Author: Lois Lee, MD, MPH

Lois Lee, MD, MPH works in Children’s Emergency Department Injury Prevention Program

Hot dogs, popcorn, gum, candy, marshmallows—These may seem like fun delicious foods to most people, but to young children under the age of 3 they are potential choking hazards that can even lead to death. These foods are about the size of a young child’s airway and can cause a blockage which can be fatal if the child can’t breathe.

Choking from food, coins or small toys is a leading cause of death and disability in children 3 years or younger. The American Academy of Pediatrics released a policy statement this month on the prevention of choking among children. They recommend that food manufacturers should design foods to avoid choking risks in young children. They also recommend routine choking-prevention counseling to parents of young children.

Children are at increased risk from choking because of several factors.

• First of all, young children like to put things in their mouths—even if it is not food.
• Even if children are eating food given to them, their ability to chew and swallow is less coordinated than an adult’s – so they are still at risk of choking.
• Also, a child’s airway is smaller in size than an adult’s, and they also don’t have the ability to cough as forcefully to dislodge a foreign object if it gets in their airway.

When my children were younger than 3-years old, they were not allowed to eat popcorn, gum or hard candy because of the risk of choking. I never even dreamed of letting them eat a marshmallow. And if they had carrots, grapes or hot dogs, we cut them into pea sized pieces. They were, and still are, only allowed to eat food if they are sitting still since they might accidentally choke on food if they are running around.

In addition to foods, parents need to be wary of toys with small parts or parts that can break off and become a choking hazard. If you have an older child with toys with small parts, you need to make sure that these toys are out of reach of children less than 3-years old. Balloons and coins are also choking hazards.

So as a parent, what can you do to prevent choking in your child?

• Avoid foods like peanuts, gum, round candies and popcorn for children less than 3-years old.
• Make sure other foods like hot dogs, carrots or grapes are not cut into a round circle or given whole, but that they are cut up for your young child.
• Learn first aid and CPR so in the event of a choking situation you can aid the child.

NECN interviews Children’s Mark Waltzman, MD about the new AAP recommended guidelines.

Lois Lee, MD, MPH

Lois Lee, MD, MPH works in Children’s Emergency Department Injury Prevention Program

The city of Boston recently celebrated the fact that no citizens within the city died as a result of a house fire in 2009—the first year with no deaths since 1972, when the Fire Department started keeping records about fire-related deaths. It seems to me in 2010 that deaths from house fires should be a phenomenon of an earlier century, but sadly this is not true.

With some of the older type of housing and the various types of heating devices families use to survive the long New England winters, this is an important fact to celebrate. The use of space heaters, the presence of old electrical wiring and living with persons who smoke in the home all increase the risk of a house fire.

Smoke detectors are key in alerting residents of a home when there is smoke and fire so they can escape in time. Not only can people be burned in a house fire, but they can also suffer from the effects of smoke inhalation.

It is Massachusetts state law that every home must have smoke alarms. But in addition to having the smoke alarms, people must check that the batteries are still good. So, unless the alarm has a long life type of lithium battery, safety experts recommend checking the batteries on a regular basis. To help people remember, it is recommended to check the smoke alarm battery on the daylight savings time days.

Although it is helpful to have a smoke alarm, obviously it is better to prevent the house fire. The proper use of space heaters and NOT smoking in bed (or at all) are important measures to prevent house fires. In addition, candles should be lit only when people are present in the home. If a fire does break out, having a fire extinguisher, especially in the kitchen, is an important first step in putting the fire out.

In addition to having a smoke alarm, it has been Massachusetts law since 2004 that every dwelling unit has a carbon monoxide detector. This law is called Nicole’s Law, named after the 7 year old girl from Plymouth who died from the effects of the odorless, colorless gas, which filled her home after a snowdrift blocked an exhaust vent from her home’s propane-fired boiler.

A carbon monoxide detector sounds an alarm when there are elevated levels of the gas, which can build up in any home with boilers, furnaces and hot water heaters powered by gas, coal, oil or wood. And our long, cold New England winters (can you tell I’m from Florida?) definitely put us at risk for potential carbon monoxide poisoning.

The detectors usually cost about $30 and can be readily purchased at a home building supply store.  The symptoms of carbon monoxide poisoning including nausea, headache and fatigue, mimic other disease like the flu. If there is concern that these symptoms are due to carbon monoxide poisoning, a simple blood test can help make the diagnosis.

In addition to the hazards of the cold, we must be aware of the potential hazards of trying to keep warm in the winter. Smoke alarms and carbon monoxide detectors are a must have in the house, and the law, in order to keep all of us safe from house fires and carbon monoxide poisoning.

Do you know how home fire sprinklers work? Read up on the Myths vs. the Facts of owning a home sprinkler.

Lois Lee, MD, MPH works in Children’s Emergency Department Injury Prevention Program

You often hear about children being left in cars in the middle of the summer, but did you know that it can be equally dangerous during the winter months?

Many parents probably understand the temptation to leave their young child in the car for “just a second” to run a quick errand, especially if the child is sleeping. But no matter how quickly you think you will be back to your car, you should never leave a child in the car alone.

Recently, a mother left her two young children in an unheated car in 28 degree weather for 18 minutes while she had a tanning session in a salon. Thankfully the children were unharmed, but they could have suffered from cold related injuries.

Unfortunately, the same scenario occurs at other times of the year. It is particularly dangerous if a young child is left in a car on a hot day when they can develop dehydration or hyperthermia, which can even lead to death.

There are other perils related to leaving children in the car unsupervised as well.

• They might be able to figure out how to start the car –  if the keys are left there.
• They could injure themselves either in the car or outside of the car –  if they are able to get out.
• The car could also get carjacked and the children kidnapped.

Some of these scenarios may sound far fetched, but they have all been reported in the news. So now matter how “quick” you will be, children should never be left alone in the car.

The dangers are real and it makes no sense to put your child at risk.

Read more of Lee’s injury prevention advice on winter sports safety.

Lois Lee, MD, MPH works in Children’s Emergency Department Injury Prevention Program

Having grown up in Florida, I never understood the appeal of winter sports until my son took up skiing. Now, to keep him and his sister active in the winter, we enjoy skiing, sledding and ice skating. These are great family activities, but they do carry some risk. Read on for safety tips to keep healthy while having fun in the cold!

Head injury

Children and adults are at risk for head injuries when participating in winter sports, either from running into another person or into a stationary object like a tree. Research has shown that wearing sports helmets can decrease brain injury risk. If you or your child has a head injury when skiing, snowboarding, sledding, snow tubing or skating, you should contact your doctor or be seen in the Emergency Department if any of the following symptoms are present:

• Not acting right, or acting “out of it”
• Sleepy or lethargic
• Loss of consciousness
• Vomiting
• Severe headache, a headache that is getting worse or a headache that does not improve with medication

Cold weather injury/hypothermia prevention

It’s important to wear appropriate clothing and to dress in layers to stay not only warm, but also dry. Check in often with your children to make sure they aren’t wet, cold or shivering. Make sure they stay away from lakes or ponds, which may appear frozen on the surface, but may not be strong enough to support even a child’s weight.

How do you keep your children both active and safe during the winter months?