Camping Safety for the Whole Family

Last updated on June 6th, 2016 at 11:15 pm

Urgent Care or ER for Kids? Resources to Help Decide

Last updated on April 8th, 2016 at 11:33 am

My husband recently had an “incident” with one of our dogs, Nelson, and ended up being bitten. Now I should clarify that we have two wonderful dogs who are both very sweet and are absolutely full members of the family. Nevertheless, Nelson, – who we’ve had since he was a puppy – weighs in at 100 pounds and is EXTREMELY fond of food, or anything remotely resembling or smelling of food.

This incident happened because Nelson got a food soaked paper towel and had retreated with it under a corner table – his usual “safe” space. My husband got plenty of doggy warnings not to come near – and yet he insisted on trying to drag Nelson out and get the paper towel. The result was a series of impressive and bloody puncture wounds on his fingers. This was also rather ironic since he’s known among family and friends as the “dog whisperer” – and was rated as such in a quiz from an excellent post on dog bites which ran on this site last November.

As a result, he spent over an hour in the ER getting checked out, filling out paperwork about our dog, and…incurring over $600 in costs to us. It was only later, when we took our son to our local Urgent Care center for a sprained ankle, that it occurred to us that maybe Urgent Care could have taken care of the dog bite issue. My husband went to the ER because he thought he might need stitches. In the end he didn’t need them – but it turns out that our Urgent Care does stitches for minor cuts and injuries – at a much lower cost. If we’d only known this, he would have gotten the care he needed for about $500 less!

Given this incident, it seemed like a good idea to take stock of what Urgent Care typically offers, especially with respect to children. Urgent care is ideal in “non-emergency situations” for after-hours care or when you can’t get in to see your regular doctor. But what is “non-emergency”?  Apparently a minor broken bone is non-emergency, since our Urgent Care handles these and has onsite x-rays. But it’s not always so easy to determine the difference between “urgent” and “emergency”.  Thankfully some excellent web resources can help with that. The Children’s Hospital Colorado has a nice overview of when go to urgent care versus the emergency room. Head straight to the ER if your child’s skin or lips have turned blue, your child is unresponsive or difficult to arouse, or your child is having serious trouble breathing. Urgent care can usually handle simple cuts, injuries or illnesses – including fractures (unless the bone is sticking out!). The full guidance can be found on their website.

Seattle Children’s Hospital has a very handy review on their website, listed by condition or issue – and they have a nice downloadable version which you can print out (scroll down to the bottom of their webpage). Further below is a snapshot of some of the guidancethey provide.

Buyer Beware

One thing I learned from my research on this topic is that the services offered by Urgent Care centers are not yet standardized, especially for children. This is essentially a new industry and the rapid growth of these types of centers has spawned – as described by a doctor at Johns Hopkins in this article – “a mishmash of clinics, some offering fairly sophisticated care, while others providing only the most rudimentary.” And general Urgent Care centers are sometimes uncomfortable treating more serious pediatric concerns. This field is so new that the American Academy of Pediatrics only just established a sub-committee on pediatric treatment in urgent care in 2015. So, probably the best advice is to check out what services your local Urgent Care center provides – ideally in advance of needing them! – and follow your instinct if you think the ER is really the better bet.

Video: Stairs, Water & More – Preventing Child Accidents at Home

Last updated on December 29th, 2015 at 11:40 am

Katrina Phillips of the Child Accident Prevention Trust explains how to make your home childproof and prevent avoidable accidents.

https://youtu.be/6JMn7gguZng

Editor’s Note: Video Highlights

There are hazards all around the home. This video covers the following key accident risks and areas of the house:

• Stairs – barriers are needed at the top and bottom of stairs to protect young children – and toys at the top of stairs can be a risk for all family members
• Bathrooms
  • Don’t leave cleaners under the sink or by the side of the toilet or bath – even if they have “childproof” caps – many 3-year olds can open these containers
  • Scalding bath water is a major hazard – always make sure the water is the right temperature before filling the bath

Note: In the UK, generally hot and cold water run through separate taps – so the advice in the video is UK-specific. In North America, the usual advice for bath water is to get the water running to the right temperature before filling it for your child – and to reduce the temperature of your hot water heater to avoid accidental scalding.

