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'We see the summer as trauma season': ER visits for children increase with warm-weather activities

'We see the summer as trauma season': ER visits for children increase with warm-weather activities

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GREENSBORO — Working in an emergency room changes the mind-set about child safety forever.

Just ask the emergency room doctor who couldn’t revive the youngster who slipped unnoticed into the neighbor’s pool and drowned; the burn center nurse whose pediatric patient was in danger of losing an eye after his parents allowed him to light a firecracker; the pediatric surgeon whose patient lost a limb after he fell off a lawn mower.

“The child (who) got away from parental supervision and had wandered down to the lake and had either fallen in or gotten into the water and drowned,” said Dr. Ross Kuhner, the medical director of the children’s emergency department at Cone Health.

“It (the water) wasn’t very deep, but it doesn’t require very much,” Kuhner, said of the drowning.

The number of child injuries go up in the summer because kids are playing outdoors more often.

“We see the summer as trauma season,” said Dr. Michael Mitchell, director of Brenner Children’s Hospital’s emergency department, which is a part of Wake Forest Baptist Health.

Of course children should be outdoors and accidents happen under the best of circumstances, but many are preventable, says the assistant professor of emergency medicine at Wake Forest and others.

Summer checkup

This is a good time of the year to remind adults how children might end up in the emergency room and what might lower the statistics. Think of it as a summer checkup, they say.

Brenner Children's pediatric safety expert Luly Beckles talks about keeping kids out of the ER.

Those working with younger patients know that parents let their guards down during the summer because of the ages of some of the children coming in with ATV-related injuries.

About 650 people are killed in ATV accidents every year in the US., and one-third are under the age of 16. North Carolina had 39 reported deaths from 2017 to 2018, according to the state Fire Marshal’s Office.

North Carolina allows children 8 years and older to drive age-appropriate ATVs with supervision.

Mitchell recalls a child under 6 driving an ATV with an even younger passenger. Both ended up in the ER.

Handling an ATV requires a lot of complex decision-making— when to stop, when to slow down, when to speed up, Mitchell said of maneuvering the motorized vehicle and reacting to conditions.

“Children have less awareness of consequences, they are easily distracted and these things are really powerful,” Mitchell said.

Medical personnel see broken bones and worse from drivers hitting a tree or falling into a ditch, including burns from coming into contact with the carburetor.

Sometimes parents simply aren’t aware that their child might be riding an ATV. Luly Beckles, a child safety coordinator with Brenner and Safe Kids Northwest Piedmont, points to a child getting on an ATV at the house of one of their friends. The vehicle wrecked and the child died.

“No one wanted this to happen, but having that conversation lets that parent know that you do not want your child on an ATV,” Beckles said.

There are other dangers, such as as children handling sparklers — often considered by parents as something benign.

“It makes me cringe,” said pediatric emergency room nurse-manager Michele Daniels of Brenner Children’s Hospital.

Dr. Ross Kuhner of Cone Health discusses helmet safety.

There’s no such thing as kid-friendly fireworks, said Dr. Ernest Grant, an outreach clinician with the Jaycee Burn Center at UNC Hospitals in Chapel Hill.

Sparklers, which produce colored flames, burn up to 1,000 degrees or more — “As hot as a blow torch,” Grant said.

“A few years ago we had someone who was a flower girl in a wedding at the beach and instead of walking with flowers they walked with sparklers,” Grant said, “and the sparkler caught her dress on fire.”

Dr. Rob Poth of Brenner Children’s Hospital recalls an experience he had involving a child and firecrackers.

“I was a resident in Philadelphia in the emergency department, and a 5-year-old child was brought in because he had picked up an M-80 (firecracker), and it exploded in his hand,” Poth said.

Mixed messages

It’s not just children who come across a stash of firecrackers without their parents knowledge that’s of concern. Photos on social media and in newspapers often show smiling youngsters holding sparklers with adults nearby.

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Poth said what we’re doing is sending children a mixed message.

“Any other time we would tell them to stay away from fire, it’s dangerous,” he said. “Handing them a lit sparkler or wand, or whatever you want to call it, isn’t much of a difference.”

Summer also is a time when children may be home alone and cooking for themselves. A larger number of burns involving children come from heating up food, such as those flavored noodles and water, in the microwave.

Health officials also grimace at children on riding lawn mowers.

Accidents may not happen every time, but it happens enough, said Leigha Jordan of Safe Kids Guilford, a local injury prevention coalition.

“We hear that a lot — “It never happened to me’ or ‘You never heard about that happening when I was a kid,’” Jordan said. “But the reason we want to get these messages out is because we do see those cases come through our emergency departments.”

No one should be a passenger on a lawnmower, as fun as it may seem, Kuhner said.

Probably “a good handful of kids” are rushed to the ER when the lawn mower hits something or tilts over.

“They got off, jumped off or fell off and got a foot amputated because of it,” Kuhner said of the stories the group hears.

Inches of water

A leading cause of accidental death of children age 5 and younger is drowning — and a good percentage of the children who drown know how to swim.

A child can drown in a couple of inches of water in the bathtub or a wading pool in two minutes or less.

With large family gatherings now taking place around water, there can be a false sense of security with so many adults around.

“If you are the one responsible for that child, you never look away,” said Daniels, the nurse-manager.

The adults should have a schedule of who is watching, she said.

Children may not have the energy to splash around enough to grab anyone’s attention or be able to call out for help because they may not have enough oxygen in their lungs.

Younger children should always be at an arm’s distance. Parents should stay vigilant with all children.

With some kids swimming in lakes and ponds, perhaps for the first time, parents should alert them to the differences, which can be deadly, Beckles said.

It’s a lot colder in open water, with lower visibility, and the ground is uneven and the depth varies, Beckles said. They should only swim in designated areas and never alone, she said.

Also remember that tubes can deflate and are not a water safety device. Instead, everyone should have on a U.S. Coast Guard-approved life safety vest.

Importance of helmets

The warmer weather also means children are out on pavement.

And the number one cause of visits to the Brenner ER is falls. Many of the visits could have been prevented if the children were wearing helmets and padding while on scooters, bicycles or skates.

These types of accidents can leave them with permanent brain injuries.

If the child is wearing a helmet, often it’s the helmet only that ends up cracked, said Kuhner, the Cone Health emergency pediatric specialist.

“I can’t say that I have ever remembered them having a significant brain injury,” he said of children wearing fitted helmets.

And for those adults who transport children— especially during field trips or if it’s a child that doesn’t normally ride with them — have a plan for making sure all children are accounted for at the destination or before locking up. If a child is riding in the back seat of a car, use a reminder system — possibly one of that child’s toys sitting on a purse or cellphone in the front seat.

“No child should be left unattended in a car even if the windows are cracked,” Kuhner said. “It can still get very hot in that car very quickly.”

He knows from seeing them in the ER.

“The only thing that you can say,” Kuhner said, “is that you can’t leave a child in a car for any length of time.”

Contact Nancy McLaughlin at 336-373-7049 and follow @nmclaughlinNR on Twitter.


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