Well-planned family trips to other countries are “surprisingly” safe and healthy, say surveys by travel medicine professionals. If problems do occur, they are more likely to be due to accidents rather than illnesses – even though there is far more information available on keeping kids healthy than on preventing accidents. The leading category of accidents is motor vehicle-related, followed by waterfront-related and falls. This posting deals with motor vehicles. Future postings will deal with the other two.
1. A comparison of the risk of motor vehicle-related deaths per 10,000 vehicles per year in representative countries. (Source: World Health Organization.)
|UK||3||Russia||19||Note that these figures are meaningful only in comparing countries. Especially in poor countries, the risk for visitors is far less than for local people. Visitors generally have access to safer transportation than do locals.|
2. Don’t drive immediately after long flights through multiple time zones. Jetlag, fatigue and lack of sleep interfere with cognitive thinking and reaction times, which are especially essential for driving on unfamiliar roads. Cranky, jetlagged children further worsen the mix. (Even at home misbehaving children are responsible for numerous accidents.)
3. Consider leaving the driving to others. Reputable local drivers can deal better with language issues, local driving customs and road conditions. Rules regarding passing, signaling and headlight use vary from country to country. Make clear to your drivers that you are in no hurry. Request safe routes rather than the fastest ones. Check vehicles for safety features for young children. Take bus tours only with reputable travel agencies.
4. Know local regulations regarding children. Rules vary from country to country. In many European countries it is mandatory to have a reflective vest for each child (and, sometimes, for adults). The vests must be worn in emergencies (if children have to stand at the side of the road, for example). Most countries have laws regulating by age, height and weight the use of baby restraints, where children may sit, the type of seatbelts that are permissible, and when airbags must be deactivated if a child sits by one. Note that height and weight measurements may be stated in centimeters and kilograms.
5. Familiarize yourself with local road conditions. In poor countries, most roads are badly designed, not properly maintained or patrolled, and have few traffic signs. Many drivers lack basic driving skills. Law enforcement is lax. Emergency medical services are inferior or nonexistent. There are ever more cars without road improvements. Driving at night is especially hazardous; some drivers turn off headlights to save fuel.
6. Don’t underestimate the hazards of driving on the “wrong” (opposite) side of the road. Problems arise when you enter a street/highway, make turns or pass other vehicles. Traffic circles (“roundabouts”), common in Britain, can be disorienting. Generally roundabouts have no signal lights, traffic moves counter clockwise, and you exit the traffic circle on the left side of the road. Avoiding errors takes total concentration.
7. Rent cars from well-known international companies. If possible, do so before leaving home.Such car rentals are more likely to have well maintained cars, provide you with the necessary documents, and supply information on what to do in case of breakdowns. Check if they have appropriate children’s restraints available or if you must bring your own. Generally, larger cars are safer but are difficult to maneuver on narrow roads.
8. Quaint local transportation may be hazardous. Riding three-wheel taxis, small open vans, pedicabs and other inexpensive, colorful local vehicles make for memorable family photos but are generally unsafe. They dart around cars and trucks and expose your family to toxic fumes from other vehicles. You must hold small children on your lap – which is dangerous if the vehicle tips over (not a rare occurrence) or is involved in a collision.
9. Think twice before allowing teenagers to use motorized bicycles, scooters and mopeds. These take practice to operate, especially on overcrowded roads. Helmets may not be available. In Bermuda, where motorized bikes are popular, visitors sustain far higher rates of injuries than locals. Mishaps occur even at low speeds. Check lower age limits for teenagers to ride such vehicles.
10. Children who cross streets safely at home may need help overseas.Crossing streets that may have no crosswalks, traffic moving on the opposite side of the road, motorbikes to dodge, and drivers who may disobey traffic signals requires consciously rethinking of well-ingrained (“kneejerk”) reactions.
Some amusement park rides are not amusing. Every year about 9,000 children under the age of 14 years get an extra ride – to the emergency room. Many more mishaps are treated at first aid stations, by private physicians or by parents. Rides intended for children younger than four years of age account for about a quarter of the ER visits.
1. Amusement parks are not particularly hazardous. Most injuries are minor. Only a small number require hospitalization. Playgrounds, winter sports, and waterfront activities may cause more mishaps per child participant. Serious accidents make headlines, in part because they are so rare.
