The Motherhood Café Presents: SAFETY 101
Angela Lusardi: Social worker for Health Department; in charge of car seat safety
Rachel Gagan: Pediatrician, Certified Lactation Consultant, mother of 2
Haley Evans: Central VA Health District Epimediologist
Steve Simpson: Environmental Health Manager
Joe Edgell: State Police, father of 2
Erica: Good Morning, today we’re talking about safety and we are pleased to welcome several local professionals who will help us with a number of safety related topics. Per usual, we have questions to get our conversation started, but please feel free to jump in and ask questions of your own. We are going to split this morning’s panel into separate sections so that each panelist may address their specific areas of expertise. However, any of you may chime in at any time! We’ll begin with State Trooper, Joe Edgell.
Erica: Joe, In your opinion, what is the best way for us to teach our children about strangers? Are child abductions common? What are situations that we need to be most aware of?
Joe: It's not the biggest thing you have to worry about; last year only 1% of abductions were from people that they didn't know. Most were either from people they knew or with older children. However, once they are able to start understanding, it's good to teach them things to help prevent an abduction. Usually someone trying to abduct a child will ask questions of the child, offer them a ride, candy or money. They may ask if they want to pet an animal; most occur around vehicles. When they're old enough, teach them to not go into a vehicle or around a vehicle they don't know, and come report to you if someone asks them things like this.
Erica: Do you have any tips about how we should teach our children to react if they get separated from us in crowded places? As we talk to them about strangers, do you have any suggestions for teaching them to find “safe” grownups?
Teach your kids to look for a mother with a bunch of kids around her. Teach them their name, your name, their address and phone number. They can learn these things very young (even at age 2) - even the directions to their house.
Also, don't teach them to be afraid of the police. Don't say things like 'They're going to take you to jail!' even in a teasing manner. I let them know that I'm here to protect them. You want them to seek a police officer, firefighter, EMS etc. out, so they can help.
Audience comment: a dog tag attached to their shoes with their name, address, mother's name and number, etc. Or a picture before you walk into a big area (like Disney World), so you have a picture of them that day.
Erica: What about internet safety? What are the things we should be most concerned about? Are there things we should never share online? What are your biggest concerns about online use and safety?
Joe: Set boundaries for your kids. Limit the sites they can visit, number of texts they can get, etc. And monitor what they're using, either firsthand or via software. And communicate with them - let them know what the risks are, and help them to understand what is and is not OK. Don't communicate with strangers via text or pictures.
Erica: Also, I would say be aware of location services on your phone, not always sharing what you're doing/where you're at all the time...info that you wouldn't want a stranger to know.
Erica: Now on to Angela! Angela, most of our attendees are parents of children under 5, so we have a working knowledge of car seats. However, it’s estimated that up to 95% of seats are installed or being used incorrectly. Could you give us a quick summary of the different types of seats (infant, convertible, booster) and what ages/sizes should be using which?
Also, forward-facing versus rear-facing is often a topic of conversation with parents of toddlers. Virginia law states children should be rear-facing until at least one year AND 20 pounds. However, other states require rear-facing until age 2 and safety experts make the case for rear-facing up to age 4. Can you explain why rear-facing is recommended and what the benefits are?
Angela: One of the best things you can do for your child is have them in a carseat. Once they are over 4'9" and knees over the edge of the seat (and over age 8), they should be big enough to sit like an adult. But regardless of age, the size is the most important, for example, you CAN turn the seat around at 1 year old, but it is safer to keep them rear-facing for at least 2 years. First fine is $50 and 3 demerits on your license, and I think up to $500 for your second offense.
I've had people say 'but my child is 8 years old, she doesn't need a car seat'. However, she's 4'1", so she's not appropriately seated in the car. Minimum requirements are just that - minimum. Always go with the safest option for your child.
Rachel: Yes, there's a difference between what is 'legal' and what is actually best for your child. The legal limit is the MINIMUM.
Angela: we go by the American Association of Pediatrics. They recommend that a child be 35 lbs and at least 2 years of age before turning them forward-facing. They may have good muscle and head control, but their spine is still developing. It is more protected in the rear-facing seats. When rear-facing, they should be at a 45-degree angle, the internal harness straps should be at or below the shoulders, and the chest plate at chest level. This helps them to ride out a crash and not flop around. Each seat has restrictions/weight limits, etc. Always go by each individual seat and their specific regulations so you know what is the most safe for that seat and your child in it.
When your child goes to forward-facing, you want the internal harness straps at or above the shoulders, and at a 90 degree angle. Rear or forward facing, the seat shouldn't move more than an inch (which isn't much!) Also, try to make sure to make all adjustments before installing the seat. Other things to consider include what they're wearing...a puffy coat or bunting can create an air pocket and too much space in between them and the harness.
