One sun-lit evening last September, my eight-year-old daughter was romping about the lawn with her classmates after school. I remember musing that it would be lovely to keep her outside like this every evening: playing with friends, at a safe distance from the pull of her iPad.
Then she came barreling into my lap, howling, bright red blood running down her lips. Her friends explained that they had all been spinning around while holding onto a hula hoop and then someone slipped, causing a sudden pile-up, during which my daughter had gotten kicked in the mouth.
I felt regret sink in my chest. I should’ve been supervising more actively and put a stop to this game before they crashed. After rinsing off her mouth and examining the damage, I was confident that the wound wasn’t bleeding so much that we needed to go to urgent care for stitches.
I brought her home, handed her an ice pack (and probably her iPad, too), and made an appointment for the dentist to examine her injured gums.
At the dentist’s office the next day, I was called into the exam room almost immediately. The X-ray revealed the little black dagger of a fracture in her front tooth. “An adult tooth,” the dentist winced. “You hate to see it.”
I described how the accident had occurred, reliving my own failure to prevent it. The dentist mentioned that she had seen similar injuries when kids knocked their teeth against the monkey bars at the playground.
“Monkey bars?” I thought. Now I was supposed to keep her away from the monkey bars? Should I just shut her in her bedroom with her iPad all day, then?
It wasn’t the first time that I felt pulled in opposite directions trying to keep my kids safe and healthy. If play and playground equipment are dangerous, but being sedentary and focusing on screens are bad too, what exactly is she supposed to be doing between the time school ends and the time she goes to bed?
The reality is that raising children involves constantly calculating risks versus benefits.
“We live in a world where we’re trying to limit screen time and promote interacting with other children on the playground or on the field,” Dr Christopher Kelly, vice chief of the department of emergency medicine at New York-Presbyterian Brooklyn Methodist Hospital, told HuffPost.
“I think many of my paediatric emergency room colleagues would agree that we don’t want to prohibit or prevent most forms of physical activity but rather, want to educate both children and caretakers on ways to safely enjoy physical activity.”
That said, doctors do see patterns in what’s bringing kids into the emergency room with injuries. Here are a few activities you might want to limit, avoid or supervise with extra caution.
“Typically, what I see as the biggest culprit for playground injuries is the monkey bars,” Dr Kelly said. “Kids of all ages, swinging back and forth, has a propensity for forceful falls.”
Kids can work up force swinging from the bars and then fall hard onto an outstretched hand.
“The monkey bars are notorious for causing supracondylar fractures, a fracture to the elbow which often requires reduction and pinning in the operating room by an orthopaedic surgeon,” explained Dr Kelly. It’s worth noting that, though complicated, this injury is not life-threatening.
You teach your kids not to touch the stove or metal pans in the kitchen, but with temperatures rising, metal surfaces and even rubber can grow hot enough to cause burns on a summer day.
“Potential playground injuries can be from the surfaces themselves, including metal slides and rubber mats, which even if padded, can get to extreme temperatures in the summer heat causing burns to young children who are either barefoot or who fall onto the surface,” Dr Kelly said, adding that these incidents can result in first or second degree burns.
Electric scooters are everywhere these days, but the faster you’re going, the greater the potential for injury in case of a crash.
“We have seen an increase in injuries related to motorised and non-motorised scooters, which can be kept to a minimum if the appropriate protective equipment is worn, including helmets and padding,” he said.
Whatever kind of wheels your kid is using, “wearing a helmet can help avoid an ED visit,” said Dr Dan Park, medical director of the paediatric emergency department and professor at the UNC school of medicine.
One of the gravest summer dangers to kids is any body of water. Drowning takes the lives of about 4,000 Americans per year, and is the leading cause of death for children ages one to four.
“Kids should never, ever, be left alone near water, even only a few inches deep, even only for a few minutes,” Dr Kelly said.
Trampolines are notorious for being involved in injuries. “Being thrown very high into the air, at very high speeds, and often at awkward angles,” Dr Park explained, can lead to “musculoskeletal injuries like fractures to the elbows and legs”.
Park has come to a compromise on these when it comes to his own kids.
“I’ll let them jump on them, but I won’t own one. In fact, a few years ago, one of our neighbours’ kids aged out of their trampoline and they offered to walk it up to our house and even set it up for us, and I still wouldn’t say yes. My kids were not happy with me.”
All-Terrain Vehicles (ATVs)
Park said that these are a firm no for his kids, given the injuries he’s seen as a paediatric emergency room physician over the last 10 years.
While kid-sized ATVs are available in youth models, the American Academy of Paediatrics recommends against their use by kids under age 16. This risk is multiplied when riders do not wear a helmet.
“In North Carolina, we see a lot of children with significant trauma from ATV accidents. The worst are the ones where they have not been wearing a helmet. In those scenarios, the head injuries can be significant and even life-threatening,” Dr Park said.
More than 3,000 children under 16 were killed in ATV crashes between 1985-2015. Another million went to the ER with injuries.
What about concussions?
While concussions in collegiate and professional athletes are often mentioned on the news, Dr Kelly doesn’t think the risk to kids playing sports is particularly significant.
“There are the occasional mild head injuries/concussions which occur more often with some of our contact sports, but probably no more so than the toddler who falls over and hits their head – almost all of whom go home after some observation,” he said.
While many injuries happen quickly, even when parents are present, careful supervision – by someone who isn’t drinking – does prevent some accidents.
“Parents can inspect the area where their child is playing and make sure they are doing activities that are within their capabilities (i.e., not having a toddler ascend a tall slide without someone following right behind them) and as they get older and get into activities with inherent risks, ensuring they are using the proper protective equipment,” said Dr Kelly.
Dr Park said his philosophy is “control what you can control. You can control locking up harmful chemicals and substances in your house. You can control your messaging about wearing a helmet.” He mentioned button batteries as another thing to lock up if you have any at home.
While I wish I’d been able to prevent my daughter’s broken tooth, Dr Kelly validated my instinct to keep my kids outside and offline.
“From my observation over the past 18 years in the paediatric emergency room, the most significant risk to a child’s welfare isn’t on a playground, or on the athletic field – it is on social media.”
Since the pandemic, ERs have seen “a heartbreaking surge in children who feel isolated, depressed and even suicidal,” Dr Kelly added. Any activity that gets kids moving or interacting with each other can help counter this.
“Whether sharing a sandbox or a basketball court, human interactions help prepare kids for life ... In the correct setting, with the appropriate equipment and supervision, there are very few routine childhood activities that I think we should avoid.”