2. Most amusement park accidents are preventable. You the parent is the ultimate safety inspector. Never let kids “please, please, please” you into letting them go on rides not intended for them – even though you’re there to please them. There are no mandatory federal safety standards for amusement rides and state and local government oversight is often murky. Be especially cautious of rides at small, seasonal parks, even more so if the rides are part of a traveling carnival.
3. Obey posted age, height and weight restrictions. However, operators base safety guidelines on standard height and weight tables, not taking into account the great variability in size of children at a given age, and not considering their maturity and impulsivity. Children younger or smaller than posted limits can slip out of restraints; those older or bigger can overload rides. Pay close attention to rides that use single lap bars for multiple riders. These bars fit closely only against the largest passenger in the car, allowing smaller riders to stand up during the ride or slip out under the bar.
4. Match rides to your child’s temperament. Don’t coax children to try rides if they are reluctant to do so. Don’t let older children do so. Children who have queasy stomachs may become ill on merry-go-rounds and roller coasters. Vomiting ruins the day. Excessive darkness, present on some rides, frightens some children and causes them to act irrationally, placing themselves and others in danger.
5. Observe rides before allowing young children on them. Rides should have safety instructions posted. Operators should be friendly, attentive and help children on and off. Observe if children exiting the ride are happy. If a part of a ride is out of sight, ask if there are hidden sharp curves, sudden drops or excessively “scary” features. Ask if a ride can be stopped if a child becomes unruly or overly frightened.
6. Check “kiddie” rides. These rides move slowly, have no ups and downs or sharp curves, and are very safe for seated, cooperative toddlers. However, many rides have no or inadequate safety restraints. Moreover, toddlers are unpredictable and impulsive, and may become “spooked’ for no apparent reason. They may get up during the ride, fall out, or become entangled in inappropriate safety devices.
7. Instruct children in safety. Accidents occur when children fail to grasp or obey safety rules. Tell them not to clown, to keep arms and legs inside, to hold on tightly with both hands, and to never get up until instructed. If they become frightened they should stay in their seats, close their eyes, hold on tight, and, if they wish, scream out loud. Alert them to stay seated if rides stop before reaching the unloading platforms, not to retrieve objects they may drop off the ride, and if they feel dizzy or weak when exiting, to sit down on the ground and wait for assistance.
8. Skip trampolines. “The incidences of injuries jumping on trampolines outweigh any benefits,” says the American Academy of Pediatrics. Falling off, crashing into other children, or jumping incorrectly can result in strains, sprains, fractures and other injuries, including potentially serious head and neck injuries. Trampolines should only be used in supervised programs, with safety guidelines strictly followed.
9. Allow children to use zip lines only where you are reasonably sure that the staff is well trained and attentive and the equipment appears to be well maintained. Zip lines are soaring in popularity, resulting in several thousand ER visits yearly, with children younger than 10 years of age accounting for almost half of the injuries. Most injuries are due to falls. There are few safety guidelines for the operators. (However, backyard zip lines may be even more hazardous than commercial ones.)
10. Resources are available for children with special needs. Many larger parks offer reduced admission fees, no waiting at rides, quiet areas for resting, communication devices, and wheelchairs, to mention just a few accommodations. Such parks also have well equipped first aid stations. Call the park’s Guest Relations for details. Check the national association devoted to helping families with your child’s disability. Most such associations have websites that include information about travel and visiting amusement park-like attractions. Also check the web for blogs written by parents about their personal experiences.
Watching fireworks is a traditional family activity all over the world and great fun. But setting off fireworks should never be a family activity and is anything but fun for the thousands of people injured each year. Moreover, all fireworks, professional-sponsored ones and the so-called backyard types, are associated with little known hazards that may especially effect young children.
There is no such thing as safe fireworks, say safety experts. Even ones considered to be safe – sparklers, for example – can reach temperatures above 1000 degrees Fahrenheit. It is a misconception that when mishaps occur only handlers are the ones injured. Especially in the hands of amateurs, fireworks can explode unexpectedly or take erratic courses when launched, landing among bystanders, even those standing at considerable distances. And since fireworks attract families, many of the injured are children. The most common injuries among spectators are burns from falling segments. Burns may be sufficiently severe to require hospitalization. Eye injuries are also common. Don’t allow children to pick up segments of fireworks that land on the ground. The segment may still be ignited and explode or be in the form of hot embers.
