Child Heath ALERT
Volume 18 A Survey of Current Developments Affecting Child Health Care September 2000
Children In Cars-Making Sure They're Safe
The start of the school vear is a
good time to be thinking a~out the
safety of children in motor vehicles.
We all know that children who are
restrained in child safety seats will
have a dramatically lower risk of
death and injury in a crash, but two
recent reports provide some critically
important information on how and
when these seats should be used.
How To Use Car Seats
...
Even though most parents are
quite good about making sure their
children ride in safety seats, child
health researchers in Louisiana noted
that seats were not always installed
and used correctly, so the seat
wouldn't be offering the protection
that parents had intended. In an
effort to reduce this problem, these
doctors ran a series of child safety
seat "check ups", where an expert
examined whether a particular seat
was appropriate for the child, how
the seat was attached to the vehicle,
and how the child was secured in the
seat. These check ups found that
three particular problems were present in many to most forward-facing
or rear-facing seats; these were:
1) the seat was not belted into the
vehicle tightly;
2) safety seat harness straps were
notsnug;and
3) the harness retainer clip was
not at armpit level
Though other problems were also
found, they occurred far less often. As
a result of these findings, the authors
of this report urge that parents should
be counseled about these particularly
common problems in the way child
safety seats are installed and used.
(Kohn M et al: Archives of Pediatric
andAdolescent Medicine, June, 2000,
pp. 606-609)
...
And
When To Use Them
Though it's widely known that
infant and convertible child safety
seats should be used for young children, fewer parents understand that
booster seats should be used for children from age 4 until they fit properly
in the vehicle seat belt (usually age 9).
As a result, many preschoolers graduate too soon from safety seats to s t
belts. To learn about the possible risks
from premature use of seat belts,
researchers from the University of Pennsylvania reviewed insurance
company data from 15 states and
the District of Columbia that
included information on crashes
involving children between the
ages of 2 and 5-years.
__ -
The authors report that while
98% of these children had been
restrained in some way, 40% were
restrained in seat belts. When they
compared the children in seat belts to
those who were restrained in safety
seats or booster seats, the researchers
found that those children who were
in seat belts were 3.5 times more
likely to suffer a significant injury,
particularly involving the head.
They conclude that "premature
graduation of young children from
child restraint systems to seat belts
puts them at greatly increased risk
of significant injury in crashes...
Results of this study support public
health efforts directed toward ensuring appropriate restraint of
children, particularly the use of
belt-positioning booster seats by
children who have outgrown child
safety seats.
"To reduce the risk of injury, children should remain in child restraint
systems until they are at least four
years old and weigh 40 pounds (18
kg), at which point children should be
placed in belt-positioning booster
seats. Children should remain in
booster seats until they are the appropriate height and weight for seat
belts." (Winston FK et al. Pediatrics,
June, 2000,pp.1179-1183)
COMMENT- It wasn't that long
ago that we would have been delighted to see 98% of children in
crashes having been restrained by
any device at all. But while some
kind of restraint is better than no
restraint, it's critical that the restraint
be right for the child's size. Now
that we've achieved widespread use
of child safety seats for infants, it's
time to alert parents to how important it is to make sure that "for ages 4
to 9, it's booster seat time!"
"Fit For A Kid": Free
Safety Check
In a world where the biggest risks
our children face involve motor vehicles, it's disturbing that most children in child safety seats aren't
restrained correctly, even though
almost all parents believe they are
using them properly.
To help solve this problem,
DaimlerChrysler is offering a free
child safety inspection and installation service at selected DaimlerChrysler dealers throughout the
country. It's important to point out
that the program, called "Fit for a
Kid", is available to all drivers-no
matter what kind of vehicle they
own. Parents and caregivers can make an appointment at a participating Chrysler/Plymouth/Dodge or Jeep
dealer to have their child safety seat
inspected and properly installed. In
addition, they will receive valuable
information so they can safely and
properly install child safety seats on
their own. Supported by the National
Safety Council and Fisher-Price, the
program is expanding from about 400
dealers last winter to an expected
1000 dealers by year's end.
Readers wishing more information can visit the "Fit for a Kid" web
site (www.fitforakid.org), which
includes animation, a video, tips on
car seat safety, and a listing of participating dealers. Readers can also call, toll-free, 877-FIT-4-A-KID and
speak to a representative who can
answer questions, locate a participating dealer, and send a pamphlet that
provides 10 tips on car seat safety.
