Research
A research team from Nationwide Children’s Hospital in Columbus, Ohio sought to quantify the extent of injuries related to bottles, sippy cups, and pacifiers in order to “educate parents, other caregivers, and health professionals about [such] injuries; help improve product design; highlight existing recommendations; and ultimately prevent [such] injuries.”

Dr. Sarah A. Keim and her team obtained data from the National Electronic Injury Surveillance System (NEISS) of the Consumer Product Safety Commission (CPSC) for patients who were treated in hospital emergency rooms between January 1, 1991 and December 31, 2010. They looked particularly at cases related to use of baby bottles, sippy cups, and pacifiers; they excluded cases in which oral use of the device was not the mechanism of injury (e.g., a child got a splinter when reaching for a pacifier, or a child was injured when a sibling threw a bottle). They also excluded fatalities (e.g., due to aspiration of the liquid, or strangulation by a rope on a pacifier).

The researchers looked at the children’s age, which body part was injured, what type of injury occurred, and outcome (e.g., hospitalization or discharge). Mechanism of injury was classified as “fall” or “other,” which included product malfunctions and burns, such as from a heated liquid in a child’s bottle.

Results
Dr. Keim and colleagues estimated that 45,398 infants and toddlers were treated in emergency rooms for injuries related to the use of sippy cups, bottles, and pacifiers. About two-thirds of these injuries (66.4 percent) occurred in 1 year olds. More injuries occurred in boys (61.2 percent) than girls.

Most injuries involved bottles (65.8 percent), but almost one in five involved pacifiers. Sippy cups were involved in 14.3 percent of injuries overall; predictably, sippy cups were seen more with injuries among 2 year olds than 1 year olds.

The mouth was the site of most injuries (71.0 percent) followed by the head, neck, or face (19.6 percent). Lacerations were the most common injury (70.4 percent), while pacifiers were associated with injuries to the soft tissue and teeth.

Since the researchers relied on emergency room data only, their estimates provide a limited look at injuries related to these products. This study did not include injuries that were treated at home, in child care settings, or in doctor’s offices.

Recommendations
Knowing that injuries due to falls while using bottles, pacifiers, and sippy cups are preventable, here are some tips for keeping your child injury-free:

• Give these products to your child only during their recommended ages. For example, the American Academy of Pediatrics (AAP) recommends that parents wean their babies from the pacifier by 1 year of age.
• Use bottles, pacifiers, and sippy cups with your child only when they’re not mobile. For example, use the pacifier only when your infant is sleeping or napping, in accordance with the AAP’s SIDS prevention guidelines. Hold your child in your arms or settle him in a high chair when you give him a bottle.
• Transition your child to an open cup between 12 and 18 months of age, as the AAP recommends.
• Stay aware of product recalls. A small number of instances in this study were related to product failure, such as pacifiers coming apart. The CPSC has recalled more than 16 million pacifiers since 1991 and more than 1 million sippy cups due to safety concerns.

Last but not least, keep your toddler safe by adopting the “don’t drink and walk” rule.

Albow is not alone in his criticism. TODAY Moms invited comments on the cover photo from its readers by posing the question, “We know you have opinions about the cover. Sure, it got everyone’s attention, but does it ultimately hurt or help the perception of breast-feeding?” Most of the 3,126 comments were critical of the cover: “I have cancelled my subscription.” “An infant OK, a kid that age NO.” “I consider this picture child abuse.” Sadly, I had to dig deep to find a positive comment: “This is a good thing, and the more mothers do it the better.”

Calculated or misguided?
“It’s [extended breastfeeding] not socially normal. The more people see it, the more it’ll become normal in our culture. That’s what I’m hoping. I want people to see it,” Grumet tells Kate Pickert, author of The Man Who Remade Motherhood, the TIME magazine article marking the 20^th anniversary of attachment parenting.

Whether TIME’s choice of cover photo was calculated or misguided, it’s clear that Grumet’s photo (along with the photos inside the magazine) has reignited the Attachment Parenting debate (a parenting approach largely characterized by babywearing, co-sleeping, and child-led weaning). Lost in the debate, however, is the fact that attachment parenting is more than the sum of its parts. It is a parenting method designed to make children confident and compassionate by responding to their needs, nurturing strong physical and emotional connections, and modeling appropriate social behavior.

Sound familiar? It should. Because it’s a parenting method that every parent embraces—keep your child warm, well nourished, and safe; stimulate their senses; calm their fears; and behave in a way that says to your child, “Do as I say and as I do.”