When fireworks light up in the sky, they pollute the environment. They release tiny particles (suspended particulate matter) which when inhaled may damage lungs. The fumes contain sulfur dioxide, heavy metals including lead, and other toxic materials. The specific composition of a given firework depends on the desired effect. Individuals with respiratory problems and young children are especially at risk. The reason that fireworks are not considered a major health issue is that exposure to them tends to be limited.
Fireworks most often are set off near bodies of water, to allow many people to see them and for safety reasons. In the US, fireworks are responsible for tens of thousands of fires annually (rarely major fires involving loss of life). Moreover, fireworks pollute the body of water with the same chemicals as pollute the air.
Fireworks are primarily designed to produce a large amount of noise in the form of a sudden bang, sufficiently loud to damage hearing. The noise can also “spook” dogs, possibly damaging their hearing, and cause them to react inappropriately, injuring themselves or running away.
Safety experts suggest that you keep your family “way back” or “at a distance” from fireworks, though these terms are not defined. Most problems arise when people are too close to backyard fireworks. When possible, keep your family out of the way of the smoke emanating from fireworks.
Taking children out of school for family vacations is illegal in many (probably most) school districts in the US, Canada, Great Britain and Australia. Most school districts have specific policies regarding absences for reasons other than illness. Some districts allow a limited number of days (usually fewer than four) for such activities – if permission is obtained beforehand. Parents who ignore the rules can be summoned to court and fined and children may be obliged to attend summer school. However, such punishment is rarely carried out. In Great Britain, attendance officers sometimes check airports and railroad stations in the days before vacations for children traveling while school is still in session.
Yet surveys suggest that parents fairly regularly ignore the rules. On Google, the topic “Taking children out of school for vacations” has 169,000,000 responses! Here are some representative responses, from parents, educators, pediatricians, and psychologists.
● The leading reasons for parents taking children on vacation during school time are significantly lower travel costs and a parent’s vacation time falling while school is in session.
● The decision to take a child out of school should be based on the grade the child is in, the child’s scholastic abilities, whether essential lessons will be missed, the child’s feelings about missing school, the philosophy of the teacher(s) on the subject, and the school’s policy. Likely, children in lower grades will miss little essential work – though this is an assumption.
● A child being absent from school disrupts the class and increases the workload for teachers. Some children are out for a week or two for travel. For the family, a child out of school is one absence. For the teacher of a class of 20 or 30, there may be numerous absences during the school year. This means repeating lessons and assigning and checking makeup work, slowing learning for everyone. The class should not be held back for absences that are not essential.
● I wonder if the people who think that it is a mortal sin to take children out of school for well thought out family trips are aware that a cornerstone of modern education is that all children do not learn the same way. Many high schools today have buildings where the students spend little time and where books and blackboards merely supplement other forms of learning.
● What are you teaching children when you swap a week of school for a sunny beach? They learn that attendance, and by extension, education, isn’t a priority. Schooling needs to come first, and nothing, not even deals on a Disney cruise, trumps attending school.
● I teach in a top rated junior high school in an affluent community. I am appalled by how often parents tell me (they don’t ask me) that the student will be absent for an upcoming trip. And I am appalled by how often the parents and students tell me that the trip is “educational” when in fact it is absolutely not. We teachers laugh about these lies in the teacher’s lunchroom. The lies show a total lack of respect for teachers.
● Travel should be an integral part of a child’s education. A semester overseas is becoming the norm at colleges and universities. Younger children should be encouraged to travel, obviously during vacation time if at all possible. However, taking meaningful, short trips – to historical places or capital cities, or with exposure to a different culture, for example – trumps missing a few days of school.
● Children have more than three months of vacation a year. Surely, parents should be able to find time for travel and visiting relatives in that time frame. Perhaps travel during vacation time is a bit more expensive, but these are facts of life, a lesson that young children have to learn to become responsible adults.
● When you take children out of school for unauthorized reasons, do you level with the teachers or do you make up excuses – a family emergency, for example? Once you get started on the road of deceit with the school, and worse, if your kids are old enough to understand what you are doing, what appears to be merely a few days of playing hooky (unauthorized absence) ends up being a big lie.
● I am a forty-year old mother. My two children attend junior high school. Somewhere in my junior high school years my father attended a conference in Athens, Greece. I was taken out of school to go along, probably for a week or so. When I think of my junior high school years, Athens is the first thing that I remember.
