Kids’ Vision Tests Can’t Find Common Diseases
Eye tests commonly used in schools and pediatricians' offices don't do a good job of finding vision errors like farsightedness and astigmatism in school-aged kids, even though they're great at catching nearsightedness. That's the news from researchers in Australia, who tested 12-year-olds with the usual eye chart test, in which children read a chart with letters in ever-smaller sizes.
School troubles could be a sign of undiagnosed farsightedness because the condition can make reading difficult, according to David Hunter, ophthalmologist-in-chief at Children's Hospital Boston. I called Hunter after reading the new study, published in the Archives of Ophthalmology, because my child has passed those eye chart tests with flying colors, but I've had farsightedness and astigmatism my whole life. So I asked Hunter: How can parents tell if a child needs more than that test?
Parents need to think about vision testing at two points in a child's life, according to Hunter: in the preschool years, when children can lose vision permanently due to amblyopia (lazy eye), and in the school years, when vision problems can interfere with reading the board, books, and computer screens.
The Australians tested 4,497 children with both the "visual acuity" eye chart test, and autorefraction, in which eyes are dilated with eye drops, and a machine measures the amount of correction needed to focus light on the retina at the back of the eye. The eye chart test caught more than 90 percent of children with myopia, or nearsightedness. But children with farsightedness, or hyperopia, can read a wall chart just fine. (About 5 to 10 percent of people are farsighted, compared to 25 percent who are nearsighted.) A farsighted child might even be able to squint and do OK in a close-vision test, Hunter says. But they're not going to be able to maintain that level of focus through the day without hurting.
"If a child is struggling at school for no obvious reason, and just seems to be having trouble, then I think [he or she is] entitled to a complete eye exam by a pro," Hunter added. That includes dilating pupils, and using machines to measure visual acuity both near and far. He was less worried about the fact that the Australian researchers found the eye test to be crummy at detecting astigmatism, in which variations in the eye's lens can cause blurry vision. If the astigmatism is bad enough to cause blurry vision, Hunter says, you're going to have trouble reading both near and far, and common eye tests will pick that up.
Farsightedness symptoms to look for include:
Not wanting to read.
Reading for just short periods of time.
Not wanting to hold things close to the face to read.
Crossing eyes to focus on nearby objects (this is more typical in younger children).
Children should have their eyes tested in infancy, around age 3, and during their school years, according to the American College of Ophthalmology. Not all children need to see an ophthalmologist, Hunter says, but it's good for parents to know that eye problems can persist into elementary school and beyond, and aren't always identified by the big "E" on the eye chart.
How to Make Your Kids Watch Less TV
About one third of children watch more than the daily two hours of TV recommended by pediatricians, but parents often wince at the battles they face in prying children away from the tube. Here's help.
Children and teenagers who say their parents had rules about how much time they could spend watching TV or playing video games were much more likely to stay within the recommended limits for screen time, according to a new study in Pediatrics. The study, conducted by researchers at the federal Centers for Disease Control and Prevention and several universities, asked 7,415 children and teens ages 9 to 15 about their TV and computer habits. They found evidence that two simple tactics work: setting family rules for screen time and getting kids moving, whether through organized sports or free-time play.
Most of the children polled—60.7 percent—said they had no organized physical activity in a week; no gym class, no after-school pick-up games, and no team sports. That's a lot of couch potatoes! There's plenty of evidence that active play makes children healthier, happier, and better students. No less a personage than Michelle Obama is pushing for children to get up and move. The simplest way to encourage more activity is to join in yourself. You could even transform the TV from a source of sloth into an exercise machine, with addictive video games like Dance Dance Revolution.
Although other studies have pointed out that parents need to set limits on TV time, this time around the researchers asked parents and children how often each agreed there were rules. Fewer than half of parents said they always or often had limits on TV time, and just 37 percent of kids said they had well-enforced rules. The bottom line: consistency counts.
We're not big TV watchers in my family, but I can see how a family discussion about the two-hour-a-day limit, and setting that as the family baseline, would be good. And since I'll always pick reading over running, I've found that having organized activities, like swim team or play dates that involve a sport, go a long way toward getting my family out the door and moving.
