The #1 killer of our children over 4 years of age is vehicle crashes. New car safety guidelines are based on safety data to keep our kids safe.
The AAP recently released new car safety guidelines for kids. The number one killer of our children over 4 years of age is vehicle crashes. These new guidelines are based on safety data and research about how to keep our kids safe. They are not meant to keep kids happy. They will be hard to enforce at the beginning, but it’s worth it to keep our kids alive! Once kids know this is not negotiable, the fighting will decrease. Spread the word to your friends with kids so yours don’t feel like they’re the only ones who must stay in a safety seat. Plus you might save a life!
A big thank you to Molly Blair for the colorful photos!
General car safety tips
Car seat choice and maintenance
The best seat is not necessarily the most expensive. Choose a seat that fits your child and your car.
Car seats expire. Write when your seats are close to expiring on your calendar.
You should not buy a used car seat from anyone you don’t know. It is not possible to verify that it hasn’t been in an accident in this situation.
Register your car seat so you will be notified in case of recalls.
If you’re in an accident, your car seats may need to be replaced. Insurance may cover this cost.
Do not remove the stickers that provide important information, such as the height and weight limits of the seat.
Always review the size minimum and maximums of your car seat. Make it a habit to check the seat’s limitations after each well visit check to be sure your child’s height and weight still fit in the seat as it is being used.
Car seat use and mis-use
Bring your child and the car seat to a certified car seat installer with each change in seat and change in vehicle.
The most common mistake other than installing a seat improperly is to move a child to the next seat too quickly. Keep your child in the seat until they meet the height or weight limit. Each transition (from rear-facing to forward-facing, forward-facing to booster, and booster to lap/shoulder belt) lowers the child’s protection.
Do not use attachments, such as a head roll, in a seat unless it was tested and sold with your seat.
Rear facing allows the head and spine to be protected in case of a crash. It is the safest way to travel. The head, neck, and spine are all supported by the hard shell of the car safety seat. They all move together, with little relative movement between body parts.
When children ride forward-facing, their bodies are restrained by the harness straps, but their heads can be thrown forward in an accident. This can lead to more spine and head injuries.
Molly Blair makes a lot of great images for her mother, Dr. Kim Burlingham, and has given me permission to share.
Potential problems with following the guidelines
Motion sickness
If your child suffers from motion sickness (car sickness) when rear facing, talk to your pediatrician.
Resistance
Kids will resist many things, including properly buckling up. It is worth it to insist that they’re safe. Try various parenting strategies.
Kids like choices, so offer choices about climbing in or getting put in the seat or if they want to help do the buckle. The choice is never whether or not to ride safely. Find acceptable choices that end with them properly buckled. There are more ideas in 5 Tricks to Get an Uncooperative Toddler Into Their Car Seat.
Older kids can learn about why they need this level of safety seat to remain safe. I know my kids are both shorter than classmates, so it was a regular discussion in my house. They always ended up agreeing that it was necessary when we looked at age-appropriate crash pictures and safety data. (Do an online search to preview sites without your kids so they aren’t exposed to more than they can handle.) I ask kids in my office all the time if I should ride a motorcycle without a helmet – it’s legal in my state. They all say “no” and then seem to comprehend that just because it’s legal doesn’t make it safe.
Summary of 2018 car safety guidelines
Infants through preschool years
Infants should always remain rear facing. Both rear-facing only seats and convertible seats can serve this purpose.
Rear-facing only seats
Rear-facing only seats are convenient because they can be snapped in and out of bases. This allows various drivers to have bases installed in their vehicle and the seat can be used in multiple vehicles.
Rear-facing only seats tend to have lesser weight and height allowances, but as infants become toddlers they do not need a carrying seat. Not to mention the safety issues with carrying a heavy kid in a heavy seat – we don’t need parents to hurt themselves!
Although these infant rear-facing carrying seats can be used to carry infants in and out of buildings to the vehicle, it is not recommended to use them long term outside of the vehicle. They are not approved for overnight sleeping.
Convertible seats
Convertible seats are able to be used rear facing until a child outgrows the weight or height maximum.
The minimum weight recommended to turn forward facing is now 40 pounds unless the seat has a lower maximum for rear facing.
This means most toddlers and preschoolers should be staying rear facing.
When kids turn forward in the car, they should stay in their harness.
School aged kids
Convertible seats
Convertible seats will accommodate children rear facing until they are 40-90 pounds.
Keep ’em rear facing longer!
The earliest it is now recommended to turn kids forward facing is 40 pounds. I know kids will fight this, but it’s worth it based on the safety studies.
This means that kids who are school aged might still fit best rear facing.
Rear facing is the safest way to travel, and remember that the #1 killer of our kids over 4 years is automobile crashes. Let’s change that and keep kids rear facing longer.
When kids are over the rear-facing maximum of their seat, turn them around, but leave the harness on. There’s a reason race car drivers use a harness and not just a lap and shoulder belt. Harnesses are safer! Use it until your child outgrows the limits of the seat.
Race car drivers still use a harness seatbelt – your kids should use one too until they’re big enough to fit without.
Booster seats
Booster seats help keep the lap and shoulder belt positioned properly until a child is tall enough and old enough to not require it. It is generally around 4 foot 9 inches that kids are big enough to sit in most vehicles without a booster. Most kids are not this tall until 10-12 years of age, even though many state laws allow much younger kids to sit without a booster.
Age is not the main factor in deciding when a child should move out of a booster. Use the 5 point test to see if your child fits properly in the vehicle. I always say it’s the size of the child as well as the size of the vehicle’s seat that matters.
Don’t let kids move out of the booster seat too soon! Age doesn’t matter as much as fit.
Seat belt alone
When kids fit properly in the vehicle’s seat without a booster seat, they still should sit properly.
If your child cannot sit upright in the seat, a booster is still recommended to keep the belt properly positioned.
No one should slide their hips away from the back of the seat to slouch in the seat. This allows the seat belt to ride up onto the abdomen, which increases the risk of injury in a crash.
Use seat belts properly and have kids sit in the safest seat always! Only teens and adults should sit up front.
Front seat
All children less than 13 years of age should remain in the back seat.
It’s easy to remember that only teens and adults can sit up front.
This is not based only on height or weight. Physical maturity makes a difference as well.
I’m surprised how often I’m asked if having a baby “stand” on a parent’s lap will make them bow-legged or otherwise hurt them. Standing and jumping while being held and supported is a natural thing babies do, so why do so many parents worry if standing will cause bow legs or other problems?
Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.
Bowed legs from allowing babies to stand with support is one of those tales.
If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs, it will not harm the baby.
Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them.
Supported standing can help build strong trunk muscles.
Other ways to build strong muscles in infants:
Tummy time
Supervise tummy time when Baby’s awake!
This is a simple as it sounds. Place your baby on his or her tummy. Be sure s/he’s on a flat surface that is not too soft.
I think the earlier you start this, the better it’s tolerated. You can even do it before your newborn’s umbilical cord stump falls off!
Initially babies will not lift their head well, so be sure they don’t spend too much time face down. This can cause problems with their breathing. A brief time doing this is safe though as long as they aren’t laying on fluffy stuff. This is a major reason to never leave your baby alone on his stomach.
Use this as a play time.
Move brightly colored or noisy objects in front of your baby’s head to encourage your baby to look up at it. Older siblings love to lay on the floor and play with “their” baby this way!
Many babies will look like they’re taking off trying to fly. Others will put their hands down and look like they’re doing push ups. Around 4 months they can support their upper body weight on their elbows. All of these are good for building muscles.
Parents often avoid tummy time because their babies hate it. It’s hard to hear babies cry, I know. You can progressively make it harder for your baby without being a mean drill sergeant! Increase the time on their tummy as they gain strength. Start with just a minute or two several times a day. If you never do it, they’ll never get better.
From day one babies held upright against a parent’s chest will start to lift their heads briefly. You will most likely go to this position to burp your baby sometimes.
The more babies hold their head up, the stronger the neck muscles get. Chest to chest isn’t as effective as floor tummy time for muscle strength development, but it’s a great cuddle activity!
