Survive the Scrapes of Summer

By Christina Elston

Childhood's long summer days are full of possibility – like a handful of money just waiting to be spent. But kids aren't always the wisest consumers of free time.

"One of the first injuries I treated was to a kid who rode his bike off a roof into the family pool," says Marion Sills, M.D., an emergency physician at The Children's Hospital in Denver. The lucky 9-year-old recovered fully, but many children aren't so fortunate.

Injury and death generally increase among children during the summer months, as kids are out of school, playing outside and involved in riskier activities. July, in fact, is the deadliest time of the year for unintentional injuries among children, according to the National SafeKids Campaign.

Parents need to be aware of and prepared for the kinds of scrapes, bruises or more serious injuries that come with kids and summertime. Here, emergency medicine experts from across the country offer their advice on keeping kids safe this summer.

Injury Prevention

Parents can do plenty in the name of injury prevention, even in the most routine situations.

On the road to summer activities, for example, "everybody should be buckling up," says Roxanne Woods, R.N., coordinator of the Center for Injury Prevention at the University of California – Davis Medical Center. Put kids in the backseat, with appropriate carseats for those who are under age 8 and/or weigh less than 80 pounds.

Even young pedestrians need supervision.

"A child under 10 probably isn't ready to be a good pedestrian," says Julie Ross, manager of the injury prevention program at Children's Hospital in Boston.

Beyond walking or riding in the car, use common sense to make play conditions as safe as possible and to prevent injuries in the following circumstances:

Summer ScrapesOn Wheels – Kids who ride bikes, skateboards, scooters, skates or go-carts without helmets often end up in the emergency room with head injuries. "Most of those kids put helmets on after that, but the ones who are seriously injured may never get the opportunity to ride a bike again," says Paul E. Sirbaugh, M.D., director of pre-hospital medicine at Texas Children's Hospital in Houston.

• Be consistent in enforcing helmet use.
"If you insist on helmets one time, but let it go another, then your child may be less consistent with use when you are not around," says Elizabeth Bennett, health education manager at Seattle Children's Hospital.

• Make sure safety helmets are worn correctly.
Ross suggests a visit to a local bike shop to help with proper adjustment.

Swimming and Boating –
To prevent drowning or near-drowning, make sure that children in boats and toddlers at the beach wear life jackets. Fence your swimming pool, keep your kids away from areas with strong tides or currents, and never leave your child alone near water.

• Have a "designated observer"
for activities around the water, especially pool parties, Sirbaugh suggests. Attaching that responsibility to an object, such as the car keys, eliminates confusion about who should be watching, says Ilene Claudius, M.D., an emergency physician at Children's Hospital of Los Angeles. The person holding the keys is watching the kids.

– Two of the best ways to prevent sports injuries are the use of proper safety equipment and "knowing your limits and staying within them," says Stephen G. Rice, M.D., program director of the Jersey Shore Sports Medicine Center in New Jersey.

If your child is planning to attend sports camp, help increase his or her activity level by 10 percent per week for several weeks before camp starts so that the child is in proper physical condition, Rice says.

On the Playground – Pay special attention to the ground under equipment in your yard or at a local park. "Playgrounds should have soft surfaces, like mulch or pea gravel, at least 12 inches deep, for at least six feet around the fall area," says Susan Hirtz, manager of the Center for Childhood Injury Prevention at Texas Children's Hospital. Incidentally, doctors warn against trampolines, which they say cause many injuries and aren't safe for home use.

Hiking in the Great Outdoors
– Wearing light-colored clothing that covers arms and legs, sunscreen, and sturdy boots can prevent most trouble on the trail, says Hirtz. Bring water and first-aid supplies, teach kids to stay on the trail, and tailor hikes to your child's age and ability level. 

Summer First-Aid

Prevention aside, all parents should be prepared to cope with emergencies that arise, says Sirbaugh, who is also pediatric medical director of the Houston Fire Department. He has seen parents so panicked that they failed to pull a drowning child from a swimming pool. CPR and first-aid classes will teach you the basics, and the training will kick in automatically when a crisis occurs, Sirbaugh says. "You're not thinking, you're just acting."

