Keeping Kids Safe

Pinpointing The Real Hazards Children Face Everyday

By Hilda J. Brucker

    When I was a child, I routinely rode in the front seat of my parent's car without wearing a seat belt. (Did our car even have seat belts back in the '60s?) I walked the city mile between our house and the library by myself whenever the buddy system seemed like a hassle. Though I owned a series of really cool bikes over the years, I never, ever had a bicycle helmet. In the summer, I played on playgrounds that had hard, wooden swings, not the modern rubber kind that grip your hips and keep you from flying off the seat in mid-air. And when I wasn't swinging, I was likely to be hanging upside down from the monkey bars, dangling by my knees over an extremely unforgiving asphalt surface. (That stunt always drove my mother crazy with anxiety, not because she feared I'd crack my head open, but because my underpants were showing.)
     Somehow I survived childhood, and I'm grateful that I did. In many ways, the world is a different place for kids than it was 30 years ago - infinitely safer and infinitely more dangerous. On the one hand, safety-minded parents today are equipped with an arsenal of information and tools my mother didn't have. We have statistics that tell us where the risks lie; advocates and legislators who work diligently to reduce hazards; and a pervasive media presence that creates awareness of safe practices, often by graphically reporting the consequences of a mere moment of inattention.
     On the other hand, new technologies like the Internet expose our kids to risks unknown to previous generations. And parents today find themselves entrusting their children to more and more people outside the family: daycare providers, scout leaders, coaches, bus and carpool drivers. When it comes to making decisions about your child's safety, how do you size up all the risks and still manage to stay sane? Unfortunately, one widespread strategy hasn't changed much at all over the years - the simple act of denial. According to Atlanta child advocate Don Keenan, focus groups reveal that many parents choose not to even consider that the unthinkable may occur, simply telling themselves that "It couldn't happen to my child."
     Keenan is an attorney who's handled hundreds of cases involving children who were disabled or fatally injured under circumstances that were largely preventable. As he began to see certain patterns of injuries emerging among his clients, his focus expanded from litigation to include an interest in injury prevention. In 1983, he founded the Keenan's Kids Foundation, a nonprofit organization devoted to raising awareness, getting information out to the public, and lobbying for stronger regulations over products that have proved to pose a hazard to children. "I feel that my life's work right now is about prevention," Keenan said. "And to take what we've learned through these cases and, God forbid, make sure that no one else has to suffer these tragedies." Now recognized as a national expert on child safety issues, Keenan has appeared on "Oprah" and all the major news shows, and has recently published a book called "365 Ways To Keep Kids Safe."
     One of his key messages is the difference between a risk and a hazard. Risks are all around us, he writes in the book's introduction, and are part of a healthy, happy childhood: the risk of getting hit by a baseball during a game, the risk of falling off a bicycle while learning to ride. Hazards, on the other hand, are dangers that should be recognized and then removed from the child's environment: toys with small parts that could be swallowed, flammable pajamas and rickety playground equipment. "We want kids to bang up their knees," Keenan stressed. "And we want them to, you know, fall on the ground; we want them to somersault. But we don't want them to put their eye out on an exposed piece of metal. We don't want them electrocuted from exposed electrical wires."

Playground Safety: Awareness and Action are Key
    One of the first projects Keenan tackled was playground safety. Most parents are keenly aware of dangers in the home and actively take steps to prevent injury, like keeping poisons out of reach, blocking staircases with baby gates, using smoke and carbon monoxide detectors in children's bedrooms. Playgrounds, however, are often neither monitored for hazards, nor maintained on a regular basis. "There's an assumption on the part of parents that if it's out there, it's been through a rigorous safety check," Keenan said. "And nothing is farther from the truth." Each year, according to the Centers for Disease Control and Prevention (CDC), more than 200,000 kids are treated in emergency rooms for injuries that happened on the playground.
     In the summer of 2003, the Keenan's Kids Foundation began the Safety Report Card Project by evaluating 30 Atlanta play areas; 29 of these had at least one safety violation according to the checklist the foundation developed. Common problems included hard surfaces in "fall zones" and sharp edges. Surprisingly, two playgrounds had exposed electrical wires and nearly half had dead tree limbs hanging over the play areas - a hazard most parents wouldn't even think to look for. The Safety Report Card Project attracted enough media attention that many unsafe conditions were finally addressed and cleaned up. And the lesson here, according to Keenan, is that vigilance is a parent's first defense. Keenan encourages citizens to inspect play areas in their communities and report any defects to park authorities or city officials. Sending a copy of the report to the local media is another strategy he recommends. To help parents get started, his Web site includes safety checklists and sample form letters for reporting playground defects.