Also, by special arrangement we
have a number of the "Fit for a Kid"
pamphlets available; since quantities
are limited, we are providing them
on a first-come, first-served basis,
and only to current CHILD
HEALTHALERT subscribers; if
you would like one, send a stamped,
self-addressed #10 (business size)
envelope with $33 postage attached
t o: CHILD HEA L TH A LER T,
Dept. FFK, RO. Box 610228,
Newton Highlands, MA 02461. 0
Teaching Children How To Avoid Dog Bites
Dog bites are a major cause of
injury in children, and they can be
both physically and emotionally
damaging. A number of guidelines
have been suggested to prevent dog
bites, but they don't tend to focus
directly on teaching children how
to avoid being bitten.
To meet this need, child health
experts in Australia have come up
with the "Prevent-a-Bite" educational program, which is designed
to teach primary-school children
how to behave around dogs in
order to reduce their risk of being
attacked. This program was tested
in an experiment conducted among
7 and 8 year-olds at 8 primary
schools in metropolitan Sydney,
Australia. Children in half the
schools were given the "Prevent-aBite" education, and children in the
other schools were not.
The educational program consisted of a 30-minute lesson given by an accredited dog handler, who
demonstrated various "dos and
don'ts" of behavior around dogs
(e.g., how to recognize friendly,
angry, or frightened dogs, how to
approach dogs and owners when
they wanted to pat a dog). Children practiced the latter technique
(asking permission, approaching
slowly, extending the hand palm
down, patting the dog under the
chin and on the chest, avoiding
eye contact, walking away slowly
and quietly); they also practiced precautionary and protective body
posture to use if they were
approached or knocked down by a
dog. They were told when not to
disturb even a friendly dog (when it
is sleeping, eating, tied up, or in a
car). A resource kit for teachers
(activities for before and after the
demonstration) was also provided.
About a week later, children in
each school were let out to play
unsupervised, and the researchers
stationed a docile Labrador doc, on
a leash about 15 feet from its owner; the situation was videotaped by
a hidden -camera. There-Aere sig-nificant differences in how children
behaved in this situation, depending
on whether or not they had gone
through the "Prevent-a-Bite" program-amon- the children who
didn't, the large majority (79%) did
things they shouldn't, whereas
among those who had gone through
the program, only 9% behaved
improperly.
The authors note that it's not yet
known how often dog bites might be prevented, but they conclude
that the " Prevent- a-B ite " program
clearly increased precautionary
behavior in the short term.
(Chapman S et al: British Medical
journal, June 3, 2000, pp. 15121523)
COMMENT.
Dog bites are a
particular problem for young children, not only because of the physical injury caused by the bite but
also because the child can develop
a life-long fear and anxiety of dogs
and other animals. Most efforts to prevent dog-bites have focused on
ways to control dogs (or their owners!), and that is important. However, it's also very important to
give children the skills-and confidence-to know how to behave
around dogs in ways that won't
provoke the animal.
We often fault researchers for
overstating their findings, but
here's a situation where we think
the authors may actually been too
modest. While we don't have strong evidence that the newlytaught behaviors will indeed prevent dog bites, common sense suggests that they certainly will help.
What's remarkable here is that the
program took only 30 minutes on
one occasion; though we suspect
that reinforcement would be helpful once or twice a year, that is
still a small amount of class time-if even a handful of bites were
prevented each year, surely that
time would have been well spent.
(Readers wishing more information on this study or the "Prevent- a-Bite " Program can
contact the lead author, Dr. Simon Chapman, by email at Simone@pub.health.usyd.edu.au.)
Being-Ready to-Treat Allergic -Emergencies-
Children with severe allergy to
foods, insect stings, and medications can have a life-threatening
allergic reaction, called anaphylaxis. This reaction, which can
involve acute shock and breathing
problems, requires emergency
intervention with epinephrine
(also known as "Adrenalin").
Giving an injection of epinephrine minutes after a serious reaction begins can be life-saving, and
as a result, doctors will often
make sure that epinephrine is immediately available to children
who are at serious risk for such serious reactions. Most often, children
will be prescribed "EpiPen" (or
"EpiPen Jr."), which is a device that
can automatically inject epinephrine when it is used according to
instructions.