If someone has WIC or Medicaid, they are automatically eligible for a free seat from the Health Department. We pay for these from the fines of people who didn't have a properly installed car seat. If you would like information on this and to see if you qualify, please visit this page for more information!
Rachel: I usually send moms to a fire department to have them properly installed. The police department is also able to help if you call the non-emergency line.
Audience: When you have a small infant, how long should you use the padded head inserts?
Angela: We don't authorize any specific type of head support, but that's something that's really up to the parent. We would just say that you be careful to not use anything that could move around/obstruct the airway. It really depends on how much the child falls over vs. stays upright, etc. Also, don't give them anything they could possibly choke on. The safest place to put your car seat is in the middle backseat. There's more airspace around the child.
Joe: Also, when you get a new carseat register it for recalls. It will alert you to anything that may be recalled, and they can send you replacement parts if needed without you having to do anything.
Most of this information and helpful videos and tips can be found here.
Erica: There are, of course, many types of emergencies, but are there basic things we should have ready in our homes? Do you have any suggestions for emergency plans or emergency kits?
Joe: There are all sorts of emergency kits you can put together. Our guys have 3 different kinds of 'go bags'. One has food, water, matches, first aid kit, etc. That's a good kind of thing to keep on hand. If you have medical issues it's good to keep them on hand just in case you're separated from your usual supply (epipen, etc.) Even though we don't have natural disasters often, they can hit, so it's good to be prepared.
Erica: Let’s switch over to Steve Simpson, Environmental Health Manager, and Haley Evans, who is also here from the Health Department. To begin, what do we need to know about Zika virus?
Haley: Zika virus is not new! You maybe have just been hearing about it recently, but it was first identified in the Zika forest in Uganda in 1947; the first human infection was recorded in 1952/1953. However, last year, there was a sort of 'outbreak' in Brazil, where a lot of pregnant women contracted it and then had babies with microcephaly.
We're still learning a lot about it, however, we don't have Zika virus transmission currently in the United States. Our mosquitos do not have it.
There are, however, travel alerts. Women who are early in their pregnancies, planning to be pregnant, etc. the CDC is encouraging them not to travel to potential Zika areas. You can get the updated list here.
Zika can also be transmitted sexually. We have evidence that men who have been infected can transmit Zika to a partner. Men who have traveled to any potential Zika area need to use a condom for at least 12 weeks following travel to a potential Zika area.
Symptoms can include conjunctivitis (pink eye), fever, rash and joint pain. They are very mild, and very rarely become more serious. Until the correlation with microcephaly, it was considered less bothersome than the common cold. Please remember: we DON'T have local transmission! There are only 25 infected with Zika in VA, and all acquired their infection via foreign travel.
I'll let Steve talk about avoiding/getting rid of mosquitos!
Steve: What I like to say is 'Don't feed em and don't breed em!' The easiest thing is to use bug spray! They like shady places and they like people. There are deet and non-deet based insect repellants. Also, use some condoms during sexual activity. Your own Zika prevention kit: condoms and bug spray! :)
Mosquitos like to breed in stagnant water, even as small as a bottle cap. Egg to mosquito is about 7 days, so any type of kid toy left out in the yard, bottle, empty can, plastic bag, etc. that collects water and it stays for a week, you can breed a lot of mosquitos. Look around your yard for any source of standing water, and empty that - even gutters if they're clogged.
Make sure your screens are in place/windows closed to keep them out of the house.
Haley: I would add, when you see homemade things to spray in your yard (on Pinterest, etc.), or hiring an exterminator to fog the neighborhood, these types of things...the species of mosquito we have isn't susceptible to these things, so save your money!
Audience comment: my husband travels widely for work. You're saying he could contract it, but after 12 weeks, he would be 'ok'?
Angela: Yes. He could become infected and transmitted sexually. 80% of people infected with Zika virus do not show any symptoms of it. So yes, 12 weeks is the recommendation from the CDC.
Audience comment: I'm concerned about chemicals on my children. Rachel, what are your recommendations for what to put on our children?
Rachel: we have proof that yes, Deet is the most effective, however, there are always concerns about things that are toxic to bugs could be toxic to people. Spray their clothes more than their bodies, and be careful not to get it on their hands/faces. However, for an informed parent, I think any bug repellant is better than no bug repellant. The items that combine SPF and bug repellent don't work well and aren't worth it.
Haley: we may not have a lot of mosquito illnesses, but we have a lot of tick-born illnesses, so it is important to protect against bugs.