Traumatic Brain Injury: An Ounce of Prevention
    Many parents are surprised to learn that the leading cause of death and disability among children is not childhood illness or cancer or even the tragic result of stranger abduction.
Though such things may play on deep-rooted fears, the greatest single threat to a child's well-being is actually, by a wide margin, traumatic brain injury. The statistics are startling; more than a million children sustain head injuries each year, according to the Brain Injury Association of America. Approximately 165,000 will be hospitalized; some of these will die and an unknown number will end up with a long-term disability.
     Traumatic brain injuries (TBI) occur as a result of car crashes, falls, sports, and accidents with recreational equipment like bikes, skateboards, jet skis, ATVs and trampolines. "It's a life-altering injury," said Carol Ball, an injury prevention specialist with Children's Healthcare of Atlanta. "Not only for the [injured] child, but for the whole family. It's not like a fractured arm or a broken leg where you can put a cast on it and the bone heals. TBI impacts cognitive skills and motor skills. You may have a child on a respirator for the rest of his life."
    "Dr. Koop [the former surgeon general] said that basically, if injuries were a disease that were killing our children, people would be up in arms, saying 'Find a cure,' " Ball continued. "Well, we know how to prevent the injuries from happening; we know how to reduce the severity of the injuries. And in a lot of cases it's appropriate supervision and proper use of safety equipment. But we just can't get people to get engaged in preventing injuries." She points out that the most familiar safety precautions are sometimes the first ones parents dispense with and stresses the following:

• Use age-appropriate restraints in the car. So much has been published about automobile safety that securing kids with car/booster seats and seatbelts would seem to be a
no-brainer, but statistics show that many of the kids killed or injured in car crashes are not restrained at all. "Not all crashes are survivable, even with a safety belt," Ball pointed out. "But children shouldn't be dying in crashes that occur at 30 or 40 miles an hour."

• Make helmets a habit. While Georgia law requires kids under 16 to wear bicycle helmets, enforcement and awareness of the law is lacking. "Parents just don't understand the risk and what can happen just riding in the driveway and the cul-de-sac," Ball said. Kids should also wear helmets when using skates, skateboards, scooters and "anything else with wheels." It's important to get the right kind of helmet for the activity; when in doubt, go for a multi-sport helmet that is designed and padded to prevent injuries from both backward and forward falls; bicycle helmets are designed mainly to protect the brain's frontal lobe if the passenger goes flying over the handlebars and are less effective in the backward falls common to skating mishaps. And fit is all important - this cannot be stressed enough. Ball suggests checking the Safe Kids Web site for helmet guidelines before shopping.

