The SafeWise Report

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SafeWise Experts: Lois K. Lee on Back to School Safety

SW Expert Lois K Lee

Our SafeWise Guest Expert for August is Dr. Lois K. Lee, MD, MPH, an Attending Physician in the Emergency Medicine Division of Boston Children’s Hospital and Assistant Professor of Pediatrics and Emergency Medicine at Harvard Medical School. Dr. Lee is also an expert with the Injury Free Coalition for Kids, our back-to-school safety partner.

We asked Dr. Lee to educate our readers about the most common accidents and injuries that happen to children at school and during their commute, as well as playground safety, immunization, and how to react if an accident occurs during play. Here’s what she had to say about back-to-school safety:

What are the most serious health, safety, and injury risks that children encounter at school?

The most serious health risks are related to infectious diseases—especially in the winter time with the frequency of upper respiratory infections (i.e. the common cold) and the flu.  Since these infections are often contagious, children should protect themselves by always using good hand hygiene.  If children who attend school do have a cold, they should always cover their cough to try to prevent the spread of infection. Getting the flu vaccine this fall is the best way to prevent getting the flu, and this is particularly important for children with asthma or other respiratory diseases.  But really every child should get the flu vaccine.

Injuries, especially on the playground, can also be encountered at school.  One of the most common injuries we see in elementary school age children are broken arms and less often, legs, often from falling off the monkey bars.  Parents should make sure school playgrounds have adequate ground surfacing to provide the recommended amount of cushion to try to minimize injuries.  We also see minor ankle and finger sprains from playing sports.  Another type of injury that parents are becoming more concerned about are concussions, which can occur with any kind of minor head injury.  Sometimes a concussion is challenging to diagnose immediately after a head injury—the child does not have to have loss of consciousness to be diagnosed with a concussion—but follow up the pediatrician is important if a child with a minor head injury has continued symptoms like headaches, dizziness, and difficulty concentrating in school, after the injury.

Children walking and biking to school are also at risk for injuries, including being hit by a car.  Walking children should stay on sidewalks and used marked cross walks.  Biking children should ALWAYS wear their helmet, follow the rules of the road, walk their bikes (and not ride them) when crossing a street, and should also use marked cross walks.

Children driven to school should use the appropriate car safety seat, booster seat, or seat belt—depending on the age of the child—with every ride in the car.   Sometimes if the ride from home to school is short, the child, or parent, may not always feel the need to ride with the appropriate restraint, but these should be used every time, with every ride in the car.  Even low-speed motor vehicle crashes can cause injuries if the child is not appropriate restrained while riding in the car.

How important is immunization for school-age children?

Immunization is extremely important for two reasons: 1) it protects the child from infectious diseases and 2) it protects the general pediatric population and the larger community in which they live from these diseases.  Having a large number of children in the population immunized results in “herd immunity,” which can prevent an infectious disease from entering into a community.  This in turn protects the larger community who then won’t be exposed to these diseases.

The recent measles outbreaks are an example of inadequate herd immunity where a sample of the children in the population were not immunized against measles, which allowed this disease to spread into the larger community and then across the U.S.

Some disease, like pertussis (also known as “whooping cough”) can cause serious morbidity and even death in infants.  Therefore, herd immunity from having a large number of children immunized prevents pertussis from being present in the general community, decreasing the risk that infants might potentially be exposed to this infection.

Are there things parents can do if they see something unsafe on the playground where their child goes to school?

They should definitely let their school administrators know if there is broken equipment or inadequate ground surfacing.  Playgrounds are a common location for injuries occurring at school—especially with falls from the monkey bars.  Head injuries can also occur from falls from playground equipment.

You can find some specific guidelines for parents here and here.

What can parents do to help their kids know how to help when a classmate is injured?

If a child is at school, the best thing for he/she to do is to find a teacher or another school staff member. Other ways their kids can be helpful is to remain calm and not to try to move the injured classmate, in case they have a painful arm or leg injury or in case the classmate has injured the neck.

What are the risks of allowing children to walk to school on their own?

The greatest risk in allowing children to walk to school on their own is related to their ability to cross the street safely to avoid being hit by a car or bicyclist.  Parents should accompany and supervise their children walking to school until they feel confident the children have the skills to navigate the roads safely on their own.  According to the National Center for Safe Routes to School, the best age is 10 years old. There is also a risk for children to get lost or distracted along the way to and from school, so again, parental supervision until the appropriate developmental age for the child to walk independently is important.

For parents who allow their children to walk to school, how can they educate their children to stay safe?

At the beginning of the school year they can accompany the child to school to ensure the child knows the safest route to school and to model safe behavior, especially when crossing the street.  For children who have mobile devices, parents should emphasize that children should minimize distractions—ideally not looking down while using their device when walking–especially when crossing the road.  Although this may become more and more of a challenge for parents to try to educate their children about as these devices are becoming more prevalent at younger ages.

Do you have any tips for staying safe on the school bus?

If the school bus has safety belts—the safest thing is to always wear the safety belt.  Kids may not feel like the school bus is a motor vehicle, because it feels and looks so much different than the cars and minivans they ride with their family and friends.  Emphasizing from an early age that the same safety rules apply to buses as to the family vehicle, can go a long way to ensuring children wear safety belts while on the bus.

Anything else to add about back to school safety?

Parents know their children best, so they should supervise and guide their children appropriately, based on their developmental level and personality.  Knowing the potential risks of infectious diseases and injuries and being observant about the areas immediately around the school, including the neighborhoods and crosswalks, and at the school, including the playground, is the best guide for parents to know how to keep their children safe this upcoming school year.

For more valuable information of keeping your bundle of joy safe and sound this school year, visit the Injury Free Coalition for Kids, where you’ll find safety checklists and other resources, as well as the location of the Injury Free Site nearest to you.

Clair Jones

Find out more about Clair, here.

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