Follow these first-aid strategies for the following emergencies:

Drowning – Need another reason to take that CPR class? "For a near drowning, the one thing that you can do to decrease the chances of neurological damage is to initiate CPR (cardiopulmonary resuscitation) by the side of that pool if the child is not breathing," says Claudius.

Concussion – If your child hits his or her head hard and does not get back up, do not move the child, says Sirbaugh. Get medical help first. If, after a head injury, your child loses consciousness, vomits more than once or twice, has a severe or increasing headache, or isn't acting normally, seek medical attention.

With or without those symptoms, however, have your child checked by a doctor after any serious accident. Sirbaugh recalls a 15-year-old patient who fell from the bleachers at a basketball game, but seemed OK. A CAT scan at the hospital later revealed a serious bleed into her brain. "She went right from the waiting room to the operating room," says Sirbaugh.

Cuts and Scrapes – Flush these injuries with clean tap water, not hydrogen peroxide or rubbing alcohol. "It does not have to hurt in order to be clean," says Sills. If you can't flush out the dirt or other foreign material easily, get help from a doctor. To stop bleeding, raise the injury above the level of the heart and apply direct pressure with a clean cloth. If the bleeding does not stop within 20 minutes, seek medical attention.

Once the bleeding has stopped, apply antibiotic ointment and a bandage to help prevent infection and to keep the skin soft, so it won't dry and crack.

Broken Bones and Sprains – Treat bruises and sprains with R.I.C.E.: Rest – Ice – Compression – Elevation. Wrap one layer of a wet elastic bandage over the injury, apply an ice bag, and wrap the rest of the bandage over it. Leave this on for 20 to 30 minutes, then wrap the injury with a dry bandage, keeping it loose enough that you can slide one finger underneath. Elevate the injury above the heart, if possible, to reduce swelling and ease pain. If your child's pain is severe or doesn't improve, see a doctor.

If a limb is obviously broken, seek immediate medical attention. Do not try to move the bones back into place; just immobilize the limb with a rolled-up magazine and towel, or some other type of splint, to prevent further injury.

Insect Stings and Splinters –
Remove splinters with tweezers, but use a credit card to scrape out insect stingers. This keeps you from squeezing the stinger's attached venom sac and injecting more venom into the skin.

Clean the area thoroughly with soap and water. If you aren't able to remove an entire splinter, or if the area becomes infected, seek medical attention. Get emergency medical help if your child experiences extreme swelling or difficulty breathing following an insect sting.

Heat Illness and Sunburn – Cool overheated kids as quickly as possible in a cold shower or air-conditioned room, and offer water or sports drinks to replace lost fluids. Children at play in hot weather should drink about eight ounces of water every 15 to 30 minutes to prevent dehydration, says Woods. If your child is vomiting and has cramps, or is acting abnormally, seek medical attention.

Treat minor sunburns by cooling the skin with plain water and then applying a simple lotion. Give Tylenol or Motrin for sunburn pain. Protecting kids with appropriate clothing, hats and sunscreen – even though they may not like it – helps prevent sunburns now and skin cancer later in life.

As Claudius puts it, "If your 2-year-old doesn't like you for five minutes and you've protected them from melanoma, then you've done your job as a parent."



Many general parenting books have in-depth sections about injuries or medical emergencies. Books targeting injuries specifically include:

Medical Emergencies & Childhood Illnesses, by Penny Shore, with William Sears, M.D., ParentSmart Books, 2002.

The 24-Hour Pediatrician, by Christina Elston, Three Rivers Press, 2002.

The Young Athlete: A Sports Doctor's Complete Guide for Parents, by Jordan D. Metzl, M.D.; Little, Brown & Co.; 2002.

On the Web

These sites offer injury prevention and treatment tips for parents:

The American Heart Association

The American Academy of Pediatrics

National SafeKids Campaign

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