• Bedrooms
  • If  your window can fully open, invest in window locks to prevent falls
  • Beware of window blind cords – young children can get wrapped in these and strangled
• Kitchen
  • It’s important to keep pot handles and electric leads or cords away from edges of counters and small hands
  • Also ensure your cabinets have childproof locks – especially if they contain cleaners
• Family Room or Lounge
  • Beware of hot cups of coffee or tea – Did you know a baby’s skin is 15 times thinner than an adult’s? – so hot liquid can do them much greater harm
• Transportation Safety
  • Car seats are critical for kids – but ensure you have the correct seat for your child’s age and weight
  • Ensure your child always uses a helmet with a bike – even if just around your yard / driveway
  • Check out the video for more safe biking tips for your child – a healthy way to get around

A Question on Vehicle Booster Seats Answered

Last updated on December 5th, 2015 at 11:43 pm

Several years ago I wrote a post on booster seats (I’m 9 Years Old – Do I Really Still Need a Booster Seat?) about how my then 9 year old son didn’t want to keep using a booster seat in the car because none of his friends did anymore and he felt he was old enough to use the regular seat belt. The point of the article was that guidelines issued in 2011 recommended using a booster seat until a child reaches 4’9” tall (57 inches) and weighs between 80 and 100 pounds – generally in the range of 8-12 years of age. This continues to be one of our most read posts on the site and still gets occasional comments – which indicates the ongoing confusion and lack of clear laws and communication about what constitutes safe car travel for our older kids.

Recently one of our readers asked a very good question about my post – which warranted some extra research:

My car (Jeep Cherokee, older) has a bench seat in back, and the back of the seat is somewhat low. If my 8 year old son is not in a booster, his head and neck are against the seat and supported; in a booster, his shoulders, neck and head are above the seat back and completely unsupported. In a wreck, that booster would cause his neck to be snapped. I really hate that the law forces me to endanger him that way with the booster. Buying a new car isn’t an option, and I wish there were some sort of aftermarket option that was safe and crash-tested, which would allow the belt to fit him and keep him out of the booster. Suggestions?

To get an expert perspective on this issue, I turned to Stephanie Tombrello, LCSW, CPSTI, Executive Director of SafetyBeltSafe U.S.A. According to Tombrello, “if a parent has a vehicle with a low-back vehicle seat, the immediate recommendation is a high back booster. There are many options in every price range and with a variety of backs.” The Insurance Institute for Highway Safety has a recommended list of “Good Bets” for booster seats in 2015, many of which are high back models. Additionally, “for some children, the Dorel (Safety 1st) Incognito booster for children 60-120 lbs. can be low enough to allow for fitting the belt properly while not placing the child high in the vehicle,” says Tombrello.

If none of these options suit, parents can consider an alternative to booster seats – the Safe Traffic System RIDESAFER Travel Vest – which Tombrello also recommended.  These vests, which are billed as the world’s first wearable child restraint system, reduce the load transferred to the child in a crash, thereby providing better safety. However, please note that these vests are limited to a weight of 80 pounds and height of 57 inches.

Virtually no US laws make it clear that children need booster seats until adult belts fit – and there’s little guidance to parents on how to determine fit. Tombrello cautions “that children must be able to pass the 5-Step Test before dispensing with a booster. The potential injuries to the bowel or stomach from the misplaced lap belt are significant.” See the box below for the steps to take to determine if and when your child can graduate to adult seat belts – and go to www.carseat.org for more information on protecting children and pregnant women in the car.