Erica: And lastly, let’s direct some questions to one of our local pediatricians, Rachel Gagen. Rachel, you see a mix of illness and injury every day. Obviously, not everything is preventable, but let’s talk about things that are! What are some common accidents you see? Is there something that you often counsel parents about?
The first thing I tell parents is: Don't freak out! Accidents DO happen, but they are often preventable. Some of the more common ones I see or hear about are:
1) The number one thing I hear is about babies falling off of beds. Babies will swell quite a bit; most babies under 6 months have a softer type of bone and have less skull fractures. However, to prevent, we recommend not putting babies by themselves on the bed, even if they're very young. Especially if the bed is very high off the floor. Place them on a blanket on the floor instead.
2) Burns! Hot coffee...when they all of a sudden can reach things they couldn't reach before. Touching a hot pan, burns from something that is up on the counter and the cord is dangling. Sticks from bonfires/bonfires in general. Monitor children around fires and ovens, make sure cords are out of reach and items are pushed back on counters, even if you don't think they're tall enough to reach it! If you are cooking or curling your hair, be aware of where your child is at!
3) Knives. Especially that 5-7 year old range; we let them start using them but still need lots of assistance. We will see, for example, a child who was just trying to open a plastic toy, but the knife slipped and they cut their hand. Always supervise!
4) Guns...I thankfully haven't seen these in my practice, but have been hearing more and more about it. Some moms keep guns in their purses; remember your kids are danger magnets! It just makes sense that if they find a gun, they are capable of pulling a trigger. If you're going to someone else's home, feel free to ask if they have a gun and if it's locked up, just like you would ask if the dog was safe to pet. It's not about whether or not someone should or shouldn't have a gun; it's simply about being smart and keeping children safe, because they are curious!
5) Cars in the driveway; backing up the car and not sure who is behind them. Bike injuries, etc. Knowing where your kids are at all times when in the car. Even my 10 year old has to be almost touching my side when in a parking lot, as they are too short to be seen by some drivers in their rearview mirrors.
Erica: Please talk a little about good medicine dosing. What are some mistakes you commonly see? Are there medications you see being misused (intentionally or unintentionally)? What should we be aware of?
Rachel: Moms usually get very worried about coughs and want something to make that cough go away. But coughing is a good sign; they are cleaning their airway. Most cough medicines are actually more dangerous than the cough, including old-fashioned 'remedies'.
Using someone else's antibiotics is illegal; you can get criminally charged for that. If the child is that sick, take them to the ER. Same thing with any medicines that aren't for YOUR specific child; the risks are too high.
Also, make sure to lock up your medicines/creams, etc. and household cleaners! If they ingest anything, call Poison Control at 800-222-1222. They will track you, they will call you back to monitor, and they will give you the right information. Anything from Tylenol to fluoride to cleaners, plants, etc.
Erica: Let’s talk about water safety! Whether bathing at home or playing near water, children can quickly get in trouble. What are your suggestions to keep our kids safe from drowning or near-drowing when in the tub or pool?
Rachel: First of all, water means ALL water! A baby is like 1/4 head; they can't get out of something easily, even if it's just an inch or two of water, due to dispersion of body weight.
At pools, especially, we need to be constantly aware. There are lots of flotation devices, but none of them are 100% effective. Also, if you're going to a party and your spouse is with you, make sure you have very clear communication about who is watching the child, and they are 'on' the whole night. Really just planning ahead to see what situation you're going into and how to be the best prepared for that. Kids who are drowning usually aren't thrashing and yelling, they slip under quickly and quietly.
Erica: In general, when should parents call the doctor, choose urgent care or opt for the emergency department?
If they've ingested something, call Poison Control (800-222-1222). If you think they are injured, call the pediatrician first; if you can't get in touch with your pediatrician, use your judgment on whether it needs the ER. For me, if your child is having trouble breathing and you don't think it can wait an hour to come see their pediatrician, if it is a real imminent distress to their airway, then go to the ER. If they're bleeding profusely and it won't stop. If they're in so much pain and nothing seems to be working at all to alleviate that pain, that's an emergency.
Audience comment: I'm worried about aspiration; my baby has really horrible reflux.
Rachel: Luckily, babies are wired to not aspirate. I actually would worry more about a baby with a weak little cough than one that has a really deep, loud cough...that kind is a good one. If a baby is acting sickly, lethargic, not normal, or if they completely stop breathing, obviously, seek immediate medical attention! If you want to learn CPR - take a class, it's a wonderful thing to know and have as a resource, although you will hopefully never use it.!
Thank you to our wonderful panelists. This was a LOT of information to digest, and we appreciate your sharing so much of your experience and wisdom with us!