Clearly, the EpiPen can only
make a difference if it is available
when an emergency occurs and if it
is used properly. In a recent report,
researchers followed up on children whose doctors had prescribed
an EpiPen because of serious aller
,,1c
problems. When the parents
were interviewed, most of them
Ui,la'l "w& some critical signs of
anaphylaxis (such as difficulty
swallowing or talking, or loss of
consciousness or collapse). Further,
many didn't recall how to use the
EpiPen.
Almost all the parents had followed the doctor's instruction to
inform the school and other caregivers about the child's allergic
problems and what might trigger a
reaction (such as peanuts or a bee
sting). However large numbers of
children didn't have an EpiPen
available at school, didn't have a
management plan in place in case
of an anaphylactic reaction, and
didn't have a school staff person
available who knew how to use the
EpiPen. (Gold MS &Sainsbury
R: Journal of Allergy and
Clinical Immunology, July, 2000,
pp. 171-176)
COMMENT. This report is
timely and important, given that
there are increasing numbers of
children with serious allergies, and
particularly allergies to peanuts and
other foods. As these researchers
point out, prescribing an EpiPen
won't help the child if the device
isn't around when it's needed or
there's no one around who knows
how to use it correctly. So it's very
important that doctors who prescribe these devices instruct the parents (and the children themselves, if
they're old enough) on when and
how to use it, where it should be
kept, and the importance of making
sure the medication hasn't expired.
However, schools and other childcare settings also need to know the
same things, and the following
resource can be very helpful in providing that critical information.
Food Allergy Network:
A Valuable Resource
The Food Allergy Network is an
organization founded by parents of
children with very serious food
allergies, and it has become a widely respected resource for information on how parents and schools can
best deal with children who have
food allergies. Their web site,
www.foodallergy.org, provides a
wide range of extremely useful
information, including "managing
food allergies in school".
Among the topics in this section
are how to avoid reactions, tips for
parents and school officials, and
perhaps most critical of all, an
"Emergency Health Care Plan", a
form that outlines what actions a
caregiver should take in the event of
an emergency. Included on the
form are symptoms that require
action, medications to be given,
whom to call, permissions from a
parent and doctor, emergency contacts, and-very importantly-the
names and locations of school staff
who are trained to manage problems
of this kind.
When parents provide their
child's school with this form, it will
reinforce the need for all these elements to be in place at school; when
schools ask parents to fill in this
form, they will be reminding parents
of the need for a similar plan at
home.
PRODUCT SAFETY
Crayons: Are They Safe?
At the beginning of the summer,
parents and child care providers
became alarmed by news reports that
claimed to have found asbestos in
Crayola brand crayons. The crayons
were tested by news organizations,
and the publicity prompted many to
remove crayons from children in an
effort to prevent them from being
exposed to this dangerous fiber.
Based on its own testing at both
a government and private laboratory, the U.S. Consumer Product
Safety Commission (CPSC) reported that it, too. found asbestos in two
Crayola crayons and one Prang
brand crayon. However, the federal
agency stressed that "the amount of
asbestos is so small it is scientifically insignificant." CPSC pointed out
that it also found larger amounts of
another fiber that looks like asbestos,
and this may have been confused
with asbestos in the earlier tests.
Both kinds of fibers come from talc,
which is used as a binding agent in
the manufacture of crayons.
CPSC stresses that the risk of
exposure to either kind of fibers
from using crayons is very low; still,
to be on the safe side the CPSC
asked manufacturers to reformulate
crayons with ingredients that won't
contain asbestos or related fibers.
The major manufacturers quickly
agreed to do so within a year. (U.S.
Consumer Product Safety
Commission, Washington DC, June
13,2000)
COMMENT.
The initial report,
not surprisingly, created quite a
scare, but the more reassuring report
from_~latively little
attention. With reassurin- findings
from both a government and private
lab, we think that those who care for
children can feel comfortable that
the crayons they love pose no significant threat to their health--and the
commitment of the manufacturers of
Crayola, Prang, and Rose Art to
change ingredients offers even more
reassurance for the future.
PRODUCT RECALLS
Recalls: Bike Helmets.