Are Vitamins and Supplements Really So Good
Late in October, just before his 65th birthday, Robert Marks got a phone call: Stop the pills. For more than a decade, the retired Lutheran minister from Grapeville, Pa., had been among more than 35,000 men enrolled in SELECT, a clinical trial designed to see whether taking selenium and vitamin E might help prevent prostate cancer. But as a letter following up the call explained, not only was the answer "no," but vitamin E apparently increased the chance of prostate cancer, if very slightly, and selenium seemed to raise the risk of diabetes.
The news was another blow in the general battering of vitamin and mineral supplements as weapons in fending off chronic and age-related diseases like cancer and heart disease. In November, researchers from the Physicians' Health Study-II reported that neither vitamin E nor vitamin C reduced the odds of major cardiovascular problems. A few days later, researchers said that more data from the study showed those vitamins didn't help stave off cancer, either. And another recent study found that supplemental B vitamins, including folic acid, didn't lower the risk of breast or other cancers.
Americans are amply fed and, for the most part, well nourished. Because much of our food is fortified with nutrients, once common deficiency diseases such as scurvy and rickets (caused by a lack of vitamin C and D, respectively) have nearly disappeared in this and other developed countries. Researchers generally believe that with a few exceptions, like pregnant women or the elderly, most people don't need supplements.
But if bottles of vitamins and nutritional supplements line your medicine cabinet shelves, hold off before going completely cold turkey. Some researchers maintain that the diets of many Americans still fall short on several essential nutrients—not enough to cause those debilitating deficiency diseases, but perhaps enough to miss out on their benefits without extra help from supplements. While experts say you should be skeptical of most claims about the disease-preventing power of vitamins and minerals, some evidence does support taking a few as a hedge. What follows is the current thinking—pro and con—on some key supplements that are both popular and well studied.
Multivitamins. Millions of people pop a multivitamin every day with little evidence that it does any good. The U.S. Preventive Services Task Force neither recommends nor advises against multivitamins (or other supplements) for preventing cancer or cardiovascular disease. Yet many researchers say a multivitamin has a role as "a very inexpensive insurance policy," says David Schardt, senior nutritionist at the Center for Science in the Public Interest. There's no need for anything fancy that claims "heart health" or "prostate health" benefits, he says; an inexpensive, basic brand is fine. Earlier this year, Harvard Men's Health Watch newsletter editor Harvey Simon recommended against multivitamins. His chief worry was that on top of already fortified foods, the folate in a multi could spur cancer. But a study since then showed that cancer was not increased in women at risk for heart problems who were given folic acid supplements. Simon is now less concerned, at least with regard to breast cancer—prostate cancer still worries him.
Calcium and vitamin D. Thumbs up. Extra calcium to protect bone health is safe and routinely prescribed for women who get too little from food. And consensus is building that Americans get too little vitamin D, which promotes calcium uptake. It is produced by sun-exposed skin and is difficult to get from unfortified foods—fatty fish are the only major food source. Studies suggest vitamin D also may help fend off cancer and ward off infections. Researchers are hungry for more evidence. "We really need to do the studies," says Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.
The Institute of Medicine has announced it will review the daily recommended dietary allowance of vitamin D, now from 200 to 600 international units depending on age, gender, and race. Experts put the high end anywhere from 800 IU to 2,000 IU a day. The IOM review is due in early 2010. Until then, while the benefits are unproven, adding 1,000 IU of vitamin D won't likely hurt and could help, especially for people who don't get much sun.
Smoking Harms You and Your Offsprings
The people who smoke must pay attention now! Smoking is not only bad for your health but also your children. Everyone knows that cigarette smoking is bad for your health. And it's bad for your children's health, too, increasing the risk that your offspring will suffer from obesity and mental health problems.
Children of mothers who smoked while pregnant are more likely to have behavioral problems by age 4, according to researchers at the University of Bristol in England. And pregnant women aren't the only ones who should worry about the ill effects of smoking on children. Kids whose fathers smoked while they were in the womb were more likely to later become obese, according to researchers in Hong Kong. Both sets of scientists looked at data on thousands of children, and both papers were published in the July issue of Pediatrics.
