Children's hospital head talks summer safety

Kids on wheels

We definitely know when summer is here and kids are out of school. It's the busiest time for us, with the number of kids coming in with injuries doubling, and at times tripling, and when we're busy in the Emergency Department of Childrens Hospital Los Angeles, it means children are at risk, often lifethreatening.

Among the most common injuries we see during the summer are broken bones, head injuries and severe lacerations from falls off of wheeled devices.

I have two children, and I know that when the weather is warm and there is no homework to be done kids love to be outside riding their bikes or scooters and skateboarding or roller skating.

These activities are all wonderful opportunities for children to exercise, interact with their peers and have fun. But it's absolutely critical for parents to understand and be vigilant about safety when children use wheeled devices.

Each and every day during the summer we see 15 to 25 injuries caused by falls from wheeled devices, including sprained or fractured ankles, wrists and elbows.

Ninety-five percent of the head injuries we see, some very serious, are because the children were not wearing proper helmets.

I recently treated an 11yearold boy who was skateboarding down several stairs in a public area without wearing a helmet. His skateboard flipped and he fell on the concrete, hitting the side of his head.

When he arrived in our emergency department, his speech was slurred, he vomited twice and he felt sleepy. A CAT scan revealed intracranial bleeding.

He was lucky. He did not require surgery and only spent a day in the intensive care unit, with no permanent brain damage. But I have seen too many other kids who weren't so fortunate.

The leading killer of children ages 1 to 14 is accidental injury. One of the most distressing parts of my job is seeing children in our emergency department with injuries that could have easily been prevented if only the parents were more vigilant. Parents must set the safety rules.

As an emergency department physician and a parent, these are my rules of safety regarding wheeled devices:

•Safety rules for children are not open to negotiation. My son would complain that the neighborhood kids made fun of him for having protective gear when skateboarding. My answer was always the same- no gear, no skateboard, period. These safety rules must be incorporated into the overall household rules. We don't think twice about getting in our cars and putting on our seat belts. Wearing proper safety gear when using a wheeled device must be just as automatic. Wearing protective gear is a must every time. No exceptions.

•A proper helmet is critical in protecting against serious brain injuries- and different activities require different helmets. For example, because most bike injuries are from falling off from the front of the bike, helmets are designed with frontal protection. However, a skateboarder typically falls backward, and those helmets are designed to protect the skull and the back of the head. Parents must make sure that children wear helmets that are specifically geared toward bikes, skateboards or scooters.

•The fit of a helmet is absolutely critical. The front of the helmet should sit right above the eyebrow. The helmet should be snug. If a finger can fit between the helmet and the head, the helmet is too loose. Adhesive helmet pads can be placed inside to tighten the fit. The chin strap should also fit comfortably. A finger should be able to fit between the strap and the chin.

•In addition to helmets, children must also wear elbow, knee and wrist pads. Again, make sure the protective pads are sport-specific because a fall from a bike creates a different force than a fall from a scooter.

•Children should not ride in busy streets, parking lots or public walkways and not down steep hills. Bike paths in parks and designated skate parks are the best locations. Children should not ride at night.

•When using any wheeled device, children should always wear bright clothing so they can easily be seen, and they should always wear closed-toe shoes to protect their feet. Never, ever allow children to ride a wheeled device in bare feet.

Dr. Alan Nager is head of the division of emergency and transport medicine at Childrens Hospital Los Angeles, designated as a Level 1 Pediatric Trauma Center by the Los Angeles County EMS Agency. He is also an assistant professor of pediatrics at USC's Keck School of Medicine.