The 5-Step Test
1. Does the child sit all the way back against the auto seat?
2. Do the child’s knees bend comfortably at the edge of the auto seat?
3. Does the belt cross the shoulder between the neck and arm?
4. Is the lap belt as low as possible, touching the thighs?
5. Can the child stay seated like this for the whole trip?

Have Insomnia? The Risks of Mixing Ambien and Parenthood

Last updated on June 24th, 2015 at 02:39 pm

If people can have no memory of driving, eating or having sex under the influence of Ambien, how can parents who use this medication limit risk to their children?

Have you ever suffered from severe insomnia? If you have you know just how critical regular, decent sleep is to normal daily function, mood, physical health, family dynamics….everything!  I suffered from horrible insomnia off and on for a few years. It started when my son was born – when my “mommy” senses kicked in and woke me up at the slightest noise. And then it got worse when I started traveling a lot for work and I developed a painful and chronic back problem. It got to the point where I could only function by using a rotating schedule of sleep aids…Tylenol PM, NyQuil, and prescription sleeping pills.

One of the most effective – at least in the short-term – was Ambien (also known as Zolpidem).  Ambien is part of a constellation of drugs called sedative-hypnotics. This grouping also includes other well-known medications such as Klonopin, Xanax and Valium (all of the benzodiazepine class).  Ambien and Lunesta are not “benzos” but are related types of sedative-hypnotics.  For someone suffering from insomnia, or traveling internationally across many time zones, Ambien can seem like a gift from the gods.  You fall deeply asleep almost instantly….at least at first….and even if you wake up before your alarm, you feel more rested than you have in a long, long time.

But after using Ambien for a while – admittedly for longer than the 7-10 days recommended by the FDA (Federal Drug Administration) and medical websites – I learned there are several downsides to using Ambien. First of all, you can develop tolerance to the medication through repeated use – which means it can take longer for the effect to kick-in and it may seem less effective if you’ve been using it for a long period of time. Also, according to the FDA package insert, you can develop a “drugged feeling” with use of around a month or more. But the most talked about issues with Ambien are what the medical community calls “abnormal thinking and behavioral changes”. This includes reports of “sleep-driving” and other behaviors reported while under the influence of Ambien, such as eating at night or having sex – with no memories of these activities in the morning.

Some of these odd sleep-behaviors can be comical. One woman found that she had painted her front door during the night, while another was experiencing unexplained weight gain that turned out to be caused by late-night Ambien-induced food binges (see this link).  My hairstylist told me of a male client that “cut” his hair under the influence of Ambien.  The result was terrible – with sections of hair cut so close to the scalp that it’s a wonder he didn’t badly injure himself.  He was mortified and she had to give him a buzz cut to fix the problem!

However, other reports of Ambien side effects are much more alarming.  There have been several reports of car accidents – most famously Patrick Kennedy’s 2006 crash – and people who wake up in police custody or the ER after Ambien-affected driving.  Plus Ambien-related ER visits have skyrocketed in recent years, with women much more affected than men.  Also a friend told me of her nighttime Ambien-fueled cooking sessions that resulted in bloody fingers from using her sharp kitchen knives under the influence.

But with all these issues, one thing really stood out for me….no one is talking about the risks of parents of young children using Ambien or medications like it.  If you can sleep-drive and crash your car under the influence of Ambien, what’s to prevent you from taking your kid along?  What about cutting your child’s hair or letting them help you “cook”?  And how might your kids cope if an emergency happens and they can’t wake you?  Even if these extreme situations may be rare, you might do or say some things you regret later. For example, I once took Ambien before putting my son to bed (remember that tolerance development I mentioned earlier??) and during reading time proceeded to explain how we needed to build a carousel in our bathroom! That might seem like a fun conversation for a toddler, but Elliott was old enough to know that Mom was behaving strangely….and it kind of freaked him out.  Another time, I told him my iTunes password….I had no memory of it later, but new apps/games (granted, mostly free) started showing up on my phone after I let him play on it.  His defense?  “But Mom, when I asked you for your password, you just told me!”  What can I say to that?