Scientists have long known that pregnant women who smoke increase the risk that their children will be born prematurely, have low birth weight, decreased lung function, and developmental delays. Moms who smoke after a child is born also increase the odds that their child will have pneumonia, asthma, ear infections, and sudden infant death syndrome, or SIDS. But this new information suggests that children face a higher risk of obesity, which itself is a key risk factor for diabetes and heart disease, from secondhand smoke as well as maternal smoking.
By contrast, the British researchers found that children had more conduct problems, including aggression and defiance, if their mothers smoked during pregnancy, but not if their dads did. That may be because exposure to the many toxins in cigarette smoke may affect prenatal development. Or it could be because mothers who smoke during pregnancy are more likely to have behavioral problems themselves. Children learn behavior, good and bad, from parents, and there's also a genetic component to behavior, as well. The researchers didn't have information on the behavior of moms in this study, so they can't prove that smoking was the cause of the preschoolers' behavior problems. But quitting smoking would end that worry, and that risk. Tobacco smoke is one environmental toxin that parents can control. (In May, researchers reported on another example of a possible link between environmental toxins and behavioral problems finding that children exposed to organophosphate pesticides in fruits and vegetables are more likely to have ADHD.)
Pediatricians are being encouraged to help parents quit, including offering prescriptions for nicotine-replacement patches or gum.
Tainted Medicines, Who Can Protect Our Kids
The massive recall of children's Tylenol, Motrin, Zyrtec, and Benadryl has parents fuming, and for good reason. There's not a parent I know who doesn't keep all these medicines on hand for soothing symptoms of childhood colds, flu, and allergies. They're usually among the first things that pediatricians recommend, too, especially since over-the-counter children's cold remedies have been banned as unsafe for children under age 2, and are discouraged for use with older kids, because there's no proof they relieve cold symptoms, and have been implicated in injuries and deaths to children.
The Food and Drug Administration on April 20 inspected the McNeil Consumer Healthcare factory in Fort Washington, Pa., that made the Johnson & Johnson products, and inspectors said they found many problems with quality control, including raw materials tainted with bacteria. (Read the FDA inspectors' report.) The finished products tested negative for bacteria, FDA officials said, and shouldn't have put children at risk. But since this is the fifth recall of McNeil Consumer Healthcare products since last fall, including a huge recall in January of Tylenol, Motrin, Benadryl and other products that smelled moldy and sickened some people, it's hard not to be worried, and mad.
"McNeil has done several recalls on Tylenol in the past year," web user Christina of Mississippi wrote on the U.S. News website this week. "That is why my trust in them has been severely shaken. My two children ages 3 and 4 years old use a generic form of Tylenol and Motrin now. Not only is it cheaper but it works the exact same way as Tylenol and Motrin."
Jen of Connecticut, who labels herself "Angry Mother!", writes: "This whole recall upsets me! I have 5 bottles of meds, Tylenol, Benadryl, and Motrin that have been recalled! I have 2 sons 9 and 7 months, my oldest uses Benadryl to help with his asthma. If his allergies act up so does his asthma! My 7-month-old uses Tylenol for teething! These companies should test and be sure these meds are safe for our kids!"
Amen to both. I'm fuming because I've been dosing my child with brand-name Zyrtec for allergies, presuming there is better quality control than with generics. Now the FDA says the generic medications are a safer choice. Unfortunately, shoddy and fraudulent medications pose a growing health threat, as I reported in a U.S. News investigation back in 2007. Americans "should be quite concerned," Roger Williams, CEO of US Pharmacopeia, a private organization that creates the nation's official quality standards for drugs, told me then. The FDA has taken a newly activist stance toward drug safety, and it sounds like there will be more action soon on the children's medication recall. But oversight of drug manufacturing hasn't changed much for the better overall.
Once again here's a situation where parents have to stay on top of the news and be proactive in managing their children's health.
- Throw out any children's Tylenol, Motrin, Benadryl or Zyrtec in your house that has been recalled. Check McNeilProductRecall.com to see a full list of recalled products and to request a refund or coupon. Retail stores can provide refunds, too.
- Consider non-drug alternatives to OTC cold remedies, including saline nose spray, humidified air, and suctioning out mucus. (Read more on non-drug remedies for congestion.)
