And They All Came Tumbling Down

This week's guest columnists are Drs. Anna Malesky and Alicia Ortiz, Family Practice residents at the University Hospital and Clinics here in Lafayette. It was our sixth shift in the Pediatric Emergency Department when we began to notice a theme.  On the Adult side of the ER, we saw falls in the elderly- on the Pedi side, we saw even more in kids.  Usually the mother can barely tell the story while clutching her infant tight to her chest.  Parents often blame themselves, or each other- who was supposed to be watching? On one shift we saw a three-month old who fell out of her car seat on to the street, while the seat was being transferred from the car to the stroller.  She had been unbuckled after the car stopped, mom assuming belts were only necessary when it was moving. In the next room was a six-month old who had rolled off his parents' bed.  Both kids had fallen from high enough to warrant head CT scans, to insure they had no brain bleeding or skull fractures. Both CTs were normal, and the parents were relieved. It's important to keep infants strapped in their car seats anytime they're in them, not just in the car. It drives our nurses crazy when parents bring a baby into the ER, swinging them in their car seats, unbuckled- an accident waiting to happen.  Also, never leave babies on beds.  It's no fun to discover that they can roll over by hearing a thud and a shriek from the bedroom you left "for just a minute."  In that vein, babies should never sleep with parents on couches or beds either.  Not only could they roll out while you're sleeping, but it's also a risk for SIDS- babies can smother to death in bed or on couches with adults. Infants also shouldn't be carried around by younger children.  Kids in their pre-teen years and younger just aren't strong enough, or reliable or careful enough, to be trusted with such a precious cargo.  Heck, even many teens can't be trusted either.  Ask yourself, would you let that child or teen carry around your favorite 15 pound china bowl?  How much more valuable is your baby? Keeping kids safe from falls is not limited to infants or toddlers.  Last week we had a pediatric trauma case, a nine-year old, who was riding on the back of a bike.  A seventeen year-old was steering, not looking where he was going, and ran them into a parked car.  Both kids flipped onto the car roof.  Neither were wearing bike helmets. Fortunately the nine-year old, after a lot of x-rays and CTs, ended up only with some cuts and scrapes.  Others aren't so lucky. According to the U.S. Centers For Disease Control (CDC), "injuries due to transportation were the leading cause of death in children" for 2016.  This includes kids killed in bike accidents, many of which would be prevented by bike helmets. Louisiana regularly ranks as the top second or third state for bicycle accident deaths. Earlier this summer Dr. Hamilton was showing friends from Maine around New Orleans. They were appalled at how no one was wearing bike helmets- apparently everyone in Maine does. The other important tip to avoid injuries from falling off bikes, is not to fall off them! When they first start riding, children should be taught the rules of the road for bikes- riding with traffic, staying in bike lanes, obeying the same rules as cars. This means stopping for red lights and stop signs, and checking both ways before crossing, unlike our kids above. Supervise your kids on their bikes until you're confident they'll be safe. Make it a "family ride" when you do this, to bond with your kids, get in some exercise, and keep them out of harm's way. Finally, your kids will eventually turn 16 and get a learner's permit.  While this affords them some independence and frees you from chauffeur duties, it's important that they know that motor vehicles are dangerous, and can cause significant harm to others.  You don't want your teen making other bicyclists and pedestrians fall- by being hit by your car!  When riding with your teen, besides enforcing the rules of the road, teach them vigilance for pedestrians and bicyclists.  Of course, vigilance means no texting and driving- ever.