How to keep your children out of the ER this summer

For all of summer's pleasures - pool parties, barbecues, bicycling, and more - an emergency department near you is feeling the usual seasonal spike in children's injuries and deaths.

No wonder summer is known in the medical business as "trauma season."

Childhood deaths from unintentional injuries, reassuringly, are rare. But add up the pain of broken bones (plus the angst of a summer spent in a cast), parents' time taken off work to nurse an injured kid, medical bills and the possibility of a lasting disability from, say, a brain injury sustained in a bicycle accident, and you've got a costly impact on families and society.

Kids 14 and under made more than 2.4 million emergency room visits in the summer of 2004, the latest summer for which data are available. Those injuries resulted in 2,143 deaths, according to a report by Safe Kids Worldwide.

There are distinct patterns to summer accidents, and many could be easily prevented. Marie Lozon, division director of pediatric emergency medicine at the University of Michigan Health System, tends not only to the young patients who are rushed through the doors of her emergency department but also to shocked parents. "Every day I hear, 'I just turned my back for a second,'" she says.

Lozon and Chrissy Cianflone, director of program operations at Safe Kids USA, weigh in on common trauma-season injuries - and how to avert such disasters.

Drowning

In summer, kids drown at nearly twice the rate that's typical for the rest of the year, reflecting a steeper increase than for other types of injuries. Between 2000 and 2005, there were 6,900 nonboat-related drowning deaths of people younger than 20, according to the U.S. Centers for Disease Control and Prevention.

Drowning is "not like in the movies," says Cianflone. There is no wild flailing and commotion. "The child will simply just slide into the water, very silently and very quickly," she explains. An adult might notice a child at the bottom of the pool and have no idea how long he or she has been there.

Always have a designated adult with his or her eyes on the water at all times and the ability to jump in quickly. Cianflone says a kid drowning is usually "a matter of everybody was watching, but nobody was watching.".

Lifeguards aren't a universal remedy, adds Cianflone, noting she's had calls from parents whose child drowned with a lifeguard on duty.

What about swimming lessons? "Parents often think this is the magical answer," says Lozon. Kids who get swimming lessons may have more competence in the water and might not panic in a dicey situation, like when a crush of kids are bunched together in the water or when fatigue sets in. But especially with younger kids, there's no substitute for supervision.

Bike accidents

Deaths related to biking increase about 45 percent in summer, compared with other times of the year. Certainly, riding around in the warm weather is a favorite childhood pastime, but doing so without wearing a properly fitted helmet is asking for trouble.

About 135 kids 14 and younger die in bicycle crashes and about 267,000 sustain nonfatal bike injuries annually. Helmet laws and public awareness campaigns, Cianflone says, have brought down the rate of deaths and injuries significantly in the past two decades.

Bike accidents often occur when the rider hits something and pitches forward. Because children's heads are proportionally bigger, kids "tend to lead with their heads," Lozon says. Ensure the helmet is covering the front of the head, not cocked back on the crown. A properly fit helmet should sit on a kid's head two adult finger-widths above the child's eyes, says Cianflone.

Car crashes

Motor vehicle crashes are the leading cause of death among kids ages 3-14 in the U.S., killing 1,335 and injuring 184,000 in 2005, reports the U.S. Centers for Disease Control and Prevention. That's a daily average of four deaths and 504 injuries.

The rate of motor-vehicle deaths spikes 20 percent in the summer because of high-traffic holidays, an excess of drinking, and parents who don't bring their children's car seats on vacation.

A properly fitted car or booster seat is essential to preventing a child's injury or death in an accident, says Cianflone. (Safe driving, obviously, is as well.) Size matters - only kids who are at least 4-foot-9 and weigh 80 to 100 pounds can safely wear a seat belt. It is estimated that 73 percent of car seats are either installed wrong or aren't used correctly.

Other dangers are:

• Kids alone in a hot vehicle, which kills 33 kids a year, on average. Never leave kids unattended, and make sure they can't pull down the back seat and crawl into the trunk while playing.

• All-terrain vehicles have a high center of gravity and are easy to tip over, plus the rider is not protected by a shell, Lozon says.

Pedestrian accidents

Kids are out of school and frequently unsupervised, and that contributes to a 16 percent spike in child pedestrian deaths this time of year. Remember that before age 10, children are particularly impulsive and also cannot judge speed, spatial relationships or distance very well.

Close to 10 percent of child pedestrian injuries occur in a driveway during the summer, according to Safe Kids. Nonfatal injuries related to vehicle backovers land about 2,500 kids per year in the ER. Don't rely on backup cameras - they have blind spots, too.

Burns

Fireworks, barbecues, campfires and fire pits are all parts of summer, but "people don't respect fire the way they should," Lozon says. In many cases, the fire had gone out and a child stumbled into the ashes. Another common injury results from kids spraying lighter fluid into the barbecue. The fire can light the arc of fluid all the way up to the container.

One-third of individuals injured by fireworks are under age 15. One of the most common such injuries is when the fuse on a firework is lit incorrectly - or doesn't appear to catch -and someone goes back to relight or check it gets caught in the explosion.

Falls

They're the leading cause of injury to children year-round, bringing about 8,000 kids into the ER daily, says the CDC. Fall-related deaths spike in the summer, up 21 percent over the average during the rest of the year, thanks to open windows, more time on the jungle gym and more kids hanging out on balconies or fire escapes.

Minimize risk by keeping furniture (including the baby's changing table) away from windows, installing bars or childproof gates on windows and keeping kids off balconies or roofs. Supervise kids on playgrounds and ditch the Crocs and flip-flops in favor of sneakers, Cianflone says.

Strangulation

Keep your kids from wearing hooded sweatshirts or anything dangling around their necks on the playground. Strangulation caused about 56 percent of the 147 playground-related deaths between 1990 and 2000; falls accounted for 20 percent, says the CDC.