- Ask your doctor for other options, particularly for allergies, which many parents pointed out often need control via antihistamines. The FDA recommends cetirizine (generic Zyrtec), which is what I bought at the pharmacy on Sunday. Cheaper, too!
Switching to generic cold and allergy remedies is just a short-term fix, however, since the same sloppy manufacturing practices and lax oversight could crop up with generic manufacturers, too. I'll leave the last word on that to another U.S. News reader, who writes: "Isn't it more important to protect infants than Pharma giants?" Legislation is pending in Congress that would give the FDA more muscle to oversee our country's increasingly complex and globalized medication pipeline. Let's hope Congress thinks children's health comes before Big Pharma, too.
How to Lower the Child’s Cholesterol
Parents should think twice before starting children on statin drugs to lower cholesterol, according to a new report on children and statins from Consumer Reports Best Buy Drugs. That's because the powerful drugs have not been extensively tested in children, and they can have serious side effects, especially muscle pain. Instead, parents should consider the two best ways to lower cholesterol without drugs: more exercise, and a healthy diet.
With about 20 percent of children now considered obese and at risk of high cholesterol, many more parents will be facing the question of whether they should put children on statins, an idea that would have seemed odd just a few years ago. In 2008, the American Academy of Pediatrics said that statins could be used for children ages 8 and above, and that 2-year-olds should be given cholesterol tests if they appear to be at risk of obesity. In 2009, doctors wrote children 2.3 million prescriptions for statins. But John Santa, an internist who directs Consumer Reports Health Ratings Center, says parents should ask themselves two questions if their child has been diagnosed with high cholesterol before turning to statins:
- Does your child have traditional risk factors for cardiovascular disease? These include being overweight or obese; having diabetes; having a family history of premature heart disease; or being a smoker. If so, talk with your pediatrician about how to lower your child's cholesterol without drugs.
- Does your child have high cholesterol but no risk factors for heart disease? If so, there's no evidence that treating child's high cholesterol with drugs will lower the risk of heart attacks once that child becomes an adult.
"With children, you're talking about many decades of potential exposure to the drugs," Santa says. He points out that children metabolize drugs very differently than parents, so it's impossible to presume that the drugs' safety and effectiveness would be the same for them. Indeed, statins haven't been tested in children long term for safety or effectiveness, and taking statins is usually considered a lifetime affair. With a new statin drug, Livalo, about to be introduced, expect a barrage of advertisements directed at doctors and parents. "Let's curb our enthusiasm here and be a little careful," Santa says.
If your child has high LDL cholesterol, generally considered 130 mg/dL or greater, talk with your pediatrician about options, and don't go in demanding drugs, Santa suggests. "Ask about the risks and benefits. A careful parent who reads both sides, I think, will have good questions for their physician."
How to Prevent Teenage Drinking
Many parents are worried that their kids will drink when they are young. Teenage drinking is such a health risk that pediatricians are now being told to screen all teenagers—and even sixth graders—for alcohol use.
That new policy from the American Academy of Pediatrics can be a powerful tool for parents to help their children avoid trouble with alcohol. But first, parents need to learn to give teenagers some privacy in the doctor's office.
"Tenacious parents who will not leave the examination room" are cited as a major barrier to routine screening for alcohol and drug use by pediatricians in the new teen alcohol screening policy. And what 13-year-old would want to tell Mom she pounded five Vodka Cruisers at a party? "We want to keep families involved," Patricia Kokotailo, director of adolescent medicine at the University of Wisconsin School of Medicine and Public Health told me, "but some things are very difficult for teenagers to express if it's not confidential." She is also lead author of the new guidelines. When Kokotailo sees teenagers in the office, she usually talks with them privately before speaking to the family as a whole, but doesn't reveal anything that children want kept private.
Mounting research showing that the teenage brain is in the midst an amazing developmental phase was a chief driver behind the call for universal screening for alcohol use. That brain growth spurt gives teens remarkable cognitive powers, but also leaves their brains more vulnerable to the damaging effects of alcohol, drugs, and tobacco. Recent research has also shown that the earlier teenagers start drinking, the more likely they are to have problems as adults with school, jobs, and relationships.