I’m in no way suggesting that people shouldn’t use Ambien.  That is a personal decision between you and your doctor – and Ambien can really help with insomnia, which I well know is a very real and serious condition.  Instead I think it could help if we (experienced Ambien users) started sharing the issues and challenges we’ve faced mixing Ambien use with parenthood and any advice we would have liked to have gotten when we started using sedative-hypnotics.  So here is my attempt:

• If there are two adults in the house, plan for only one to take a sedative-hypnotic medication on any given night – and communicate when you are taking one so the other person is alerted
• For women, make sure you are taking the lower dose of Ambien recommended by the FDA in 2013 (5 mg for immediate-release rather than 10mg for men, and 6.25 mg for extended-release rather than men’s 12.5 mg) – women clear the drug more slowly than men and studies have shown more next-day drowsiness and driving impairment in women
• Skip the Ambien if you’ve had any alcohol or have taken other medications that can influence the brain – like narcotic pain relievers (e.g. medications including hydrocodone or oxycodone) or other anti-anxiety and insomnia medications – these combinations are associated with increases in Ambien-related ER visits
• Even if you are finding the Ambien is taking longer to work….don’t take it until you get into bed, especially if your kids are still up – you may be surprised the next morning by what you did or said!…(see earlier)
• Consider telling your children that you will be very sleepy that night – maybe because you aren’t feeling well – so they shouldn’t bother you in the night unless it’s an emergency (we didn’t want to tell our son that mom was taking a medication to sleep, although I did when he was older and understood my health and sleep challenges)
  • The one Ambien/parent story I found on the internet was about a mom whose son threw up on her while she was sleeping because he wasn’t feeling well but couldn’t wake her (even though Dad was also in the bed!) so make sure your kids know to ask the other parent for help that night
• If you are the only adult in the house, think about asking a close friend or family member to be “on call” if something ever happens when you’ve taken an Ambien – you can tell your children to contact them in the night if something serious happens and leave a note with the number somewhere obvious on an Ambien night
• If you can, limit how often you take Ambien, possibly by alternating other non-hypnotic sleep aids or by using alternative therapies – I was able to drastically cut my use of insomnia medication through acupuncture treatments and mindfulness meditation (though I know this won’t work for everyone)
• And, finally, be kind to yourself…using Ambien on occasion doesn’t make you a bad parent – being severely sleep-deprived can though!

Parents, When Does Your Child Really Need A Life Jacket?

Last updated on August 29th, 2015 at 10:01 pm

When you think of a life jacket, that sturdy vest that keeps you afloat, you probably think of large boats.  While it is true that you should ALWAYS wear a life jacket when you are on a boat, a life jacket has far more uses for keeping you and your children safer around water.  Today we are going to talk about when to wear a lifejacket, what constitutes a real life jacket, and how to convince the (usually male) disbelievers to wear a lifejacket.

Let’s start with the obvious, wearing a life jacket on a boat, because too many people still leave the life jacket sitting next to them ‘in case I need it’.  70% of boating fatalities result from drowning, and 85% of those who drown are not wearing a life jacket.  It doesn’t matter if you have a little Sunfish sailboat for tooling around a small lake, a ski boat, a fishing boat, or a 90 foot ocean-going Oyster, if you end up in the water unexpectedly because you trip, are hit by the boom, get knocked by a wave, are dizzy from sunstroke, or any other unexpected accident, your odds of drowning are really high.  Even if you see the person go in, think for a minute how hard it is to see a wet head in the water if they aren’t also wearing a life jacket, much less how difficult it is to retrieve the person when they are shocked, cold, and maybe injured.  Even if you can get back to them and haul them onboard in a matter of minutes, they may already have started the process of drowning. My mom rule is that if you are above deck, you have a life jacket on, even docked or at anchor.  And if it’s rough weather, it stays on, period.  The new life jackets are light and comfortable, it’s not a hardship.  Granted, if you are on one of those huge passenger ferries or a cruise ship, no one expect you to parade around all day in a lifejacket, but do know where they are kept and if you have a child, know where the child-sized jackets are stored.  For your own recreational boating, click here  to learn about Coast Guard approved lifejackets, the only type of lifejacket you should ever trust with your child’s life, and your own life.  If you are traveling, call ahead and ask, many places have life jacket loaner programs, so you don’t necessarily have to invest yourself.

