Swaddling: Is it Safe?

Despite our desire to help our babies sleep, what we want most is for them to be safe. We all want to help soothe the crying baby in the first picture, and help her achieve the serenity she appears to have in the second picture. How do we do that without constricting the chest, improperly positioning the hips, or endangering her if she happens to roll onto her stomach?

The link will take you to the American Academy of Pediatrics website "healthychildren.org". To summarize the points briefly:

1. Safe swaddling snuggles the arms, not the legs. The legs should be wrapped loosely enough to be in a flexed posture, allowing proper development of the hip joints.

2. Safe swaddling is loose enough to allow an adult's hand to fit between the blanket and the baby.

3. Safe swaddling is only OK until age 2 months. After that the baby may be able to flip onto his stomach and needs his arms free to be able to safely do that.

4. Safe swaddling does not overheat a baby. If she is sweating a lot the baby may be too warm.

5. Safe swaddling is done with the baby alone in her own crib or bassinet, with no soft bedding/toys/wedges/bumper pads/pillows.

HealthyChildren.org - Swaddling: Is it Safe?

Shopping Carts Are For Groceries

Don't let your child's head be the watermelon!

My on call weekend is over, and I am enjoying an evening at home when I can just worry about my own kids for a while. Not that I mind doing my job, it's just refreshing to be free of the on-call phone for an evening.

It was interesting this weekend that I was grocery shopping with my 9-year-old daughter while I answered a call about a child who fell out of a shopping cart. My daughter was having a lovely time pushing our grocery cart, standing on the sides or front while I pushed, and at times coasting along for a ride while the cart rolled down the aisle. She was a big help to me, "guarding" our cart while I ran back to get the Italian bread crumbs that were strangely located in the cheese and yogurt aisle.

The child who had fallen out of the cart was in the cart basket jumping up and down while her parents unloaded the cart into their car. Luckily, she was fine except for a bump on her head. 

I have had so many "fall out of the cart" calls over the years that it seemed like a good topic for a blog post. And I learned some interesting information when I did a bit of research:

1. Most shopping cart injuries occur in children under five years of age.
2. Common types of shopping cart fall injuries are fractures and head injuries.
3. Most falls from shopping carts involve children riding in, climbing into, or climbing out of the shopping cart basket.
4. Another important cause of shopping cart injuries are "tip-overs." 
5. Older siblings are often involved in "tip-overs" when they lean or ride on the cart, throwing it off-balance.
6. Parents are near the cart when most of the injuries happen, but most parents step away from the cart several times during a shopping trip.

I am sure the parents of the child who fell out of the cart basket now realize it's not a safe place for a child to ride. However, after reviewing all of this research I had to reflect on what I personally could do to make grocery shopping with my 9-year-old safer. For example, I shouldn't allow her to ride on the sides of the cart OR leave her alone!

What advice can I give you? Don't take your child grocery shopping?

At least don't let them ride in the basket or sides of the cart. Make short, quick shopping trips so your child doesn't get too bored. Keep one hand on your young child at all times. Have an organized list that allows you to get in and out of the store efficiently. Shop when it isn't crowded so it's easier to focus on your child.  And don't let them ride in the basket.

Has your child outgrown her booster seat?

New recommendations about booster seats for children state your child should remain in the back seat, in a five-point-harness car seat until the height and weight limits are out-grown. Then, your child should definitely be in the back seat, in a booster seat until age eight. In general, once your child is eight years old he should be 4 feet 9 inches tall before coming out of the booster seat. This will likely be until age 10 to 12! The front seat is for children who are ages 13 and up.

However, after age eight and before 4’9” tall there may be some car seat belts (in the back seat) that will properly fit your child without a booster seat. There are five steps to determine if the seat belt fits well without a booster:

1. Does the child sit all the way back against the seat of the car (their back and their bottom is up against the back of the seat)?
2. While they are sitting all the way back in the seat do the child’s knees bend comfortably at the edge of the car’s seat?
3. Does the shoulder belt come across the collarbone, between the neck and the arm?
4. Is the lap belt low in the lap, touching the thighs?
5. Is this a comfortable position that can last for the whole car ride?

This information originates from the American Academy of Pediatrics, and was printed in the spring 2011 newsletter (Volume XVI, No 1) of the Michigan Chapter of the AAP. Online sources of information can be found at www.facebook.com/childpassengersafety , http://twitter.com/childseatsafety, and www.healthychildren.org/carseatguide.

New Car Seat Recommendations

Wow! Nine years after the last policy guidelines were released the American Academy of Pediatrics has issued new guidelines for children and car seats: The big changes are to keep your child rear facing until possibly two years old, unless they outgrow the limits of the seat earlier, and to use a belt-positioning booster seat (not a bench style booster) until reaching 4 foot 9 inches tall (between ages 8-12). Here is the link. I'll add more to my blog later--this information just came out and I need some time to review it, as well.

http://www.healthychildren.org/English/news/pages/AAP-Updates-Recommendations-on-Car-Seats.aspx

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2011-0213v1

Now back to my post. After reviewing the AAP guidelines (which you can see for yourself using the above links), as well as a helpful algorithm that accompanies the guidelines, I believe I can summarize them more effectively for you. The recommendations are evidence-based, meaning they have been shown in scientific studies to prevent injury and fatalities among children in motor vehicle accidents. The big changes are to stay rear-facing as long as the car seat accommodates until age two, to use a car seat with a built-in harness for as long as possible, and when that seat is outgrown to stay in a booster seat until 4'9" tall! This is a lot to absorb, and many older children will be quite vocal about their opinions of booster seats. However, their safety is at stake here so it is time for parents to take a stand.

