I’m not sure whether to call this the good news or the bad news, but Covid-19 is not the only thing that parents need to think about right now.
Summer regularly brings up a set of safety concerns for children, and that is as true this year as any other. Of course, this year is very different, and when I talked to pediatric emergency room specialists around the country, they reinforced summer safety advice, while noting some of the special twists and dangers of this dangerous and twisty time.
“Everyone has cabin fever, and they want to get out and have a good time,” said Dr. Mark Zonfrillo, an associate professor of emergency medicine and pediatrics at the Warren Alpert Medical School of Brown University. And even as many parents may feel that it’s all they can do to enforce social distancing and mask-wearing, it’s important to remember the safety measures from the before times as well.
Dr. Maya Haasz, an attending physician in the pediatric emergency room at Children’s Hospital Colorado and an assistant professor at University of Colorado School of Medicine, said they are seeing injuries that reflect a summer of individual activity rather than team sports. Kids are out riding their bikes and their scooters, she said, but not always wearing helmets. “We’re seeing more significant head injuries,” she said.
And because some parents are still scared to go to hospitals, injured children are sometimes not coming in immediately. The delay can be painful for the child and problematic for the doctors, for example if a laceration is more than a day old, and can’t be safely sewn up.
“We’re doing a tremendous amount to keep the hospital safe,” Dr. Haasz said. “You are not at risk of getting Covid in the hospital.”
But to help keep kids out of the emergency room, remember the sunscreen and the bike helmets and the adult supervision for kids in the water.
Drowning is the leading cause of death for children from 1 to 4 and it can happen silently and swiftly, leaving behind devastated families and regrets that never go away.
Dr. Maneesha Agarwal, a pediatric emergency physician and assistant professor at Emory in Atlanta, said that in 2018, 443 children from 1 to 4 died from drowning, and that it kills about 1,000 children of all ages every year. There are two peaks in age, she said, first the toddlers and young children who accidentally gain access to a body of water, and then the adolescents, the risk-takers, “who might be horsing around, sneaking into pools.”
With the pandemic, children may not be going to community pools, where there would be lifeguards, and the home pool market has been booming. “A lot of people are getting new pools and first-time pools, so with that comes a responsibility for not only proper barriers and pool gates, but also proper supervision in an era of distraction,” Dr. Zonfrillo said.
Parents need to think about layers of safety, Dr. Agarwal said, such as having a four-foot tall fence around the entire pool, but also alarms. Parental supervision is key. “We recommend for younger children and not experienced swimmers that they should always be within arm’s reach,” Dr. Agarwal said. Parents should not assume they can rely on a lifeguard, who will have many swimmers to watch.
Even kiddie pools and shallow bodies of water can be dangerous, Dr. Zonfrillo said: “A toddler can drown in just a few inches of water.”
If you have a trampoline, supervise children carefully, follow all safety instructions, and make sure there is only one child on the trampoline at a time. Trampoline sales have gone up in the pandemic, and doctors have been very concerned about trampoline-related fractures and trips to the emergency room. “A bunch of kids on a trampoline can really cause a lot of injury,” Dr. Agarwal said.
Bikes, Scooters and ATVs
Be mindful of bike safety, be vigilant about helmets. And remember that kids can get badly injured on scooters and on all-terrain vehicles, or ATVs. ATVs are very common, especially in rural communities, Dr. Agarwal said, and nationally, about four children are seen in an emergency department every hour with ATV injuries. She recently treated a child who had taken “every single precaution,” she said. “He was on a designated ATV recreational area, he had a helmet, he was supervised, he had no passengers — and yet he still managed to roll over his ATV on himself.” Bottom line: Although she understands their appeal, Dr. Agarwal said, “Don’t put your kid on an ATV.”
Take the summer sun seriously: Keep children in the shade as much as possible, use hats and protective clothing in addition to sunscreen. Apply lots of sunscreen, reapply it every couple of hours, and after children go in the water. Make sure children stay hydrated, especially if they’re exercising. Children who are engaged in athletics should start hydrating before they go out to practice, Dr. Agarwal said, and if they haven’t been practicing during the shutdown, they should ease back in, and be particularly careful about hydration and heat exposure when they go back to practicing.
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Frequently Asked Questions
Updated July 27, 2020
Should I refinance my mortgage?
- It could be a good idea, because mortgage rates have never been lower. Refinancing requests have pushed mortgage applications to some of the highest levels since 2008, so be prepared to get in line. But defaults are also up, so if you’re thinking about buying a home, be aware that some lenders have tightened their standards.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Heat stroke is always a worry, especially vehicular heat stroke, which happens when small children are left in cars. Many doctors were worried that the pandemic might put children at additional risk, if parents who are reluctant to take them into stores leave them in vehicles. “In hot temperatures, the temperature in the car can rise within minutes,” Dr. Zonfrillo said. Ideally, parents should leave children at home while they do errands.
This year, Dr. Agarwal said, the numbers are actually looking a little better. For the past two years, over 50 children a year have died from heat stroke; there have been 11 deaths so far this year.
Be aware of the danger posed by firearms that are not properly secured and stored. Firearms are not specifically a summer risk, but this is a summer of children not going to camp, and home injuries loom large. Firearm sales have increased in the pandemic, and Dr. Agarwal says that pediatric emergency doctors are worrying over these new owners especially, and whether they are storing the guns safely — they should be stored unloaded, locked up in a gun safe or with a trigger lock, and with the ammunition locked up in a separate location. “I want to encourage all parents to ask about the presence of unsecured firearms in any home where children go to visit,” Dr. Agarwal said.
Other at-home injuries to avoid in an at-home summer include poisonings and falls, especially falls from windows. A window screen alone is not a sufficient protection. Be aware that even the substances you’re using to protect your children can be toxic; the pandemic has meant increased poisoning incidents involving hand sanitizers. Dr. Zonfrillo emphasized the importance of what he called “re-child-proofing the home, based on the child’s developmental age.”
Social isolation may be taking a toll, especially on children who suffer from anxiety or depression, and on those who may not have been able to get help and therapy virtually. On the other hand, as children begin to interact more, whether in person or virtually, and even start school again, doctors worry about bullying.
Dr. Haasz said this is a time for “really keeping an eye out for friends and family who have mental health concerns.” To help keep vulnerable children safe, it’s again important to be sure the home is injury-proofed, she said: “Lock up anything they could use to hurt themselves, even seemingly benign medications like Tylenol and Benadryl.” And if you’re worried about your child’s mental health, she said, bring it up.
“You are not going to harm your child by asking them questions,” she said. “If you are concerned about them, talk to them. If you’re concerned they’re going to hurt themselves, bring them into the hospital.”
Dr. Perri Klass is the author of the forthcoming book “A Good Time to Be Born: How Science and Public Health Gave Children a Future,” on how our world has been transformed by the radical decline of infant and child mortality.