Two companies are recalling
almost 80,000 bicycle helmets
because they failed safety tests and
would not adequately protect children or adults from serious or fatal
injuries. Rand International, of
Farmingdale, NY, is recalling about
70,000 "L.A. Cruisin "models
in
child sizes (helmets are blue or
pink) and youth, and adult sizes
(these helmets are white or black).
They were sold nationwide at Kmart
and Rose's stores from April, 1999
through March, 2000, for about $8.
The other recall involves Cycle
Express Co. of New York, which is
recalling almost 9000 girls' helmets,
size small, for ages 2 through 5years. They are mostly pink
mixed
with silver glitter, bordered by purple
tape, with a decal that reads
"Hearts
&Flowers."
The helmets were sold
with bike bag-purse combo and hair accessories at Toys R Us stores
nationwide from October, 1999
through April, 2000, for about $13.
(U.S. Consumer Product Safety
Commission, Washington, D.C.,
July 5, 2000)
..."4 Wheelin" Infant
Walkers...
Safety Ist Inc., of Canton, Mass.,
is recalling to repair about
170,000
Mobile "4 Wheelin" Walkers,
which are shaped like cars. Babies
can lose their lower teeth when the
teeth are caught in parts of the threespoke steering wheels. Also, on
some of these walkers, the telephone
could break apart, releasing small
parts and posing a choking hazard.
The Mobile "4 Wheelin" Walker
is intended for babies 6 months old
until the age they begin to walk.
The walker has a green body and
includes a three-spoke steering
wheel with squeaking horn, clicking keys, two rearview mirrors and
a phone with electronic ring.
Model number 45701, 45701A or
4570111 is written underneath the
walker tray. Only walkers with
these model numbers are part of the
recall. Other writing under the
body includes, "Made in the U.S.A.,
1997,," and "Safety lst, Inc." Mass
merchandise, juvenile products,
and major discount department
stores nationwide sold the walkers
from April, 1998 through April,
1999 for about $50.
Consumers should stop using
these walkers immediately and contact Safety I st to receive a free,
replacement steering wheel and
electronic telephone with installation
instructions. To order repair kits,
call Safety lst at (800) 964-8489
between 9 a.m. and 5 p.m. ET
Monday through Friday, or write to Consumer Relations Dept., Safety I st Inc., 45 Dan Road, Canton, MA
02021. (U.S. Consumer Product Safety Commission, Washington, DC, August 8, 2000)
...
And Tangled Treeples
With KFC Kids Meals
KFC Corporation, of Louisville,
Ky., is voluntarily recalling about
425,000 Tangled Treeples toys that
were included with KFC Kids Meals.
The toy is a green plastic container
with small, blue plastic animal figures
inside. The bottom of the container
can fit over a child's nose and mouth,
which could pose a suffocation hazard
to children under three years of age.
The toy's green, plastic container,
which is about 3 inches in diameter
and 1.25 inches deep, has trees molded on the outside. Inside are seven "Tangled Treeples" animal figures,
including a monkey, owl, snake, raccoon, and bear. Children can empty
the animals out of the container and
link them to form a chain. Writing
on the outside of the container reads,
"Treeples" and "Made in China."
KFC restaurants nationwide included the Tangled Treeples toys with
KFC Kids Meals from June, 2000
through July, 2000.
Consumers should immediately
take the green plastic container away
from children under the age of three.
They should discard the container or
return it to any KFC restaurant for
an individual-sized side item, such
as macaroni and cheese. For more
information, consumers can call
KFC at (800) CALL-KFC anytime,
or visit the company's web site at
http://www.kfc.conVSAFETY.htm.
(U.S. Consumer Product Safety
Commission, Washington, DC,
August 10, 2000)
Your Subscription to CHILD HEALTHALERT now
includes permission to
copy articles and commentaries!
Subscribers may photocopy individual articles and commentaries from CHILD HEALTH ALERT if
1) the entire article and commentarV are photocopied without editing of any kind,
2) the material is not reproducedfor commercial purposes
3) the material is not transmitted electronically or displayed oil ally web sites, and
4) each article includes the following: "Reprintedfirom CHILD HEALTH ALERT,
R 0. Box 610228, Newton Highlands, MA 02461
Child Health
ALERT
September 2000