INFANTS AND TODDLERS:
Infants under the age of two have relatively larger heads and weaker necks than older children and adults. In a crash this puts them at high risk for a head or spine injury. For this reason they should stay rear-facing in a car as long as possible up to the age of two years.

Many infants under the age of twelve months are in an infant-only rear-facing seat that can be attached or removed from a base that is left in the vehicle, and then carried by the attached handle. A convertible car safety seat is another option. It is a non-removable seat designed for infants that can be used both rear-facing and forward-facing. When an infant outgrows the infant-only seat they are best supported in a rear-facing child safety seat until they outgrow the rear-facing height or weight limits of a convertible car seat. Currently, most convertible car seats have a rear-facing limit of 35 pounds.

AGES TWO OR OLDER, OR HAS OUTGROWN LIMITS OF REAR-FACING CAR SEAT
A forward-facing car seat with built in harness should be used for children ages two and older, or children younger than two who have outgrown their rear-facing convertible seat. The built-in harness should be used as long as possible, until the child has exceeded the weight and height limits of the car seat. Different brands of car seats allow for different maximum weights, ranging from 40lbs. to 80lbs.

HAS OUTGROWN LIMITS OF FORWARD FACING CAR SEAT WITH HARNESS
Children who have outgrown the limits of their forward-facing, built-in harness car seat should use a belt positioning booster seat until they are 4 foot 9 inches tall (which is the average, or 50th percentile height for an eleven-year-old girl and boy), and at least eight years old, OR they can safely use their own vehicle's lap and shoulder restraint system. Most children in most cars will need to be 4'9" tall to safely fit into a vehicle's built-in seat belt without using a belt-positioning booster seat.

PROPERLY FITTING LAP AND SHOULDER BELT
A properly fitting seat belt will look like this: First the child should be sitting up nice and tall in the seat with their lower back against the back of the seat. While in this position the lap part of the belt will fit low across the hips and pelvis (across the upper thighs is the goal, not on the tummy), the child's knees will bend at the edge of the seat (not stick straight out), and the shoulder portion of the belt will cross the middle of the chest and shoulder (not coming across the neck or face).

FRONT SEAT?
Children under the age of thirteen should ride in the back seat.

Please Wear Your Helmet!

Every day I tell kids they should wear helmets. They should wear bike helmets whenever they are on something with wheels (bikes, skateboards, scooters, rip-sticks, roller-blades...) or ski helmets if skiing or snowboarding. They should wear the appropriate helmet for a motorized dirt bike or for off-road vehicles, as well.

Every day I have small children tell me they don't need a helmet because they never fall. Then I realize I have to convince both child and parent (mostly parents in this age group of kids) that the point of a helmet is to protect in case of an accident. I don't doubt the child's skill on the bike, or the quiet cul-de-sac the family lives on. I say that a helmet is like a seatbelt in the car. You always wear your seat belt in the car, right? But do you really think your Mom or Dad will get in a crash? No! So why wear the seatbelt? Just in case of an accident, in case something happens that we didn't know would happen. Helmets are the same kind of thing. They protect you in case of an accident, and we wear them because we don't know when accidents will happen.

I also tell kids (getting to a little older group now) something Dr. Van Es told one of my girls during her check up with him. I loved this explanation, and now I use it all the time. Doctors are good at fixing broken arms and legs, we just put them in a cast and a few weeks later everything is as good as new. Also, we can put band-aids on scrapes, and sew up cuts with stitches. But doctors are not good at fixing brains. If your head cracks open and you hurt your brain, there isn't much that we can do other than wait and see what kind of damage was done (and I add my own spin on it here, especially for adolescents). For example, a bad brain injury can take away your ability to talk, you might not be able to walk and have to use a wheelchair, you might not be able to control yourself to get to the bathroom and therefore need to wear a diaper, you might not be smart anymore...etc. So the helmet is extra important when you are on your wheels because it gives your brain an extra hard layer of protection in case of an accident.

And after feeling really good about how I have educated everyone I drive home for lunch in the summer and see lots of kids (many are my patients) in my neighborhood biking, skateboarding, rip-sticking, and scootering around with NO HELMETS. And they are in the street!

But street versus sidewalk is worth mentioning when it comes to helmets. The worst head injury from a device in this category of someone in my pediatric practice was a six year old girl who lived across from the elementary school and was a friend of my oldest daughter. She was on her little scooter on the sidewalk in front of her house, unhelmeted. Mom was gardening in the yard, right there to supervise. She hit a little crack or rock, fell off the scooter and hit her head hard on the pavement. Forty-five minutes later she was vomiting and very drowsy and lethargic, and within another hour or two was in the operating room having the bleed into her brain drained by a neurosurgeon. She is ok, but fortunate to have such a good outcome. Probably this was preventable if she had been wearing a bike helmet.

It is not enough to just tell kids to wear their helmets. They don't believe they need helmets because they don't think they will fall. As parents it is our responsibility to make our kids wear their helmets, with consequences if they do not wear them. We need to get all the parents in the neighborhood in on this rule, so one child doesn't have to feel the stigma of being the only one who has to wear a helmet. And we as parents have to set a good example! We need to wear helmets, too. It's a little funny to see families riding around town with three helmeted kids on bikes, but the parents on bikes have bare heads. How long do you think those kids will be wanting to wear helmets?