The more reclined you are, the more they work. Think of yourself doing push ups. If you do push ups against the wall, it’s pretty easy. If you put your hands on a chair, they get a little harder. Then if you put hands and feet on the floor, they’re even harder. Lift your feet onto a higher surface and it’s even harder.
Chest to chest time can be an easy version of tummy time, but I don’t want it to replace tummy time completely. Make time for both each day!
Lifting gently:
When your baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. This can usually start around 6 weeks of age.
Babies will get stronger neck muscles by lifting their head and strong abdominal muscles by tightening their abs even though you’re doing most of the lifting. You could call these baby sit ups!
Be careful to not make sudden jerks and to not allow the baby to fall back too fast.
Kicking:
Place your baby on his back with things to kick near his or her feet.
Things that make a noise or light up when kicked make kicking fun!
You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.
Bicycling:
When you ride a bike, you get exercise, You can help your newborn stretch and strengthen leg muscles by making the bicycle motion with his or her legs.
When babies are first born they are often stiff from being in the womb. They will learn to stretch their legs, but you can help by moving them in a bicycle pattern. They usually find this to be great fun!
I also suggest doing this after they get their first few vaccines to help with muscle soreness, much like you move your arm around after getting shots. Generally by 4 months, babies kick enough that they can do this on their own.
Sitting:
Allow your baby to sit on your lap or on the floor with less and less support from you.
You can start this when your baby has enough head and trunk control to not bop around constantly when you hold him or her upright for burping. Don’t wait until 6 months to start – by this age some babies can already sit for brief periods alone if they were given the opportunity to practice when younger.
A safe easy position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V” – this offers protection from falling right, left, and back.
When your baby is fairly stable, you can put pillows behind him or her and supervise independent sitting. Never leave babies unattended sitting at this stage.
Big benefits
“Will standing hurt my baby’s legs?” is the wrong question.
Parents should ask more about what you can do to help your baby develop strong muscles. Standing with proper support is not only safe, but also beneficial!
What are your favorite activities to help your baby grow and develop strong muscles?
Did you know there’s a name for the super swollen male parts from bug bites? Actually two names: Summer Penile Syndrome and Lion Mane’s Penis. Doctors might even call it seasonal acute hypersensitivity reaction. If you’ve ever seen it, you know it can be quite impressive.
What is summer penile syndrome?
Summer penile syndrome is a fairly common concern during the summer months. It’s usually due to a chigger bite on the sensitive skin of the penis or scrotum. You can often find a small bug bite near the center of the swelling.
They can itch like crazy, but usually don’t interfere with urinating.
Despite the significant swelling, there isn’t usually much pain, only itching. Unless there’s a secondary infection, there won’t be any fever.
What is a chigger?
Chiggers are a type of mite, which is an arachnid in the same family as spiders and ticks. They are also called harvest mites, harvest bugs, harvest lice, mower’s mites, or red bugs. Chiggers are so small they often go unnoticed until several hours after they attach to our skin. They can attach even under clothing, and the most common places that we notice chigger bites are in the areas of our pants.
Chiggers live in moist, grassy and wooded areas. They are commonly found in the warm summer months.
Adult chiggers don’t bite. It’s the larvae that cause itchy problems. The larvae are red, orange, yellow, or straw-colored, and no more than 0.3 millimeters long.
Chigger. Source: https://commons.wikimedia.org/wiki/File:File-Chigger_bite.svgAfter crawling onto the skin, the larvae inject digestive enzymes into the skin that break down skin cells. They do not actually bite the host even though the bumps are called chigger bites. They form a hole in the skin called a stylostome. Their saliva goes into deep skin layers, which results in severe irritation and swelling.
People usually start to itch within a few hours and often scratch the feeding chiggers away. A hot shower with plenty of soap will kill chiggers and prevent them from finishing their meal, so showering after being in grassy or wooded areas can help prevent deeper reactions.
The good news is that in the US, chiggers are not known to carry diseases.
Prevention
Even though they don’t cause disease, chigger bites are something to avoid because they can cause significant itching for weeks.
Bug sprays with DEET will deter the chiggers. DEET is approved for use in children over 2 months of age.
Clothing can be treated with permethrin to avoid ticks and chiggers. Permethrin can be purchased at sporting goods stores to pre-treat your clothing. It should not be used directly on skin. Once dried into the clothing, permethrin will last for about six washings. You can also treat your shoes, which makes a lot of sense since chiggers are usually found in the grass and crawl up onto your skin.
Even untreated clothing can help a little if you don’t have time to pre-treat with permethrin. Wear long sleeves and long pants. Be sure to tuck the pant legs into your socks so they can’t enter from the bottom leg hole.
Much like any bug bite, control of the itch is important. If kids scratch any itch, it can become secondarily infected from the break in the skin allowing germs in.
Antihistamines
Antihistamines are used for allergic reactions. We commonly use them for seasonal allergies, but they can help most allergy reactions.
Bug bites itch when our bodies react to the saliva injected into our skin with histamine. Histamine is our body’s allergic response and it itches. If you aren’t allergic to the bite, you won’t itch from it. This is the way we react to allergies, which is why we get itchy eyes and noses with allergies to pollen.
Diphenhydramine (Benadryl) is a short acting antihistamine that can help control allergic reactions, but tends to make kids tired or wired. It also only lasts a few hours, which can require frequent dosing.
I don’t like topical antihistamines, which are often sold to treat bug bites. I worry that kids will get too much of the medicine when it is applied to each bite. It’s a low risk, but still a risk. Just because they aren’t taking it by mouth doesn’t mean it isn’t absorbed. Children using a topical antihistamine for an extended time over large areas of the skin (especially areas with broken skin) may be at higher risk, especially if they also are using other diphenhydramine products taken by mouth or applied to the skin.
I am a fan of using an oral long-acting antihistamine, such as cetirizine or loratadine, to treat bug bites. Most kids with one bug bite have many. One dose of an oral antihistamine helps to control the overall histamine reaction, making each bite itch less.
Antibiotics
Despite the significant swelling, these usually do not require prescription antibiotics.
If your child has open areas from scratching the skin, you should keep the area clean and consider using a topical antibiotic ointment to help prevent infection.
Steroids
Over the counter topical hydrocortisone is a very low dose steroid. It can be used on insect bites to help stop the itch.
Stronger steroids that require prescriptions are occasionally used, but you will need to see your physician to discuss the risks and benefits of prescription steroids.
Oatmeal baths
Soaking in an oatmeal bath might help the itching. It works very well for dry skin conditions and sunburn relief as well.
You can buy commercially made oatmeal bath products or you can grind regular plain oats to make it fine enough that it dissolves in bath water. Test a small amount in a cup of water to see if it’s finely ground enough before putting 1 cup of oats into the bath water.
Some people have even made a paste of oats and applied it directly to the itchy skin for relief.
Baking soda
Another kitchen remedy for bug bite itch relief is baking soda. Mix a pinch of baking soda with a few drops of water to make a paste. Put this paste on the bites. Reapply as needed.
Ice or cool cloth
One more kitchen treatment is ice. Many kids won’t tolerate this one, but if they can’t tolerate an ice pack placed over clothing, you can try applying a cool wet washcloth directly to the skin.
When should you see your doctor?
If your child has any of the following symptoms, talk with your doctor.
Trouble urinating.
Pain or itch not controlled with the above measures.
Fever.
By Robbie Grubbs from Houston (What????) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons
June 21, the first day of summer, is National ASK (Asking Saves Kids) Day. The ASK Campaign encourages everyone to ask if there are unlocked guns in the homes where children play. Learn how to make it less awkward.
June 21, the first day of summer, is National ASK (Asking Saves Kids) Day. The ASK Campaign encourages everyone to ask if there are unlocked guns in the homes where children play. The Asking Saves Kids (ASK) Campaign encourages parents to ask a very important question before playdates: “Is there an unlocked gun in your house?” It’s a simple question, but it has the power to save a child’s life.
Keeping a gun in the home increases the risk of injury and death, yet 1 in 3 American homes with children have at least 1 gun.