What most parents don’t think about is when lifejackets should be used off of boats.  If you have an inexperienced or weak swimmer, a very young child, or anyone with physical or mental limitations, have them wear a life jacket whenever they are near water.  If you are in a pool and at arm’s length, it isn’t necessary, but for a day at the beach or the lake, at one of those fabulous big resort pools, or even if you just have more than one child to watch, a life jacket adds a layer of safety and peace of mind.  It is almost impossible for anyone, even vigilant lifeguards, to see beneath the surface of rough water, so better to keep the head above water in the first place.  Children forget they can’t swim, they jump in or walk until they are over their heads, or just get tired, and next thing you know, they are bobbing just beneath the surface.

You may be thinking, I’m covered, I picked up a great floatation suit at the store, or always have those inflatable arm bands in our bag.  First anything inflatable.  If it inflates, it deflates.  Those inflatable arm bands are still sold everywhere, because the water safety field hasn’t gotten the message out there, but if you have some, do me a favor, pick up the scissors and drive a hole right through them before you put them in the garbage.  Not only can they deflate, especially at a beach or in rough water, but they really limit a child’s arm motion if they are trying to swim.  I’m all in favor of having fun in the water, and inflatable rafts and rings and toys can be great fun, but they are for fun, not for safety.  Inflatable arm bands aren’t even for fun.  If you have a question about any floatation suit or vest you have, see if there is a label saying it is Coast Guard approved.  Or go directly to the Coast Guard website to learn more. A true life jacket can turn an unconscious person onto their back so their face is not in the water.

There is the gray area of a child who is over-confident in the water but doesn’t have solid swimming skills, or has the skills but not the confidence.  For this child, you really want them in the water practicing their skills, under your supervision, but a life jacket may be too restrictive.  My go-to is still the SwimFin. It’s a shark-shaped fin that straps securely around a child’s middle.  A UK-product, it has passed the European Union flotation regulations, except that it is still not a life jacket, because it won’t keep someone on their back if they are unconscious.  I would never use SwimFin in the ocean or any other open water that has a current, a tide, or waves, but for a pool when you want to play more safely, it is absolutely brilliant.  It changed one of our vacations from my daughter saying ‘I’m bored, I want to go back to the room’ to my having to beg to get her out of the pool at the end of the day.  I still kept an eagle eye on her, but it gave her the freedom to practice her strokes and jumps.  Her swimming skills and confidence improved exponentially and appropriately on that trip.  Major bonus, all the kids at the pool wanted to wear one because it looks so cool.

Finally, how to you convince the ‘I’m too cool to wear a life jacket’ members of your family (statistically the males).  For them, I have two videos to recommend.  Both tried and tested within my family.  For the younger males, have them watch this ‘Heroes Wear Life Jackets’ video that features Coast Guard Rescue Swimmers.  My son said he was definitely more likely to wear a life jacket after watching – because it makes life jackets cool.

For the older males, here is an award-winning interactive video that simulates what happens when you are knocked into the water.  You have to keep scrolling to stay alive.  I admit I couldn’t watch for long, but the guys I work with said it got pretty graphic and frightening.  But, it did convince one of the most recalcitrant non-jacket-wearing avid boaters I know to start wearing a life jacket.  I didn’t push or nag, just forwarded the link in an email and said, ‘thought you might find this interesting’.  Sometimes all it takes to change behavior is a slight nudge in the right direction and someone else explaining why they need to change.

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