● In our school, the administration is supportive of short trips during school time. When the children return they are expected to give a talk on their experiences and bring back pictures and typical objects to show. Possible negative fallout from this is that other children are envious of the ones traveling. Remarks heard – probably emanating from their parents – are that the kids who travel are rich and spoiled.
● A significant issue in our school district is teachers “calling in sick”, usually before a school holiday, to extend their time off. Not a good example for parents and children.
● One advantage of home schooling children – an option that seems to be increasing in popularity – is that you can take your children anywhere at any time. Their education travels with them.
Do your summer plans include plans to protect your kids from the sun?
1. Summer vacations increase sun exposure. (So do winter vacations in snow country.) While you may be savvy about protecting your kids from everyday sun-related hazards, summer vacations add numerous factors to contend with: more hours of sun per day, more time spent outdoors, more intense harmful UV (ultraviolet) radiation, being at the beach or around pools, being closer to the equator, higher altitudes and children taking medication that may enhance sunburns, to mention just a few. All these factors require additional protection.
2. Most parents are too complacent about sunburns in children. Most burns are mild and heal relatively rapidly; symptoms are rarely severe and there is little or no visible scarring. In fact, the sun’s intense ultraviolet radiation on children’s vulnerable skin causes irreversible damage to the DNA in skin cells. This sets off a cascade of negative effects.
3. Intense, intermittent sun exposure, the kind that occurs on summer vacations, has a worse prognosis than constant tanning. Melanomas, the most serious type of skin cancer, are associated with such exposure. The worse the burn and the younger the age of the child at the time of the burn, the earlier in adulthood melanomas may occur. In a lifetime, two percent of the population experiences melanomas.
4. Familiarize yourself with the UV Index. Daily readings of sun intensity are available on the web for every location in the US, Canada, UK and Australia. Forecasts include predictions for the following days and give recommendations for minimizing skin damage based on the day’s sun intensity. See UV Index.
5. June is a risky month for skin damage. In the northern hemisphere, the sun is almost directly above and shines the most hours. Skin may be especially vulnerable as tans from the previous season, which may offer some protection, have faded. Cool weather plays no role in sun intensity. Intentionally tanning skin at the onset of summer to protect from subsequent burning is counterproductive. Each tan is a mild sunburn and damages the skin. Damage is cumulative for life.
6. Skimpy beach attire has no place in the sun. Dressing up for the beach may be a nuisance but traditional “protective” beach apparel – white T-shirts, for example, especially when wet – provide virtually no protection. Clothing that is virtually 100% protective is available. The more skin covered by such clothing, the greater the protection and the less the need for sunscreens. Infants less than six months of age should be kept out of the sun.
7. Sunscreens are essential for exposed skin, but no panacea. Sunscreens merely slow down tanning, they do not eliminate it. Many parents erroneously believe that sunscreens prevent burning/tanning, and allow children to stay in the sun for prolonged periods of time. Sunscreens are rarely applied correctly. Generally, far too little is applied and it is reapplied too infrequently. Applying the correct amount is expensive. When applying, don’t forget to protect ears, lips, necks, scalp and hands. Sunscreens’ effectiveness is reduced by water, perspiration, wind, humidity and other factors. Occasionally, sunscreens cause rashes. For more information on the use of sunscreens on children go to: http://www.cdc.gov/cancer/skin/basic_info/children.htm
8. Eye protection is as important as skin protection. Infants’ eyes absorb more harmful radiation than do adults’. Ideally, infants should wear sunglasses or stay out of the sun to reduce the risk of cataracts in later life. Get sunglasses that wrap around towards the ears to protect the sensitive skin of the eyelids. Avoid “fun” or “novelty” sunglasses. These are marketed for young children for fun but offer no protection. Buy sunglasses at reputable stores that sell eyeglasses. Be mindful that having infants keep sunglasses on is challenging. See kidstraveldoc/sunglasses.
9. Other protective measures. Hats with four-inch brims help protect the eyes, neck and forehead. Have sunshades on strollers; some specifically block radiation. Being in the shade of a building but having a blue sky or fluffy white clouds directly above offers little protection. Being under a beach umbrella protects from direct radiation but allows considerable radiation reflected from water and sand. Dirt, grass and concrete reflect comparatively little radiation.
10. People of color are less likely than Caucasians to develop melanomas. But when they do occur, the outcome is worse. The reasons: a misconception that dark-skinned people do not get skin cancer and the difficulty in recognizing melanomas in dark skin.