There's abundant evidence that no matter how much teenagers diss grown-ups, they still view their parents as their biggest role models. And while the pediatricians are calling for some privacy in the exam room, they emphasize that strong parental involvement is key to controlling teens' drinking. That's great motivation to tell your children what you might have hesitated to say before:
- Talk with your children about your family's history of alcohol or drug use. There's a genetic component to alcoholism, and kids should know if they're at greater risk of problems.
- Give your children one-on-one time with the pediatrician. Think of it as their lesson in how to navigate the healthcare system.
- Set a firm policy: No alcohol, drugs, or tobacco until age 21. Use the new research on the teenage brain to explain that this is about keeping those brains safe.
- Never host a teenage party with drugs or alcohol. "The liability is enormous if one of those kids goes out and drives and kills himself, or others," says Kokotailo.
- Show your kids how to use alcohol responsibly; have a beer, sure, but don't get drunk. Current federal dietary guidelines call for no more than one drink a day for women, two for men.
"Prevention is a big thing," Kokotailo told me. "We now know better how alcohol affects the brain and neurodevelopment of young people." Her hope is that with more pediatricians asking about teenage drinking, and with more parents telling children what they need to know about alcohol and keeping a close eye on their behavior, teenagers will be better equipped to make their way to a healthy adulthood.
How to Help Your Kids Do Exercise and Reduce Child Obesity
Now many child has obesity problem. childhood obesity is a major issue in the world. At the core of the problem is the fact that less than one third of all children ages 6 to 17 get regular vigorous exercise, defined as at least 20 minutes of physical activity that makes them sweat and breathe hard, according to a new joint report from the American Heart Association and the National Association for Sport and Physical Education. That's in stark contrast to what the U.S. Department of Health and Human Services recommended in its recently released Physical Activity Guidelines for Americans: at least 60 minutes of moderate or vigorous exercise daily.
So what should parents do to get their kids moving more often? First, don't assume your child gets sufficient exercise in school through physical education classes, experts say. Most, but not all states require P.E., according to the new report. That means parents should incorporate physical activity into family time at home. Here are 5 tips to get started:
Encourage a little bit at a time. Minutes spent playing kickball with friends during recess count toward the hourlong daily goal, as does climbing trees in the backyard after school. "It doesn't have to be all at once," says Nancy Brown, CEO of the AHA. "Kids should be doing things appropriate for their age, so that [exercise] becomes a behavior and a natural part of what they do."
Practice what you preach. "We think that parents and other adult role models need to set an example by being active themselves," Brown says. And it's not hard to find activities the whole family can do together, such as a daily walk or bike ride in the neighborhood. Other simple but fun options: hide-and-seek, jump rope, tag, or a game of basketball in the driveway. Mowing the lawn, raking leaves, and shoveling snow count, too.
Advocate for well-maintained, safe sidewalks and bike paths in your neighborhood, and volunteer to supervise the use of school facilities after hours. Children are more likely to want to play outside—and you'll feel more comfortable with them doing it—if it's safe, so attend neighborhood association or city council meetings to request proper upkeep of nearby sidewalks and paths. Also, consider gyms and tracks at local schools as options for physical activity after hours and on weekends. Often, schools are willing to make gyms and equipment available on the weekends but simply need parents to volunteer to supervise, Brown says.
Don't underestimate the value of some video games. The AHA and Nintendo recently teamed up to promote the use of the Wii Fit to help Americans meet recommended physical activity guidelines. The goal of the partnership is to teach people how so-called "active-play" video games encourage regular exercise. If you're having a tough time getting your child to play outside, consider buying a video game that requires the child to get moving, Brown suggests.
Don't let other activities or physical disabilities limit your child. Thirty-two states allow students to waive P.E. because of health issues, physical disabilities, religious beliefs, early graduation, or participation in other activities, such as cheerleading or marching band. But those kids—even those with physical disabilities or health problems—still need to get an hour or more of exercise per day, says Charlene Burgeson, executive director of the NASPE. "Not being physically active isn't the way to go. If students have health issues or disabilities, there may be a way to modify the [physical] activity" to accommodate them, she says. "By not giving them that activity, we're really doing them an injustice." Solving this problem may mean approaching the school or gym teacher to ask how the class can be modified to accommodate your child.