Every year thousands of kids are killed or injured by guns. When parents think of asking about guns in a playdate’s home, they often can’t imagine how to enter into that conversation.
It doesn’t have to be awkward to ask before your child visits friends. I’ll show you how.
But first let’s review why this is so very important.
Guns are common in our communities. Ask if they are in the area your children will play, and if so, be sure they’re stored safely! #ASKingSavesKids
Many parents buy a gun to help protect their family, but a gun in the home increases the risk of a family member being hurt or killed by a gun more than preventing a crime.
Kids have natural curiosity and if they find a gun, they are likely to play with it, even when they are taught to not touch guns.
Toy guns and real guns are so similar, it can be difficult to tell them apart.
Several studies over the years show that gun education programs fail. Diane Sawyer’s Young Guns episode showed that even soon after gun safety education, kids will play with a gun and not follow the rules they just learned.
Regardless of the reason for or type of gun, there are guns in 1 in 3 homes with children in America. Too many of those guns are not locked. A gun in the home increases the risk of homicide, suicide, and accidental injuries.
Don’t mistakenly think that your gun is needed to keep your family safe. For every time a gun in the home was used for self-defense, there were 4 unintentional shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides.
Accidental shootings
Accidental shootings occur far too often, especially in young children.
See the table below that lists the numbers of leading causes of injury deaths by age. In children under 15, there were 73 unintentional firearm deaths in 2016. That number does not include homicides and suicides.
Our kids must practice active shooter drills at school because school shootings are occurring with more frequency. Many of these shootings are kids who bring their parent’s gun to school.
Suicide
Suicide attempts with guns are usually fatal. Sadly too many people consider suicide as an option when they’re down.
Having a gun in the home when a teen is depressed increases the risk of death by suicide. Over 80% of teen suicide by firearm is done with a family member’s gun.
Keeping guns locked with the ammunition locked separately is important even when you don’t have young children. It can deter teens from accessing guns in a time of despair.
Hiding guns is not a safe plan. Nearly 80% of kids know where the family gun is hidden. Parents usually don’t realize the kids know.
I’ve seen more than a couple surprised parents when they learn that their child knows where the family gun is stored in a drawer or closet. They presumed the child had no idea about the gun, but kids know things. It’s bad enough if they know your secret hiding place for birthday gifts, but if they know where the unlocked gun is, natural curiosities can take over.
It’s not political
I don’t care if you’re a Republican, Democrat, Liberal, or other political affiliation. This isn’t about politics. It’s about keeping kids safe.
This is not about the Second Amendment. Americans have a right to bear arms. But with rights comes responsibilities.
This is about the responsibilities that come with the right to bear arms. Adults have a responsibility to keep children safe.
When having the discussion, keep it about safety. Don’t make it about politics. That turns people off and gets them on the defensive. Don’t judge whether it’s okay to own a gun. Focus on the issue of making sure all guns are safely stored unloaded and locked.
As parents there are many awkward things we must deal with. Being awkward or difficult doesn’t make it okay to just ignore it if safety is involved.
By introducing safety concerns that are not judgement issues, it can be more natural to then talk about more sensitive topics.
Use these non-controversial openers to start the conversation before playdates.
Pets
Allowing a dog who is not friendly and patient around kids to be with the kids is a red flag. Ask if there are pets and how they respond to kids, especially kids they don’t know. If you’re not comfortable with that pet, ask if the parent can keep the kids and pet separate.
When kids are afraid of animals, the other parent needs to be aware.
If there are any pet concerns, see if they can keep the pet in another room while your child is there. If not, have their child to your home instead.
Allergies
If your child has allergies to animals or foods, the other parent needs to be aware. Talk about the allergy and what can be done to help your child not suffer.
When the parent is not able to keep your child safe from allergens in their home, ask if their child can come to yours instead.
Other safety risks
There are numerous other safety risks that could be used as introductory concerns. You can’t ask everything, but pick the things that are most important to you.
Will the kids be riding bikes or scooters? Are there enough helmets for everyone or should your child bring his own?
Is there a wooded area that will require bug sprays or tick checks after the play date?
If they play outside, how closely are they supervised? Do you need to send along sunscreen?
Does your child need to wear sneakers or will they be staying indoors and the flip flops are okay?
If a parent will be responsible for driving your child, do they have an appropriate car seat or booster seat?
Do they have a trampoline or pool? If so, what are their rules and safety measures?
Be first
Be the first to ask a child to your home. With the invitation, list everything you think another parent might be interested in knowing. Hopefully they will reciprocate by giving similar information when they invite your kids over, but if not, ask.
“We’d love to have Johnny over. We have a German Shepard, but he’s really good with kids. If Johnny needs him to be put in the master bedroom, just let me know. We also have a trampoline, but if the kids get on it, a parent is always outside. If that’s not okay, let me know. And we have a rifle, but it’s in the gun safe and the ammunition is locked separately. Is there anything we need to know about Johnny?”
My Pocket Pediatrician
Take a look at Dr. Lili’s comprehensive video on gun safety for more information! Here’s the full version:
And here’s a shorter version with the most important information:
Take the ASK Pledge
Pledge to ASK if there are unlocked guns where your child visits. Encourage friends and family to do the same!
Constipation is one of the most common problems that affects kids. Sometimes it’s mild and changes to diet and routines can help sufficiently. Those are of course the ideal treatments. But if it’s more severe or if kids are resistant to change, Miralax is my go-to treatment. Several parents have asked me about its safety due to what they’ve seen online. I know many more are probably worried but just haven’t asked. With all the concern, I thought I’d share some of the concerns and reasons that I still recommend it.
What is Miralax?
Miralax has been used since 2000, and since I finished my pediatric residency prior to that, I can remember the alternatives we used previously. Many of them were difficult to get kids to take due to poor taste or grittiness. When Miralax was first available, treatment of constipation improved significantly due to the tolerance and acceptance by kids. It was initially available by prescription only and expensive – thankfully both of those hurdles have been removed.
Miralax is the brand name for polyethylene glycol 3350 or PEG 3350. It is now available as an over the counter medication, so no prescription is needed. Generic versions are available. It has been used by many kids over many years, often for long periods of time, to treat constipation.
Is it a laxative?
PEG3350 is a stool softener, not a laxative (despite the name).The molecule binds to water, but is too large to be absorbed through the gut so it passes through the gut and carries the water with it. It works by increasing the water content of the stool. The more PEG taken, the softer the stool.
PEG is not a laxative and should not cause cramps. It is not habit forming. As mentioned above, it is not absorbed into the body it just goes through the GI tract and leaves with the stool.
How is it used?
PEG 3350 is a tasteless powder that dissolves in liquids. It often needs to sit for a few minutes and re-stirred to fully dissolve.
It may be dissolved in water, with a slight change to its taste, but is palatable. Be careful of adding it to drinks high in sugar (even juice), since your child may be on it for a long time, and they don’t need the added sugar. Consider making flavored water with your child’s favorite fruit. Simply put cut up fruit in water in the refrigerator for a couple hours. Infused water tastes great and is a healthy base for your Miralax mixture – or anytime your kids need a drink and don’t like plain water.
I don’t recommend adding it to carbonated beverages.
I recommend mixing a capful of powder in 8 ounces of water and titrating the amount given based on need. My office website discusses this in detail.
Why do we need medicine?
Constipation is common.
Very common. It causes pain, poor eating habits, fear of toileting, and sometimes even leads to ER trips and CT scans. It can last months to years in some kids, so it is not a minor issue when kids suffer from it.
Diet changes are hard – especially in kids!
Kids are often constipated because they have a diet that is poor in water and fiber. They need to eat more fruits, vegetable and whole grains. Many kids drink too much milk and eat too much cheese.
Changing habits is very difficult in strong willed kids. When it comes to food, they’re all strong willed! Dietary changes of course should be done so they are healthier on many levels, but if their stomach hurts all the time, they are unlikely to get out of their comfort zone with foods. Habits change too slowly to help the constipation if used alone.
