding support should view a referral to a chiropractor or to get craniosacral therapy as a red flag and consider getting a second opinion for their breastfeeding problems from someone who uses evidence based therapies that have been proven to work.

More on Chiropractic and Craniosacral Therapy for Breastfeeding Problems

Ask the Pediatrician

Got questions about your kids?

Need answers?

Ask the Pediatrician

It you likely won’t be surprised that most other parents have asked the very same questions at some point.

You should always call or make an appointment with your pediatrician if you have questions about your child.
You should always call or make an appointment with your pediatrician if you have questions about your child.

Fortunately, someone has answered them!

Find your answers?

Of course, you should always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Still, these answers can be helpful, especially for non-urgent problems.

More on Ask the Pediatrician

Dry Drowning – Hype or Hazard

Every day, about two or three kids drown in the United States.

And that’s why drowning is a leading cause of death for children and teens. In fact, it is the number two cause of unintentional death, right after motor vehicle traffic accidents. Not surprisingly, drowning is the number one cause of death for toddlers and preschoolers.

So, what are many parents afraid of?

Dry Drowning

Although the focus should be on making sure you learn CPR, fence off your pool, supervise your kids around water, and have them wear a Coast Guard approved life jacket around the water, some parents are overly worried about dry drowning instead.

“Parents are being unduly alarmed by media reports suggesting that children can die from drowning a week after swimming,” said Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians. “Some children can experience complications from swimming. For example, it is possible for a child to inhale water and develop an infection, such as pneumonia, which can become very serious and cause breathing problems. If a child has breathing problems at any time, the parent should take him or her to the emergency department. But there are no cases of completely normal, asymptomatic patients who suddenly die because they went swimming a few days ago. It’s also time to retire those incorrect terms, because it is inaccurate and incorrect to say a child was initially fine after a water event and then “dry drowned” a day or week later.”

Another story on The Today Show alerting parents to the dangers of dry drowning.
This story on The Today Show “alerting” parents to the dangers of dry drowning, ended up scaring many of them.

It isn’t hard to see why.

Although media reports of “dry drowning” deaths are rare, they are continuously shared on Facebook and other social media platforms, making it seem like they are much more common.

Still, it is important to note that what folks call dry drowning is often “delayed” drowning. Your child is not going to get sick simply because they coughed in the pool. They are going to have to cough, choke, and actually inhale some water to develop “delayed” drowning, which is rare.

Even though it is rare, you should still know about it though, right?

“You’ll want to keep a close eye on your child for about 24 hours following a close call in the water. Delayed symptoms of drowning include shortness of breath, difficulty breathing, coughing and/or chest discomfort. Extreme fatigue, irritability and behavior changes are also possible.”

Delayed Symptoms of Drowning: Know the Signs

Of course, but it shouldn’t be overblown to the point where you get panicked whenever your kids are in the water.

Or if you think more about dry drowning than you do about a much more common hazard – drowning.

What to Know About Dry Drowning Hype

Dry drowning is often a rare type of delayed drowning that occurs after a child inhales water and later develops what can become life-threatening symptoms, including fatigue, fever, coughing, and troubling breathing.

More on Dry Drowning Hype

Helping Kids Avoid Sea Sickness on a Cruise

Planning a cruise with your kids?

How do kids not get sea sick on cruises?
How do kids not get sea sick on cruises? Photo by Vincent Iannelli, MD

You’re not alone.

Cruises have become a popular family vacation.

Helping Kids Avoid Sea Sickness on a Cruise

Are you going to call your pediatrician about a prescription for some Scopolamine patches?

I’ll save you some time.

Scopolamine patches are not approved for young children or teens. They can be prescribed for adults.

Fortunately, most kids don’t have problems with sea sickness on large cruise ships.

And there are other options if they do, including:

  • Dramamine for Kids – chewable tablets (dimenhydrinate) that kids between the ages of 2 and 12 years can take every 6 to 8 hours
  • Dramamine – tablets (dimenhydrinate) for kids over age 12 that they can take every 4 to 6 hours
  • Dramamine All Day Less Drowsy – tablets (meclizine) for kids over age 12 that they can take once a day

It is also nice that Dramamine is over-the-counter, so you don’t even need a prescription. Just grab some before your trip, along with sunscreen, insect repellent, and whatever else you think you need.

Keep in mind that there are also motion sickness treatments to avoid, mostly because they don’t work. This includes the Sea Band acupressure wrist bands that you see everywhere.

What about ginger?

While most alternative treatments don’t live up to their hype, there are studies to suggest that taking ginger can help relieve and prevent sea sickness and other types of motion sickness.

You can even get Dramamine Non-Drowsy Naturals with ginger root for your kids.

“Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant.”

Grøntved  et al on Ginger root against seasickness. A controlled trial on the open sea

Will it work? Most of the studies about ginger and motion sickness have been small and can probably be explained by the placebo effect.

Also keep in mind that newer, non-sedating antihistamines that work for allergies, like Zytrec, Claritin, and Allegra, don’t work for motion sickness. Neither does Zofran.

Helping Kids Avoid Motion Sickness in a Car

An even more common problem than sea sickness seems to be motion sickness in the car. As with sea sickness, Dramamine can be an option for long car rides.

For some young children, even short car rides, like to the store or across town, can be a trigger for car sickness.

What can you do then?

You may have to try different things, but it may help to:

  • avoid letting your child read, watch movies, or play video games in the car
  • have her listen to music or audio books, etc.
  • avoid big meals right before traveling, but also don’t travel on an empty stomach
  • encourage her to look at things outside the car, in the distance, preferably toward the front of the car
  • wear sunglasses

If motion sickness continues to be a routine problem for your child, an evaluation by a Pediatric Neurologist might be helpful.

What to Know About Avoiding Sea Sickness

Sea sickness isn’t often a problem for kids on big cruise ships, but you do have some options to treat and prevent motion sickness, whether it is in a boat, plane, or car.

More on Avoiding Sea Sickness

What to Do About Your Child’s Earache

Kids commonly complain of earaches.

Some don’t necessarily complain of an earache (otalgia), but just tug at their ears or a little more fussy than usual, so you might just think that it’s their ears.

Surprisingly, an earache doesn’t always mean that your kids have an ear infection.

Why Does Your Child’s Ear Hurt?

Tick bites would be a rare cause of ear pain.
Tick bites would be a rare cause of ear pain. Photo by Vincent Iannelli, MD

So what else besides an actual ear infection can cause an earache?

Does your child have a new tooth coming in?

Has he been swimming? (swimmer’s ear)

Does he have a sore throat or runny nose? (although most middle ear infections come after a few days of cold symptoms, simply having a sore throat or runny nose might cause some ear pain)

As you can imagine, lots of things can cause earaches, but the most common include:

  • teething
  • swimmer’s ear (otitis externa) – unlike otitis media, these kids typically have outer ear pain, or pain when you move or tug on their ear lobe
  • middle ear effusions – fluid that is left over in the middle ear after an ear infection (has nothing to do with swimming)
  • sinus congestion – some kids associate the extra ear popping that comes with allergies or a cold/sinus infection as being painful or uncomfortable
  • pharyngitis – because of referred pain, some kids with sore throats complain of ear pain instead of throat pain

And then some younger kids simply tug on their ears because they can. They are otherwise well, sleeping all night, eating well, and aren’t fussy.

What else can cause earaches? A toothache, too much earwax, or that rock your kid put in his ear a few weeks ago…

What to Do About Your Child’s Earache

Once you know why your child has an earache, which typically means a trip to your pediatrician, you need to know what to do about it.

You’re thinking a prescription for an antibiotic is coming, right?

Many parents will be happy to hear that most earaches won’t mean an automatic antibiotic prescription. Instead, your pediatrician will likely:

  • recommend symptomatic care for teething
  • prescribe antibiotic ear drops for swimmer’s ear
  • recheck your child’s middle ear effusion in a few months, as this goes away on it’s own in most cases without any treatment
  • treat underlying congestion from allergies, colds, or a sinus infection as needed
  • recommend symptomatic care for a sore throat

But what if your child really does have a middle ear infection? Then he will get antibiotics, right?

Not necessarily.

Since most ear infections get better on their own, antibiotics are typically reserved for:

  • children under age 6 months with acute otitis media (typically ear pain and a bulging ear drum)
  • children who are at least 6 months with acute otitis media and severe signs or symptoms, including moderate or severe pain for at least 48 hours or a temperature of 102.2°F (39°C) or higher
  • children who are under 24 months with “double” ear infections – both ears are infected at the same time, even if they just have mild symptoms

For most other children, instead of having you start antibiotics right away, your pediatrician might have you wait for 48 hours – the observation option. You can then start the antibiotics if your child doesn’t get better after a period of watchful waiting for two or three days. Until then, an age-appropriate dose of Tylenol (acetaminophen) or Motrin (ibuprofen) can often help control pain or fever.

In addition to your pediatrician, a pediatric ENT specialist can be helpful if your child has persistent ear pain.

What to Know About Children with Earaches

While it is sometimes obvious to know what is going on when older kids complain of ear pain, it is important to understand that not every earache means an ear infection, and even when it does, it might not mean a prescription for an antibiotic.

More on Children with Earaches