Lesser-Known Hazards: What to Watch For
    The dangers inherent in some common activities are just beginning to be recognized and publicized. Take trampolines, for example. In 2003, the Consumer Product Safety Council (CPSC) received more than 80,000 reports of trampoline-related injuries to children under 14.
     Between 1991 and 2000, trampoline injuries tripled and children sustained the majority of them, leading the American Academy of Pediatrics (AAP) to issue a revised policy statement. The AAP now recommends that trampolines never be regarded as play equipment, either indoors or outdoors at home, or used in physical education classes in schools. Injuries result from falls and bad landings, from lack of supervision, from badly manufactured equipment (there have been many trampoline recalls in recent years), from allowing more than one person on the trampoline at a time, and from untrained attempts at somersaults or other stunts. Basically, a trampoline should be regarded as a piece of gymnastic equipment that's not suitable for children, period. Even if you don't have one at home, you may want to find out if your children have access to a trampoline at school, a recreation center or a friend's house.
     Cheerleading, not previously recognized as a sport, has also evolved to include serious gymnastic stunts that can put young girls at risk of fractures and head and neck injuries. In 2001, there were 25,000 cheerleader injuries that resulted in a trip to the emergency room, according to the CPSC. That's double the amount reported in 1999. Between 1995 and 2000, eight high school cheerleaders suffered catastrophic, crippling injuries, compared to only seven catastrophic injuries for high school basketball players - even though there are eight times as many kids participating in basketball than in cheerleading (these statistics come from the National Center for Catastrophic Sports Injury Research).
     Laws and safety guidelines have not kept pace with cheerleading's development into an athletic activity. According to Keenan, only 12 states recognize cheerleading as a sport. Most often, regulations are developed only in response to a tragedy; both Minnesota and North Dakota banned pyramid stunts after a cheerleader died in a mishap. Keenan would like evidence-based guidelines to be in place regarding safety equipment and injury-prevention practices. He urges parents to check out the recommendations endorsed by the American Association of Cheerleading Coaches and Advisors and make sure the programs their children participate in measure up. Again, vigilance is the key.
     The family car can also present hazards not related to crashes. Be aware of the following dangers, consider how they apply to your family, and take any steps necessary to protect (or educate) your children.

• Backing maneuvers According to the CDC, 2,500 children are injured and 100 are killed each year when a driver backs over them, and most often it's a family member. Between 1999 and 2003, a whopping 42 percent of non-traffic/non-crash fatalities were "backover deaths" of kids under 14. The popularity of SUVs, with their wider blind spots, has no doubt increased the problem.

• Power windows By 2004, the advocacy group Kids and Cars had collected reports of 43 deaths by strangulation when kids got their necks caught in power windows. According to Keenan, many power window motors produce 50 to 80 pounds of force, more than five times as much as is necessary to raise a window. Many types of window switches are far too easy for a child to activate unintentionally, by leaning on or bumping against it. And there is currently no regulation in effect that requires auto-reverse devices on power windows, though some manufacturers include them as standard safety equipment on some models. The bottom line: know how the switches work on your car windows and use the child lock feature to deactivate switches in the rear seat. Check for auto-reverse technology when shopping for a new vehicle, and never, ever leave a child unattended in a car as strangulation deaths can occur in mere moments when your back is turned.

• Garage doors According to the CPSC, 60 children between the ages of 2 and 14 have been crushed and killed by automatic garage doors since 1982. Countless others have suffered injuries and irreversible brain damage. The good news is that all garage doors manufactured after 1993 automatically reverse direction when a sensor detects a solid object beneath it. The bad news is, there are thousands of older garage doors out there that have never been retrofitted with safety sensors or replaced. Besides testing and maintaining your own garage door regularly, make sure keypad controls are mounted out of reach of small children, and teach your kids never, ever to make a game of ducking under a moving garage door.

• Airbags As of January 2004, 141 kids have been killed by passenger airbags, according to the National Highway Traffic Safety Administration. Your car's owner manual will include information about how car seats and booster seats should be situated in relation to the airbags. To ensure maximum safety, read it and follow the guidelines.

The Internet: Safety in Cyberspace
    Unlike movies and books, which are scrutinized and rated according to content and suitability for their audiences, the Internet is largely uncensored and unregulated. In some families, kids are more tech-savvy than the parents, who may not be familiar with chat rooms, instant messaging, search engines and other tools children have grown up with. If you don't know how to use these things, above all else, get your child to show you. Consider sharing an email account with your child so you can monitor his correspondence, and find out if he has a free email account at Yahoo or Hotmail that you're not monitoring. Experts advise keeping the computer in a family room or other central area, rather than in the child's bedroom. You should also be aware that kids might have access to the Internet at school, the library, friends' homes, rec centers or cafÚs. Handheld devices like cell phones and game consoles also sometimes provide Internet access.
     The media has reported heavily on how sexual predators use the Internet to prey on youngsters, and though this risk is probably the most horrendous, it's also the most unlikely. What is highly likely is that kids will, at some point, be inadvertently exposed to objectionable material like Web sites or spam that promote pornography, violence or hate crimes, or harassing messages that come through chat rooms, messenger services and email.
     How you limit and monitor your children's Internet activities depends largely on their ages. For younger children who are beginning to use the Web for school activities, provide safe search engines like Ask Jeeves For Kids or Yahooligans. Consider installing a filtering program like NetNanny that blocks objectionable material and allows parents to set their own restrictions regarding chat rooms, file sharing, and even the times of day kids can sign on to the Internet. But realize that no program is perfect.
     Many of the more serious Internet hazards, like predators, can be avoided by being sure kids never reveal personal information about themselves or your family. Keep the following in mind:

• Make sure the screen names your child uses in chat rooms are "generic" rather than the child's actual first and last name. Periodically sit in while your child chats to see what kind of dialogue he's engaging in.

• If your child has a personal Web page, check it often for content and teach her never to include information like address, phone number, school attended, etc.

• Stress to your children that on the Internet, people may not be who they say they are.

    Dr. Laura Mee, a pediatric psychologist at Children's Healthcare of Atlanta, advises that it's important for parents to have good listening skills and encourage kids to talk about any unsettling experiences, whether online or otherwise. "Always continue to say to your children, 'Let me know. Tell [me] if something happens that you're uncomfortable with; tell me if something feels weird,' " she said. And remember, when your child does encounter an upsetting message, person, or site online, how you respond will largely determine whether or not she confides in you the next time.
     Teens who know their way around the Web may be tougher to manage and some parents prefer to step back a little, believing older children have a right to a certain amount of privacy. On the other hand, said Carole Moore, a former criminal investigator who now writes about personal safety issues, "Kids lose their inhibitions on the computer. The things that go on will make a parent's jaw drop. Anyone who thinks a kid deserves privacy has no idea what's going on and needs to take a look at the kid's computer. To me, that's the place parents really need to pay attention." Moore recommends installing a stealth program on computers used by both younger kids and teens. Such programs, including Advanced Keylogger and PC Tattletale, make a record of every activity that takes place on the computer, allowing parents to monitor email, instant messaging, Web browsing, etc.

Stranger Danger and Sexual Predators
    The threat of children being abducted or molested is every parent's worst nightmare, the most emotionally charged safety issue of all. The good news is, while media reports have portrayed stranger abductions as a modern epidemic, they are actually relatively rare events. The majority of the missing kids you see today are either runaways or have been taken by a non-custodial parent or other family member. Based on a 1999 study sponsored by the National Department of Justice, there are between 100 and 130 instances of stranger abductions per year. In 2001, the FBI handled just 93 such cases. In addition, there's no statistical evidence that these crimes have increased over the past 25 years; the only upward trend seems to be toward increased media coverage.
     At the same time, it pays to talk to your children about the ways predators can lure children into a trap. Teach them that adults don't have to ask kids for help. If someone approaches them and asks
for directions or aid in finding a lost pet, instruct them to say no and quickly move away. Teach them how to scream loudly and to fight, kick and otherwise resist anyone who attempts to drag or carry them away. Better yet, Mee said, use role-playing activities to practice defensive actions, from not opening the door to a stranger to yelling for help if accosted on the street or playground.
    "Because it's role playing and it gets them physically active when doing it, it engages another part of their brain, as opposed to just a parent lecturing a child," Mee explained. "It's a different way of learning that may lay down a stronger memory of what to do."
     Keenan also urges parents to find out if there are known sexual predators in their neighborhood, yet he cautions that although sex offenders are required to register their addresses with the justice system, the law is rarely enforced and up to one-third of the known offenders cannot be located at any given time. A simple Internet search will locate offenders by zip code, and parents can even sign up to receive email alerts when a new offender moves into the neighborhood. Unfortunately, if you find out one of your neighbors has molested children in the past, all you can do is remain vigilant, network with other parents, and speak candidly to your children about the people they should trust and those they should avoid.
     When it comes to keeping your precious ones out of harm's way, the best defense is a well-informed parent and open dialogue with children of all ages. It could make all the difference.