I encourage first changing the diet to help constipation, but if that fails, or if it is too significant of a problem, PEG 3350 is my first choice. I have recommended it for years without any known side effects or complications, other than the kids who have frequent watery stools on it. This usually responds to continuing the medicine to release the large stool mass that has built up. Some kids just need to decrease the dose a bit.
What’s the concern?
I was quite surprised in 2015 to see that researchers were starting a study on the drug. It surprised me not only because I’ve never heard valid concerns about the safety or efficacy of the medicine (I have seen some really weird stuff online, but nothing that is valid), but also because I’ve never seen headlines that a study is starting. Usually headlines report results of studies. Why did it hit the press before the study was even done? I have no idea.
Even more interesting… it seems the study hasn’t started yet. Three years later. Not a high priority, apparently. Which fits with the low level of concern I find among general pediatricians and pediatric gastrointestinal specialists.
Yet parents still ask about the risks.
What was the proposed study?
Initial reports stated that they were going to look at the safety of other molecules in the PEG 3350.
PEG 3350 itself is a very large molecule that isn’t absorbed by the gut, but there are concerns that smaller compounds could be found as impurities in the manufacturing process of PEG 3350 or formed when PEG 3350 is broken down within the body.
The question is if these smaller compounds are absorbed by the gut and accumulated in the bodies of children taking PEG 3350.
Some families have reported concerns to the FDA that some neurologic or behavioral symptoms in children may be related to taking PEG 3350. It is unclear whether these side-effects are due to PEG 3350 since neurologic and behavioral symptoms can lead to constipation.
These guidelines basically state that not many studies are required to diagnose functional constipation after a thorough history and exam. This means that we don’t need to do expensive tests to make the diagnosis.
The common things we recommend (fiber, water, probiotics) don’t have any proof that they work. There is evidence that PEG 3350 works.
Historically once something is approved in adults, physicians start to use them in children. Companies generally don’t invest money in studies to expand uses after approval because they know that the products will be used in broader ways without the specific indication. They don’t want to spend money they don’t need to spend, which makes sense from a business perspective. It’s also more difficult to do studies in minors.
New rules encourage pediatric testing, but all the drugs previously used in children will not need to undergo this testing. Because they’ve been used for years, we rely on post-market safety data.
Are there studies in children?
Many of the news articles say that studies have not been done in children, but this isn’t true.
This 2014 research article reviews the history of PEG 3350 and compares to other medicines used in pediatric constipation. It also shows safe blood electrolyte levels while on PEG 3350 long term.
In 2001 a study was published showing safe and effective pediatric dosing.
A 2003 studyshowed safety and better tolerance than previously used medications for constipation.
If you look at the references of any of these studies, you will find more. The only side effects noted are related to diarrhea, cramping, bloating — all things that would be expected with a large stool mass blocking the new, softer, water filled stools from coming out. Once the large stool mass is out, these symptoms resolve.
For what is PEG approved?
PEG is used in many products, not just stool softeners. It is found in ointments and pills to allow them to be more easily dissolved in water. PEG can also be found in common household products such as certain brands of skin creams and tooth paste.
PEG 3350 is approved for treatment of constipation in adults for up to 7 days. Approval is based on studies available at the time a medicine is approved. Many commonly used medications are not specifically FDA approved for use in children less than 16 years due to difficulties and expense in testing drugs on minors.
How do we know it works?
There have been several studies in children and the collective experience of pediatricians around the world showing improved tolerability over other treatments for constipation because PEG 3350 has no taste, odor, or texture.
It has been shown to be either as effective or more effective than other constipation treatments. See the links to these studies above. Until children can keep stools soft with adequate amounts of water, fruits, vegetables, and fiber, long term use of PEG is well tolerated.
How long can PEG be used in children?
This is a very difficult thing to study because the longer a study follows their subjects, the more subjects are lost to follow up.
There have been studies of up to 30 months that showed safe use. Blood electrolytes, liver and kidney tests were all reassuring that PEG is safe during the study.
Pediatric gastroenterologists and general pediatricians have often recommended even longer periods of time without any known side effects.
If my child has taken PEG 3350, should I worry?
Is MiraLAX safe?
I cannot stress enough that the studies that have been done all support the safety and efficacy of PEG 3350.
After years of experience using PEG 3350 with many children, I have not seen any neurologic or behavioral problems caused by PEG 3350. I do see many kids with baseline neurologic and behavioral problems become constipated, so they often end up on PEG 3350, but if the issue is carefully assessed, the problems start prior to the treatment.
Generally if the stools are softer, you can more easily work with the behavioral issues that cause the constipation, such as loss of appetite/poor diet and failure to sit on the toilet long enough to empty the stool from the rectum.
If you decide it is time to stop the medicine, be sure to discuss this with your child’s doctor to keep them in the loop about how things are going!
In recent years I’ve been getting more and more reports of athletic heart screenings. Local schools and sports clubs are offering to have athletes get a heart work up for a relatively small fee. Of course most are perfectly normal, which is a peace of mind to parents. Some have found minor things that aren’t of much consequence, but a few have found important heart issues. So why is there even a question of whether or not to do an athletic heart screen if it discovers important heart issues?
Why worry about healthy athlete hearts?
Sudden cardiac death in athletes has been in the news a lot over the years. We all want to minimize the risk that our child has an undiagnosed heart condition that may cause sudden death when exercising. We want to prevent sudden death by identifying those at risk and keeping them from the activities that increase risk.
Communities and schools now are more likely to have defibrillators on hand in case of problems, but some children might benefit from an implantable defibrillator.
If you’ve not taken a CPR class in the past few years, a lot has changed, including teaching people how to use defibrillators. And you no longer follow “A B C” so it is very different. CPR is recommended for all teens and adults.
There has been a lot of controversy over the years whether or not routine ECG screening of athletes is a cost-effective means to find at risk young people. Northeastern Italy has done a comprehensive screening program of competitive athletes and has lowered their sudden cardiac death rate, which is evidence for the ECG screening. Despite this shown benefit, there are many problems with the feasibility of testing a broad range of athletes to evaluate for risk of sudden death (SD).
Complex issues from the Statement linked above:
the low prevalence of cardiovascular diseases responsible for SD in the young population
the low risk of SD among those with these diseases
the large sizes of the populations proposed for screening
the imperfection of the 12-lead ECG as a diagnostic test in this venue
It is generally agreed upon that screening to detect cardiovascular abnormalities in otherwise healthy young competitive athletes is justifiable in principle on ethical, legal, and medical grounds. Reliable exclusion of cardiovascular disease by such screening may provide reassurance to athletes and their families.
In short:
To do an ECG screening on all athletes is not inherently unwarranted nor discouraged, but it isn’t recommended either.
What is recommended?
Although an ECG is not recommended, it is recommended to do a 14 point questionnaire for all athletes at their pre-participation sports exam. This is listed below.
Why isn’t an ECG (commonly called EKG) recommended?
Positive findings on the history (questionnaire) or physical exam may require further testing, but using an ECG as the initial screen for underlying problems in the 12- to 25-year age group hasn’t been found to save lives.
Changes in the heart in growing teenagers can make it difficult to tell if an ECG is abnormal or a variation for age (unless read by a pediatric cardiologist, which is often not possible for these mass screenings).
False negative and positive results can lead to missed diagnoses (normal ECG but real underlying condition) or unneeded testing (abnormal ECG with a normal heart).
Mass ECG screening of athletes would be very expensive and has not been proven to save lives.
If your family can bear the cost and wants to do the screening, it should be done. But if the screen is abnormal, do not jump to the conclusion that your athlete will be banned from sports forever. A more complete exam by a pediatric cardiologist will sort that out.
Know that hearts can change over time. One normal screen does not guarantee there will never be a cardiac event in your child.
If you do not feel that the screening is something you want to pay for or if you feel that it is not necessary for your child who has a negative 14 point screening, you should not be required to do so.
The evidence does not support mass required screenings.
If your child has identified risks based on the questionnaire, a more thorough testing should be done.
What are the 14 points?