Summer Safety: How to Prevent Kids End Up in the ER
Summer holidays is coming. Drowning and other accidents spike when school is out, earning the summer the moniker "trauma season". Just ask any ER nurse or doctor, and he or she will rattle off a list of typical mishaps that bring families into their care right around now. There are distinct patterns to summer accidents, and many could be easily prevented. Here are the most frequent ways that children get hurt and how to prevent the accidents.
1. Drowning. Summer is a good season to swim. It is not a bad thing for children to swim in the hot summer only if they are safe. The most basic, common-sense advice to prevent children from drowning is to have an adult watching the water at all times. Sounds obvious, like something any parent would do instinctively, but a kid drowning is usually "a matter of everybody was watching, but nobody was watching. Kids should also have swimming lessons before they jump into water. kids who get swimming lessons may have more competence in the water and might not panic, buying them some time in a dicey situation, like when a crush of kids are bunched together in the water or when fatigue sets in. But parents shouldn't overestimate the protective value of swimming lessons. Swimming lessons are fantastic, but it's not a panacea for supervision.
2. Bike accidents. Deaths related to biking increase about 45 percent in summer, compared with other times of the year. Certainly, riding around in the warm weather is a favorite childhood pastime, but doing so without wearing a properly fitted helmet could be asking for trouble. Before kids ride, the parents should assure that the helmet is covering the front of the head, not cocked back on the crown. It is recommended to buy a helmet that meets the standards of the Consumer Product Safety Commission, which should be evident by a CPSC sticker inside the helmet.
3. Motor vehicle-related accidents. Motor vehicle crashes are the leading cause of death among kids ages 3 to 14 in the United States. A number of factors are involved, including high-traffic holidays—in particular, Memorial Day, the Fourth of July, and Labor Day—an excess of drinking, and parents who don't bring their children's car seats on vacation. A properly fitted car or booster seat is essential to preventing a child's injury or death in an accident, says Cianflone. (Safe driving, obviously, is as well.) Size matters—only kids who are at least 4-foot-9 and weigh 80 to 100 pounds can safely wear a seat belt. It is estimated that 73 percent of car seats are either installed wrong or aren't used correctly. Parents can have their work checked at a car-seat inspection station. The Safe Kids USA website can help you find one.
4. Pedestrian accidents. Kids are out and about more often in the summer, frequently unsupervised, and that contributes to a 16 percent spike in child pedestrian deaths this time of year. Again, a child's level of development plays a role in their risk: Research suggests that before age 10, children are particularly impulsive and also cannot judge speed, spatial relationships, or distance very well.
Close to 10 percent of child pedestrian injuries occur in a driveway during the summer, according to Safe Kids. Nonfatal injuries related to vehicle backovers landed approximately 2,500 kids ages 14 and younger in the ER per year between 2001 and 2003, according to the CDC. Nearly half of those incidents took place at the child's home. And don't trust the car camera that allows a driver to watch a screen on the dashboard for a shot of the field to the rear. It has blind spots, too. "We recommend you walk around the back of the vehicle every time you get into the car," Cianflone says.
5. Burns. Fireworks, barbeques, campfires, and fire pits are all integral parts of summer. Parents just need to keep the heat away from the kids. "People don't respect fire the way they should," says Lozon, who sees plenty of toddlers with burns on their chests, legs, and faces. In many cases, the fire had gone out, which perhaps led to adults letting down their guard, and a child stumbled into the white ashes, which remain searing hot. Another common injury Lozon's emergency department gets this time of year results from kids spraying lighter fluid into the barbeque. The fire can light the arc of fluid all the way up to the container, which can explode in the hand.
And of course, the Fourth of July is notorious for injuries related to fireworks. According to the CDC, a third of individuals injured by fireworks are under the age of 15. One of the most common such injuries Lozon sees is when the fuse on a firework is lit incorrectly—or doesn't appear to catch—and someone goes back to re-light or fiddle with it. The firework explodes and fingers are blown off or the face, eyes, or head gets burned.