Miscellaneous. Many over-the-counter and prescription medications including ibuprofen (Motrin, Advil), antihistamines, and anti-acne substances can increase skin sensitivity to the sun, worsening burns. Ask your pharmacist or check the web for more information. UV rays penetrate three feet (one meter) or more of water placing water sport participants at risk. If sun exposure is unavoidable for infants less than six months of age, make the exposure as brief as possible and use the same protection measures (clothing and sunscreens) as for older children. Such protection is safer than risking sunburns. Check the expiration date on sunscreens. Products lose potency after a year or so. Storage at high temperatures also decreases potency.
Do your kids know when to hug a tree?
1. When planning family travel and outdoor activities, include telling young children what to do if they lose sight of you. (Avoid the word “lost;” It seems to scare children.) Generally, young children panic when they don’t see you and realize that they are in an unfamiliar setting. They look all around and then run as fast as they can in whatever direction they happen to be facing. This greatly complicates retrieving them. Being lost is an extremely frightening experience for young children, often remembered into adulthood.
2. Teach them to stay put when they don’t see you. Tell them that you will be right back. The “Hug a Tree” program teaches them to literally hug the nearest tree, enabling you to retrace your steps to reunite. Hugging a tree may also help reassure them that the situation is under control. Or teach them “Freeze,” a game in which children run about until a designated caller yells, “Freeze!” The children stop in their tracks (freeze) and remain in place until someone gives the all-clear signal. Play this game with them.
3. Or tell them to approach “another mommy” (a woman with a young child). Mommies are easily identifiable by young children and easy for them to relate to. Telling them to approach security personnel and police officers is obviously OK, but such people may be more difficult for young children to identify and to feel comfortable with.
4. Try not to frighten children when speaking to them about “becoming separated.” Intermingle your message with reminders of the fun they will be having wherever you are going. Tell them that sometimes you, the parent, can become separated from them, and that if that happens you will return promptly. And don’t scold them when you find them. Use the situation as a teaching opportunity. Tell them what you and they did wrong to have created the predicament.
5. Envision situations where separation may occur. Elevators are one example. Children run into elevators as soon as doors open, and the doors may close before you get in. They should hold your hand when entering. Should they find themselves riding alone, they should remain in the elevator until it returns to your floor. Otherwise, they usually get off as soon as the door reopens, often on another floor. Pressing the elevator button will return the elevator to your floor eventually.
6. Pin identification tags on young children. In crowded areas attach a tag with your cell phone number to the child’s outer clothing. Law enforcement officials say such identification speeds reuniting parent and children, and in no way encourages abduction. Random abduction of children from public places is an extremely rare occurrence, says the FBI, and is usually committed by family members. Stories that this happens frequently at amusement parks, airports, and other such venues are untrue.
7. Place a leash on toddlers. You may get some disapproving stares and, rarely, some uncalled for sarcastic remarks from total strangers, but leashes do prevent toddlers from wandering off. They are especially helpful if you have an active child or more than one toddler in your charge. See KidsTravelDoc/Leashes.
8. Electronic surveillance systems allow you to “see” your children when you cannot. Most consist of a transmitter and receiver. Transmitters are lightweight, may resemble small teddy bears, and attach to a child’s clothing. You hold the receiver. Transmitters send signals if a child wanders further than a predetermined distance. Receivers have maps that display the direction and distance of the location where the child is at that moment, and may have a beeper that becomes louder as you approach the child. Some receivers can activate the transmitter to set off a loud alarm to alert adults in the vicinity of the lost child. See KidsTravelDoc/Surveillance Systems.
9. For older children, check that they understand where you will meet them. They may not be listening when you tell them, especially if they are excited about the place you are visiting. Write down the meeting point and see that they put the paper into their pocket. Check out the meeting point. Stores and arenas may have more than one exit. Landmarks change from one visit to the next. Many amusement park rides have exits not in view from the entrance. Cell phones are invaluable for helping older kids reunite after becoming separated. In wooded areas consider supplying them with a whistle.
10. Report missing children to security officials immediately. Don’t spend time searching alone. Most public places have protocols for missing children alerts including security personnel with two-way radios and surveillance cameras. Report back to security when you find your child. Dressing children in items that stand out in crowds helps find them. If you have more than one child, dress them identically. And once they are dressed for the day’s outing, take a picture of them so that you can show security personnel in the event you become separated.