These 14 points are listed in Table 1 of the above linked statement: The 14-Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes
Medical history*
Personal history
1. Chest pain/discomfort/tightness/pressure related to exertion
2. Unexplained syncope/near-syncope†
3. Excessive and unexplained dyspnea/fatigue or palpitations, associated with exercise
4. Prior recognition of a heart murmur
5. Elevated systemic blood pressure
6. Prior restriction from participation in sports
7. Prior testing for the heart, ordered by a physician
Family history
8. Premature death (sudden and unexpected, or otherwise) before 50 y
of age attributable to heart disease in ≥1 relative
9. Disability from heart disease in close relative <50 y of age
10. Hypertrophic or dilated cardiomyopathy, long-QT syndrome, or other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias; specific knowledge of genetic cardiac conditions in family members
*Parental verification is recommended for high school and middle school athletes.
†Judged not to be of neurocardiogenic (vasovagal) origin; of particular concern when occurring during or after physical exertion.
‡Refers to heart murmurs judged likely to be organic and unlikely to be innocent; auscultation should be performed with the patient in both the supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.
§Preferably taken in both arms.
What do I recommend?
I think that if you can afford the screen and any potential follow up recommended if it is abnormal, it is a great tool. It can be reassuring, though nothing can guarantee that no problem will develop.
In a perfect world cost wouldn’t matter, but I know it does, so if people can’t afford the screening, they should not feel like they are not doing the right thing if they skip it.
The 14 point question is all that is recommended to be done and can catch the majority of problems if done with a thorough physical exam.
A plug for an annual well visit in your medical home.
I know this is difficult due to the requirement of all athletes have a physical in a specified time frame before a season starts, but there are benefits to doing a physical in the medical home. At your usual physician’s office there should be record of growth over the years, a complete personal and family medical history, and previous vital sign measurements. Not to mention that your regular clinic should be able to update your vaccines if needed so there are no surprises when your school nurse looks at your record in the fall. Seeing your physician yearly also helps to build a relationship, so there is a better comfort level to talk if problems develop.
At this time insurance generally covers one well visit per year. Most physicians will fill out the sports physical form at this annual visit. When you go elsewhere, you usually must pay cash. You might as well get a comprehensive physical using your insurance. You pay a monthly fee for the privilege of having it – use it! Just be sure to schedule well in advance – everyone needs physicals at the same time due to state or club requirements, so slots fill up quickly.
Schedule your physical when you schedule a sport or camp.
When you sign your kids up for any new school, sport or camp, look to see what forms are needed. Call your doctor’s office at the same time you sign up for the sport or camp to schedule the annual physical. Just be sure the date you schedule is in the time frame that is needed to get the forms completed.
Pay attention to your insurance rules for how often physicals can be done. Don’t necessarily schedule near your child’s birthday if it is outside the range that is needed to fulfill form requirements so you can avoid a second physical when only one per year is allowed.
If in doubt, call your pediatrician’s office and ask!
Summertime is a common time that teens learn to drive, but also the most dangerous time. Teens have more free time during the summer, so have more opportunity to drive than during the school year. Car crashes are the #1 cause of death in teens. We are now entering the “100 Deadliest Days,” the time between Memorial Day and Labor Day. This is when the average number of deadly teen driver crashes climbs 15% compared to the rest of the year. Make sure your teen is a safe driver before you let him or her hit the road alone.
Teens tend to be impulsive risk takers. Even cautious new drivers are inexperienced, so they are at risk of not knowing how to handle a situation. In addition to riding along with your teen as they learn the rules of the road, you should talk to them about expectations and safety. Continue the talks as they gain confidence because the risk of accident actually increases in the late teen years.
The AAA Driving Agreement has a nice chart depicting privileges that vary based on circumstance.
From https://noys.org/global-youth-traffic-safety-month/
Special Situations
Overconfidence of the teen driver
Research has shown that after the first few driving years, teens risk of having an accident actually increases. This may be due to teens gaining confidence and taking more risks.
According to the 2017 study, 75 percent of high school seniors “feel confident” in their driving abilities, and 71 percent use a phone behind the wheel. Driving while drowsy, speeding, having multiple passengers and browsing music become more prevalent as new drivers gain confidence.
Distraction
Distractions are a common cause of accidents. Younger drivers have the highest proportion of distraction related fatal crashes.
Over 70% of teens admit to using their cell phone while driving despite recognizing the dangers of this distraction.
Parents need to model safe behavior and stay off their phone while driving. Texts can wait. If it’s that important, pull over to check your phone. Have your teens agree to no cell phone use in a driving contract.
Other passengers are another source of distraction. Teens easily distract one another. Limit the number of passengers your teen is allowed to chauffeur.
Even changing the radio station can be a significant distraction. Ask teens to set the station and leave it – or to make a soundtrack and play it for the road.
Speeding
Speeding is a contributing factor to many crashes. Speed limits are set for safety and going faster makes it harder to maintain control of the vehicle.
Talk to teens about the importance of not only following speed limits, but also about adjusting speeds to road and weather conditions.
It is better to arrive alive but late rather than to speed to attempt to get there faster. Talk to your teen about calling if they plan to be late rather than just trying to speed home to make curfew.
ADHD
The symptoms of ADHD, such as an inability to pay attention and impulsivity, can make driving even more dangerous than it is for a typical teen. There are more car accidents among teens with ADHD than the general population, but newer studies show ADHD drivers on medication are at a significantly lower risk than those not taking medicine. Talk to your teen about medication management if he or she has ADHD.
Safety tips for safe driving
Buckle up – it’s the law but even more important, it’s the safest way to travel. Make sure any passengers are properly buckled before you drive.
Avoid carpooling to reduce the distraction of others in the car. The more kids in the car, the higher the risk.
Avoid eating while driving.
Ignore your cell phone. (Parents be forgiving if your kids don’t answer your call or text right away.)
Know where you are going and how to get there before you get on the road. If you aren’t sure you’ll remember, set a GPS before hitting the road and turn the sound on to minimize the need to look at the screen.
Don’t drive when you’re tired. Drowsy driving is equated to drunk driving. If you have trouble staying in your lane or keeping your eyes open, you’re too tired to safely drive.
Adjust seats, mirrors and climate controls before driving.
Set your music for the road before you start driving.
Watch for pedestrians and bicyclists. Five percent of teen deaths in crashes are pedestrians and 10% are bicyclists.
Don’t drive under the influence of alcohol or any drug that affects your ability to focus behind the wheel. Car crashes are the leading cause of teen death and about 25% involve an underage drinking driver.
Follow the law and parental expectations
It goes without saying that teens must follow the law when driving. They must respect the rules of the road for their own safety and the safety of others.
In addition to the laws, household rules about passengers, nighttime driving and cell phone use can be individualized to your teen’s abilities and weaknesses. Even if a teen can legally drive alone, if he or she hasn’t demonstrated the ability to do it safely, parents should not allow it. More supervised hours can make a difference in their experience and if they in general do not show the ability to make safe choices, they should not have the ability to drive a vehicle unsupervised.
Memorial Day signifies the start of summer, the opening of pools and trips to the beach. Regardless of where you’ll be outside or around water, it’s always important to be safe. Make sun and water safety a priority! Bug safety will be covered separately in a future post.
Safe in the sun!
Keep kids safe in the sun with many methods, not just sunscreen.
Protecting your child in the sun is very important. Make sure you understand how various sunscreens work, how they should be used, and what else you can do to protect your kids from the sun.
Infants under 6 months
Babies under 6 months of age should be kept out of the direct sunlight as much as possible.
Move your baby to the shade or under a tree, umbrella or the stroller canopy. Be careful near reflective surfaces, such as water. Shade may reduce UV exposure by only 50% if there’s reflected sun.
Dress them in lightweight but long sleeved clothing and wide brimmed hats to keep the sun off their skin.
It’s okay to apply sunscreen to small areas of the body that you cannot cover with clothing, such as face and hands.
Make sure infants stay hydrated in the heat. Do not give extra water to infants until they are on solid foods. Breastfeed more often or give extra formula to prevent dehydration.