6. Falls. They're the leading cause of nonfatal unintended injury to children year-round, bringing about 8,000 kids into the ER daily, says the CDC. And fall-related deaths spike in the summer, up 21 percent over the average during the rest of the year, according to Safe Kids. Warm temperatures mean more open windows, more time on the jungle gym, and more kids hanging out on balconies or fire escapes.
There are two easy ways to prevent children from falling, says Cianflone: supervision and window guards. Exploring, climbing, touching, pushing, and grasping at the world around them is how children grow and develop, she says, so risk can't be completely eliminated. But watching kids and removing the hazards in their environment can help prevent a mishap. Keep furniture (including the baby's changing table) away from windows, install bars or a childproof gate on windows, and don't allow kids to play on balconies or roofs.
Going to the playground has its perils, too. On an annual basis, kids 14 or younger make 200,000 visits to the emergency departments in the United States because of playground accidents, according to the CDC. A few precautions can keep kids safe. To avoid trips and lost balance (and heads banged painfully into pieces of metal equipment), ditch the Crocs and flip-flops in favor of sneakers with adequate rubber on the soles, says Cianflone. As with adult supervision around the pool, says Cianflone, adult eyes focused on kids on the playground equipment is key.
7. Accidental strangulation. Keep your kids from wearing hooded sweatshirts or anything dangling around their necks on the playground—it's a strangulation hazard if it gets caught in a piece of equipment. In fact, strangulation caused about 56 percent of the 147 playground-related deaths between 1990 and 2000; falls accounted for 20 percent, says the CDC.
8. Trampoline injuries. Just like swimming pools, trampolines get uncovered during the summer months. Their power to injure needs to be heeded. "It's a physics lesson," says Lozon. "You've got motion, height, and bodies colliding." Heads smash together, ankles and elbows get stuck between the springs and the rim of the equipment, bones break, and bodies get launched off the trampoline. A recent study in the British Medical Journal found that the risk of injury increases with the number of bouncers. If a trampoline is a must for your family, Lozon suggests getting one with safety walls and coverings over the springs. Allow only one bouncer at a time, she says.
How to Assess if Your Child Has Exercise-Induced Asthma
When exercise leads to wheezing or coughing, people often blame the symptoms on being out of shape. But a new study shows that, in children at least, there may be more to the story. In fact, these symptoms were often accompanied by a decrease in lung function—a hallmark of asthma—even when children had no prior history of asthma or allergies.
It's possible that children who experience problems following intense exercise may have undiagnosed, intermittent, exercised-induced asthma, says Clifford Bassett, chair of the public education committee at the American Academy of Allergy, Asthma, and Immunology, who was not involved in the new study but has reviewed the findings. The research, presented Tuesday at the American Thoracic Society's International Conference in New Orleans, found that short periods of heavy exercise caused decreased lung function in some children with no history of asthma or allergies. Nearly half of the 56 healthy children studied had at least one abnormal pulmonary function result following exercise. More research is needed to determine why this occurs and how it can be prevented, the authors wrote.
Complications of exercise-induced asthma include permanent narrowing of the child's airways, emergency room visits and hospitalizations, and poor athletic performance, according to the Mayo Clinic. But Bassett says that it's likely that many children with exercise-induced asthma go undiagnosed. Some parents may not realize their children are having difficulty breathing after physical activity because kids tend to hide how they feel due to peer pressure or embarrassment, he says. And the symptoms may not happen during every round of physical activity. High pollen counts or poor air quality days may make symptoms more likely in susceptible children.
Still, there are signs parents should be on the lookout for, especially if there is a family history of asthma or allergies. If any of the following symptoms occur, a doctor can perform tests that will safely evaluate whether or not your child has asthma. Bassett advises staying alert for these problems:
- Shortness of breath that worsens during physical activity.
- Cough that may or may not produce phlegm.
- Chest tightness.
- Reduced athletic performance, meaning the child is physically able to do less than he or she could accomplish in the past.
- Excessive fatigue associated with athletic performance or exercise.
- Wheezing that worsens during exercise and may begin suddenly.
- Prolonged recovery time following exercise, lasting noticeably longer than in the past.