Mineral vs chemical sunscreens
The sunscreen does not have to be baby specific, but chemical sunscreens are absorbed more than mineral sunscreens. One of the concerns of young infants using sunscreen is they absorb chemicals too much, so mineral sunscreens are preferred for them.
I think most things marketed for babies are really for parent’s piece of mind. They aren’t necessarily better for baby. And they can mark up the cost just because it says it’s for Baby. But one of my favorite sunscreen brands for babies – Blue Lizard – actually prices competitively for the baby product. I like this brand because it was developed in Australia to be used safely at all ages. All of their products are mineral based.
Mineral based products use zinc oxide and titanium dioxide to reflect sun rays. There is minimal absorption. The downsides are they are not as light on the skin and they can wash off when sweating or swimming.
Chemical sunscreens, on the other hand, are absorbed into the skin. They absorb the sun rays that enter the skin. These are best for older children who are exercising outdoors and swimmers since they do not wash off as easily.
What is SPF?
SPF= Sun Protection Factor
The SPF increases the time you can spend in the sun, depending on your skin type. If you would typically burn in 1 hour, an SPF of 15 will keep you from burning for 15 hours, if you reapply every 2 hours. If you would burn in 20 minutes, an SPF of 15 used every 2 hours would protect you 15 x 20 minutes, or 5 hours. This is why fairer skinned people need higher SPF levels.
The sun protection factor (SPF) should be at least 25 and should cover both UVA and UVB rays. The sooner your skin burns, the higher the SPF you should use.
How should sunscreen be used?
For all infants and children over 6 months, be generous with sunscreen. Apply sunscreen at least 30 minutes before going outside, reapply it every 1-2 hours if sweating or swimming (even if it states it is waterproof), and use sunscreen even on cloudy days. One full ounce should be used to cover an adult.
Reapply the sun screen every 1-2 hours.
Try to keep children out of the sun between 10:00 am and 4:00 pm, when the sun’s rays are strongest.
Clouds are not sufficiently protective against the sun. UV rays on cloudy days may be reduced by only 20% to 40%.
Does sunscreen cause cancer?
I don’t know why this is a popular question these days. Well, yes, I know why people question it. The rumor that chemicals in sunscreen are dangerous is commonly circulated online. That’s why it’s questioned, but I don’t know what started this rumor.
Sun causes cancer.
Sunscreens have been studied extensively and have been shown to be safe. Use them.
Sunglasses should be used to protect the eyes from sun damage. Hats with wide brims also keep sun out of the eyes.
Be sure your sunglasses are rated to protect against UVA and UVB 100%. Darker glasses don’t offer more protection necessarily. They must be rated to protect against UVA/UVB.
Bigger frames are better. Especially the ones that wrap around the sides of the face.
Higher cost doesn’t mean better protection – look for the rating! Even inexpensive sunglasses can provide protection. This is good, since most of us need several pair due to them getting misplaced or broken – especially the ones for our kids!
All parents should take a basic CPR course! Young children can drown in only a few inches of water, even if they’ve had swimming instruction.
Children who are swimming – even in a shallow toddler’s pool – should be watched closely. Even if there’s a lifeguard at the pool, there is too much to monitor when there’s a pool full of kids. You must watch your own kids until they’re strong swimmers.
It’s recommended that infants and toddlers have an adult within arm’s reach. For young children, you should continue to pay constant attention and be free from distractions. It’s easy to be distracted when talking to another person or checking your phone. Don’t consider it watching kids if you’re pool side reading a book.
Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes!)
Enforce safety rules – no running near the pool and no pushing others underwater.
Water wings, tubes and other floating devices are not approved flotation devices and should be used only under direct and close supervision. Because they give a false sense of security, I don’t recommend them.
Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive in the shallow end.
And then there are teens…
Talk to older kids and teens often about water safety. As they gain confidence in the water, they take more risks.
Teens are especially notorious for risk taking behaviors. Let them know your expectations. Teens might roll their eyes, but studies show they do best with rules and clear expectations from parents.
Of course they should not drink alcohol ever, but risks increase around water. They should never swim alone, even if they are captain of the swim team. If they are going to a river or lake, they need to be careful of inherit risks there, such as diving into shallow waters and boat safety.
As always, be sure you know where they’re going and when to expect them home. If they’re in water they won’t have a cell phone available at all times, so you might want to schedule “check in” times.
Drowning Risks
Drowning is a real risk. Dry drowning? Not so much.
Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens.
Trying to swim in a particular direction but not making headway
Trying to roll over on the back
Appear to be climbing an invisible ladder
What about swimming lessons?
The American Academy of Pediatrics does not recommend swimming lessons for children under one year of age because they cannot really learn skills to keep them safe.
Even young children who have had swimming lessons should not be unattended at the pool because they are not able to always make safe choices.
How can I protect my child around the backyard pool?
Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes! Who wants mosquitoes in their backyard?)
If you have a swimming pool at home, it should be completely surrounded on 4 sides with a tall fence that has a self-locking gate. The house cannot serve as one side of the barrier. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence.
If your pool has a cover, remove it completely before swimming. Never allow anyone to walk on the pool cover. Your child could fall through it and become trapped underneath.
Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.
Spas and hot tubs are dangerous for young children. They can easily drown or become overheated in them. Don’t allow young children to use them at all due to these risks. If older children use them, they should be supervised. Be sure they are well hydrated. After using a hot tub, be sure everyone showers. You don’t want hot tub folliculitis!
What about at the ocean or lake?
Talk to kids about the pull of undertow if you’re wading into the ocean. (If you don’t know what this is, walk into the water without your kids first.)
Use coast guard approved life preservers correctly whenever needed. All people should wear a life preserver when riding in a boat unless they are inside a cabin. Children should wear a life preserver when they are near the water’s edge or on a dock, even if the law doesn’t require it.
A life preserver fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age five, particularly the non-swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.
Adults should not drink alcohol when they are swimming or boating. They are not only at risk of dehydration from the alcohol, but they also risk lives. It presents a danger for them as well as for any children they might be supervising. Don’t ruin a fun time with a tragedy.
Keep it fun in the sun!
Sun and water safety are not only important, but if you’re not careful, it can ruin a vacation. Practice sun and water safety every day!
Parents often wonder when it’s okay to let their kids stay home alone. There is no easy answer to this question. Many states, including Kansas, do not have a specific age allowable by law. The Department for Children and Families suggests that children under 6 years never be left alone, children 6-9 years should only be alone for short periods if they are mature enough, and children over 10 years may be left alone if they are mature enough. (For state specific rules, check your state’s Child Protection Services agency.)
Growing up
Is your child ready to stay home alone?
Staying home alone is an important part of growing up. If a child is supervised at all times throughout childhood and the teen years, he won’t be able to move out on his own.
This might be the case if there is a developmental delay or behavioral problems that make it not safe for that person to be alone.
The age at which kids are able to be alone varies on the child and the situation. Parents must take many things into account when considering leaving a child alone.
Maturity of the child.
Age does not define when kids are ready to stay home alone. You must consider how responsible and independent they are.
Does your child know what to do if someone knocks at the door? Can they prepare a simple meal? Do they follow general safety rules, such as not wrestling with a sibling or jumping on the trampoline unsupervised? Will your child be scared alone? Do they know how to call you (or 911) in case of problems or a true emergency? Are they capable of understanding activities that are dangerous and need to be avoided when unsupervised?
Readiness.
Is your child asking for the privilege of being left alone or are they afraid to be alone?
Forcing a child who is afraid to stay alone can be very damaging. Only allow kids to stay alone if they want to and are capable of the responsibility.
Behavior.
Some kids are typically rule followers. Others are not. If your child has problems following rules while supervised, he is not ready to be left alone.
Dangers are more likely to come if kids are risk takers and cannot control their behaviors. House fires, hurt pets, physical fights among siblings, kids wandering the neighborhood, and online behaviors that put kids at risk are but a few ways kids who don’t follow rules can get hurt.
Even if kids used to be able to be unsupervised, things change. If you think a child or teen is depressed, using drugs or there are other concerns, it might not be safe any longer to leave them unsupervised.
Number of children and their ages.
Kids can supervise younger siblings as long as they are mature enough and the dynamics between the two allow for it.
Two kids of similar ages can keep each other company if they are able to be responsible alone and not fight.
Some children can stay alone, but are not yet ready to take care of younger siblings. If they can do it when parents are home, they might be ready for unsupervised babysitting.
In Kansas kids must be 11 years of age to watch non-siblings, but there is no law for siblings. Leaving an 11 year old alone with a baby is much different than leaving the 11 year old in charge of a school aged child!
You must know your kids and their limitations.
Left alone or coming home to an empty house?
When you leave kids home, you can first be sure doors are locked and kids are prepared.
If they will be coming home to an empty house (such as after school), there are a few more things to consider. Will they be responsible to keep a house key? Is there an alternate way in (such as a garage code)? Do they know how to turn off the house alarm if needed? How will you know they made it home safely?
Pets.
If there are pets in the home, is your child responsible to help care for them? Can they let the dog out? Will they be allowed to take the dog for a walk? Do they have to remember to feed the pets?
It’s not just your child’s abilities when there are pets involved. Your pet’s temperament makes a difference. Does your pet have a good nature around the kids?
Neighborhood.
Where you live makes a difference. Do you live on a quiet cul-de-sac or a busy street? In a single family home or an apartment building? Do you have a trusted neighbor that your child can call in case of emergency? Is there a neighbor that your child seems to be afraid of? Are there troublemaker kids down the street?
If you don’t know neighbors what can your child do if there is a problem?
Will they go outside?
You’ll have to set ground rules about leaving the house, which will vary depending on the situation.
Is your child allowed to go outside when you’re not home and under what conditions ~ with a group of kids, with your big dog, on foot only or on a bike, daylight/dark, etc?
If they can go outside who do they tell where they are going and when they will return? Are there area limitations of where they can go? Run through scenarios of what to do if someone they don’t know (or feel comfortable with) tries to talk to them.
Do all the kids play outside after school with a stay at home mom supervising? If you will allow your child to go out expecting that the other parent will be there, be sure to talk with that other parent first to be sure it is okay — the parent might not want that responsibility.
Baby Steps.
Gradual increases in time alone are helpful.
Start by doing things in the home where you tell kids you don’t want to be disturbed for 30 minutes unless there’s an emergency. Let them know it is practice for staying home alone to show responsibility. When they do well with that, try going to a neighbor’s house briefly. If they do fine with that short time alone with you in close proximity, take a quick run to the store. Gradually make the time away a bit longer.
Time of day.
Start with trips during daylight hours when they don’t need to make any meals.
Only leave kids alone when dark outside if they are not scared and they know what to do if the power goes out, such as use flashlights, not candles.
Overnight stays alone are generally not recommended except for the very mature older teen. And then you must think about parties or dates visiting…
List of important things.
Make sure kids have a list of important phone numbers. They should have an idea of where you are and when you’ll be back. What should they do if they have a problem? List expectations of what should be done before you get back home.
Are there any no’s?
While it is impossible to list every thing your child should not do when you’re not home, make sure they know ones that are important to you. Having general house rules that are followed are helpful to avoid the “I didn’t know I couldn’t…” Think about how much screen time they can have, internet use, going outside, cooking, etc. Are they allowed to have friends over? Can they go to a friend’s house if their parents are home? What if those parents aren’t home? Some kids might be ready for unsupervised time at these activities, others not.
Emergencies.
Go over specifics of what to do if …
fire
electricity goes out
someone calls the house
a friend wants to come over
they are hungry
there’s a storm outside
they spill food or drink
Quiz them on these type of topics.
Do they know what the tornado alarm sounds like and what to do if it goes off? And do they know the testing times so they aren’t afraid unnecessarily?
Can they do simple first aid in case of injuries? Discuss the types of things they can call you about– if they call several times during a short stay alone, they aren’t ready!
Supervise from afar.
When kids are first home alone, you can call to check in on them frequently. Tell a trusted neighbor that you will be starting to leave your child home alone and ask if it is okay for kids to call them if needed.
Ask how things went while you were gone. Did any problems arise? What can be done to prevent those next time?
Internet.
Internet safety deserves several posts on its own since there are so many risks inherit to kids online.
Be sure you know how to set parental controls if your kids have internet access. Review all devices (computers, smart phones, tablets, etc) for sites visited on a regular basis.
Talk to your kids about what to do if they land on a site that scares them or if someone they don’t know tries to chat or play with them online. Be sure they know to never give personal information (including school name, team name, game location and time, etc) to anyone on line.
If they play games online, remind them to only play with people they know in real life. Do your kids know how to change settings so that the location of photos cannot be tracked through GPS?
home alone.
At some point kids will need to be independent, so work on helping them master skills that they need for life. This includes learning to stay home alone.
We hear about child molestation and rape far too often these days. While we can’t anticipate all the situations our kids will be exposed to throughout their lives, we can teach them how to protect themselves in all situations and if there’s trouble to speak up. Teach them to respect themselves, to respect others, and to never keep secrets. Talk about consent often, starting in the toddler and preschool years!
Start in the toddler years?
What about their innocence?
It’s never too soon to talk about body safety. You don’t need to cover all the specifics at young ages, but there are many age appropriate things to talk about at each stage.
The message and words change over the years as your child grows, but start young!
Teach proper body part names.
We call eyes “eyes.”
An elbow is an elbow.
Why should we call a vagina a “hoo hoo” or a penis a “wee wee”?
If kids ever need to talk about those body parts and the other person doesn’t know the slang, it’s more difficult to get the point across.
Wouldn’t you feel awful if your preschooler tried to tell a teacher that another adult touched her inappropriately, but the teacher thought “hoo hoo” was just a fun term, so didn’t act on the issue?
Teaching kids about private body parts is important. Let them know that their swim suit area is private. No one should be able to look or touch there without permission from Mom or Dad and from the child himself.
Teach respect of personal space.
Many kids love to hug and kiss everyone they see.
Other kids hate to be hugged or kissed.
Sometimes they just don’t feel like it, but other times they’re okay with a big bear hug.
All of these feelings are okay, but we must be mindful of how these interactions are approached and consented.
Ask permission.
Teach your kids to always ask permission before entering someone’s personal space.
They can say something as simple as, “Can I give you a hug and kiss goodbye or should we high-five or blow kisses?”
Encourage kids to demand permission before being touched. You can model this kind of expectation by asking before touching.
~ Can I be a tickle monster and get you?
~ It’s time to wash your back. Should I do it or do you want to do it yourself? Now it’s time to wash your penis, do you want help?
~ Do you want me to rub your back to help you fall to sleep?
Be sure others ask similar questions of your child.
Talk to family members about this when the child isn’t present. You don’t want it to be an ordeal in front of everyone, so a little discussion ahead of time can help the adult understand and follow your expectations.
If adults continue to enforce a hug or kiss, it’s a red flag that they don’t appreciate boundaries. I would not recommend allowing your kids to be alone with them. They might simply be innocently wanting a hug from a cute kid, but they also might be testing to see how the child reacts in preparation for more intimate touches.
Don’t force your kids to be kissed or hugged by anyone, even family members. If they don’t want Grandma or Uncle Buddy to get too close, they shouldn’t be forced to give a hug or kiss.
Think about the message that sends.
They should not have to submit to being touched. Ever.
Teach proper hygiene.
Once kids are potty trained, they can start learning to wash their own genitals. It will take practice before they can do an adequate job, but if you don’t start teaching them, how will they ever know what to do?
If they still need help toileting or bathing, be sure they know that only adults who have permission are allowed to help. This means you must tell them that it’s okay for any specific person to help.
Wipe properly.
Many girls wipe inadequately after urinating. Some rub too hard, which irritates the genitals. They often miss some of the urine and the inner labia stays moist, which leads to redness and pain.
Teach them to wiggle the toilet paper between the skin folds.
Many kids will need help wiping after a bowel movement for many years, but you can show them how to wipe until the toilet paper no longer has streaks on it. Using a flushable wet wipe is often helpful.
At bath time teach them to wash their genitals.
For girls this means using a mild soap and rinsing between all the skin folds with water well. Soap residue can really irritate the sensitive labial skin.
For boys, washing the genitals and between the buttocks is important too. If he is uncircumcised, teach him to gently pull back on the foreskin to rinse the head of the penis. If it does not yet retract, do not force it.
Encourage questions.
As kids get older, they have lots of questions about their body. You want them to ask you or another trusted adult for answers, rather than going to the internet to find answers.
Answer questions as truthfully as you can. Don’t feel like you have to answer more than what’s asked.
Where do babies come from?
Of course when they ask how babies are made, you need to answer it to a level they can understand.
Young kids don’t need to know that a penis goes into the vagina to release sperm and fertilize an egg. They can’t comprehend that.
Think about what they’re asking and answer that question truthfully without going into details they won’t yet understand.
If you’re not ready to answer the question when it’s asked, buy yourself time. Tell them that it’s a great question and you want to think about it. Be sure to give a specific time that you’ll be able to answer the question. Think about it, prepare what you’ll say, and discuss it at the chosen time.
If you’re in an unhealthy relationship, work with a counselor so you both can learn to work together to improve the relationship. If that’s not possible, especially if the relationship isn’t safe, think about how to safely separate. It isn’t easy, but if your kids grow up watching an abusive relationship, they are more likely to end up in the same situation.
Teach kids to ask for help.
It can be really hard for kids to learn when it’s best to work out problems and when to ask for help. No one likes a tattle tale, but there are times kids need help from adults.
When safety’s an issue, an adult should be part of the solution. If a friend is doing something dangerous, such as running into the street, it’s best to tell an adult.
If kids are simply frustrated that another child won’t share a toy or play the game your child wants to play, that is something that kids can at least start working out on their own.
Praise kids when they make smart choices about asking for help when needed and when they solve their own conflicts appropriately.
No means no. Stop means stop.
Teach kids that we always need to respect others when they say no or stop.
For example, if Sissy says to stop tickling her, stop.
When friends or adults don’t listen if they’re told no or stop, kids need to think about if they feel safe and if they still want to be around their friend. If they don’t feel safe, they need to talk to you or another trusted adult.
Books can help talk about these difficult topics. Some suggestions for saying “no” appropriately and “stop” when needed:
For teens, I love this Cup of Tea video. It explains so well that no means no!
No secrets!
Remind kids that they’ll never be in trouble for telling you things. There are never secrets in families. We might keep surprises, but never secrets.
You might need to change your wording at times… If you’re buying or making a gift for someone, it’s a surprise, not a secret. Surprises are fun. We can build up suspense for the fun by not telling. But secrets make us feel bad because we can’t share them.
Remind your kids that if anyone asks them to keep a secret, it’s best to tell their parent.
A great book on this subject is Some Secrets Should Never Be Kept!
Believe kids.
Sometimes it’s hard to believe what our kids tell us. But if we don’t believe them or we discount their stories, they will stop telling us things.
I know that I’ve been challenged to believe many things my kids tell me, but instead of downplaying the story or telling them to stop lying, I try to ask more questions.
Once my daughter told me about an accident the bus had while she was on a field trip. I didn’t believe her (surely the school would have alerted parents) and asked more about what she was saying without outright saying she was lying or telling stories. I asked for more clarification, thinking she’d contradict what she had said, but she kept to the same story. It wasn’t too much later that the school sent out a message that the bus had been in an accident and there were no injuries. I told her that I got the message and she just beamed. She knew I didn’t believe her! But it was an opportunity to let her know that sometimes I might not believe stories initially, but I was proud that she told me and continued to try to show me the truth.
If your kids ever tell you they don’t want to visit or stay with a certain person, find out why. If they say they’re scared, don’t discount it. Even if you trust the person, believe your child. Molesters are adept at grooming families to gain trust. Kids generally don’t make abuse up.
Men and women are different.
When kids are young, teach in general terms about males and females.
You can talk to young kids about why men and women look different than kids. Many will question why men have facial hair, women have breasts, or how a baby will get out of mom’s tummy. They might want to know why you have feminine hygiene products in the bathroom or what they’re for. Answer the questions to their level of understanding.
Talk about puberty before changes happen. Younger kids are more open to learning new things. Once changes start, kids are confused and more self conscious. Puberty starts in girls around 8-12 years of age and in boys about 2 years later. When you notice changes, reassure your kids that it’s normal and they’re just growing up!
For more on menstruation specifically, check out my Q&A about periods.
Some of my favorite books on puberty:
Online activities.
The internet has opened the doors to a lot of knowledge and sharing of information. It can be used to better ourselves, but it can also leave kids open and vulnerable. It can lead to bullying. Sometimes it encourages feelings of inadequacy. Online predators can take advantage of our kids.
This is a huge topic and cannot be covered here, but in short: teach kids to never share anything online that they wouldn’t want the public to see. It is okay for parents to monitor online activities, it’s not threatening their privacy. It’s helping them stay safe.
Think of supervising online activities like supervising learning to drive.
You would never just give the car keys to your teen and expect them to safely drive. You first have them learn the rules of the road and pass a written test to get a learner’s permit. The learner’s permit allows them to drive while being supervised. After many hours of supervised driving, they may get a license that allows them to drive alone, but you probably wouldn’t let them take a long road trip alone yet. They start out with quick trips around town, then onto highways, and finally longer trips. The specific timeline of that depends on the teen. Some need longer times at each stage, others show maturity and responsibility more quickly.
Common Sense Media has a number of helpful articles about online safety.
Our actions impact others.
Kids can learn how their actions affect others and that they can’t alter anyone else’s behavior without first changing their behavior.
While this doesn’t seem initially to impact sexual consent, it does. What happens if we all do what we want when we want, without caring what others think or feel? We take advantage of others and hurt people. We don’t want our kids to grow up without empathy or social conscience. It also helps kids to identify their own feelings in response to other people’s actions, which might help them avoid people who make poor choices.
Talk to kids when you see opportunities to talk about the impact of behaviors. Find examples they can identify with.
For example, if a child was being noisy at the library, what kind of impression did they make? How did the noise affect everyone else’s experience at the library? What situations can they think of that they were noisy when they should have been more quiet? How can we be more mindful of our own noise level?
What can kids do if they see a bully? Is it hard to recognize the significance of bullying when everyone’s laughing at another child? Should they join in the laughter when someone’s being teased? Can they stand up for the person being bullied? When should they talk to an adult?
rewind
A fun game to play that can help kids learn how to change their behavior to get a better outcome I call Rewind. You roll play and rewind a situation and play it out differently. When kids complain about the outcome of an event, have them role play it to try to get to a better ending. The trick is they have to be the first to change what they say or do. In the real world we can’t just expect someone else to change a behavior.
For example, if your son is upset that no one would play hop scotch at recess, he can’t simply expect that someone will join him the next day. Other kids might not realize that he wants to play. Maybe he can ask kids to play with him. Roll play what to say if he’s turned down. Think about why other kids don’t want to play hop scotch. Are they all busy playing basketball? Talk about being open to taking turns: maybe another child will play hop scotch with him if he plays basketball with the other child first. The trick is that he just can’t expect others to change their behaviors unless he changes his first.
Respect
One word that summarizes most of the above is respect.
Respect Yourself
Respect yourself enough to eat right, sleep adequately, and exercise. Take care of your body and mind. Be the best you can be. Don’t do things that you know could harm your body or cause you to get into trouble.
Respect Others
Respect others and their wishes. If you’re kind and respectful towards others, they will appreciate it.
This does not mean that kids have to do everything other people ask them to do. They should never do anything that makes them feel uncomfortable or that they know is wrong. See the last respect point…
Demand that others respect you
Just like you should respect others, they should respect you. If everyone respects other’s thoughts and feelings, we would have no abuse or bullying in our lives.
We can’t change other people’s actions all the time, but we can leave situations where people are not kind and respectful. Kids need to know that they should talk to an adult if someone is not being respectful to them.
We hear about child molestation and rape far too often. Teach kids to respect themselves, respect others, and to never keep secrets.