Is the cover photo good for breastfeeding?
“Time” will tell whether negative media is better than no media. However, when only 1 in 10 U.S. babies breastfeed exclusively for six months perhaps it’s time to tone down the rhetoric and stop arguing about the small number of mothers who breastfeed three, four, or more years, and focus instead on the many mothers who try to breastfeed but can’t. Perhaps it’s time to acknowledge that how long a mother breastfeeds—six days, six weeks, six months, six years, or not at all—was never meant to be a measure of motherhood.

So you might think.

But formula companies these days are up against a formidable alternative: breastfeeding. The benefits of breastfeeding for mothers and babies—and, along with that, the high cost of not breastfeeding—are widely recognized.

What’s more Nestlé, Gerber’s parent company since 2007, has been charged with marketing strategies designed to undercut breastfeeding at the expense of infant health. Positioning itself as the breastfeeding moms’ best friend is an attempt to overcome its troubled past. Thus, the company has rebranded its “Nestlé Good Start” label with the smiling Gerber baby, developed a series of videos about “how to nourish Generation Healthy through the milestones,” (more about that in a minute) and launched its new feel-good marketing campaign.

But there’s nothing to feel good about with this advertisement. Beyond the adorable baby and the mother’s gentle touch, this ad has nothing to offer the breastfeeding mothers who are its intended audience. “You want your baby to have your imagination, your smile, your eyes … not your allergies,” it declares. After acknowledging that “breastfeeding is the best way to naturally protect your baby” from this danger, it gets to the heart of its message: “If you do introduce formula, choose the Gerber Good Start Comfort Proteins advantage.” Such statements are well-recognized as “booby traps” to breastfeeding.

According to the ad, this formula is “inspired by breast milk” and produced by a company that is “nourishing” what it calls “Generation Healthy.” But what it isn’t—and cannot be—is a replacement for breastfeeding.

And while the final screen promises “expert feeding advice 24/7,” it seems best to remember that this company has at its heart one goal: selling formula, and, after that, a line of complementary foods.

Simply put, breastfeeding promotion is not the job of a company whose products compete with breast milk. Nor should it be. The company’s marketing bias cannot help but affect its advice.

Take, for example, Gerber’s video series, mentioned above. The first video promises to cover “all about breastfeeding,” a tall order indeed for just over 10 minutes of screen-time. The advice here is generally sound, given by a self-described breastfeeding mother named Francesca as she guides her friend through using several breastfeeding positions with her newborn. However, while Francesca notes that the American Academy of Pediatrics recommends mothers breastfeed for at least a year or as long as the mother and baby want, she ignores the group’s call for exclusive breastfeeding for the first six months.

The second video tackles pumping and storing milk, perplexingly recommending that mothers stop pumping when their breasts are “somewhat emptied,” rather than fully emptied. The third video turns to bottle-feeding and bottle care and by this video, Francesca is no longer said to be breastfeeding. The fourth is about “choosing a formula for your baby,” which Francesca explains she did when she decided to supplement her breast milk. The “milestones” the series is designed to address, then, are a short period of breastfeeding followed by supplemented feeding (or, the company’s narrator points out, exclusive formula-feeding), and then the introduction of complementary foods. The implicit message? We’re here for you when you give up breastfeeding—which you will.

We recognize that some women choose never to breastfeed and that only 1 in 10 U.S. mothers breastfeed exclusively for six months. But it is disingenuous, at best, for formula companies to promote breastfeeding, knowing that they profit only when mothers choose not to breastfeed.

While Gerber might promise that its “experts are here to help,” breastfeeding mothers are best advised to get their help elsewhere. Talk with your health care provider or a lactation consultant about the breastfeeding resources in your area. La Leche League has trained leaders available to answer questions in many areas, and breastfeeding counselors from the newly-minted Breastfeeding USA may be able to help with breastfeeding questions and concerns.

When it comes to breastfeeding, don’t look to Gerber for a “good start.”

Yes, that’s right: bike to school. May 9, 2012 is the first-ever Bike to School Day, scheduled in conjunction with National Bike Month. The event is organized by the National Center for Safe Routes to School, a group dedicated to “connecting the trip to school with safety, health, community, and choice.”

For 15 years, Safe Routes has coordinated a Walk to School Day each autumn; in 2011, the event involved 3,700 schools and “hundreds of thousands” of schoolchildren. Participation for this year’s bike event is small by comparison, but a total of 700 events in 49 states is still robust for an inaugural event.

Why participate?
The purpose of the event is threefold:

• to enhance children’s health by increasing physical activity
• to improve air quality and the environment by reducing automotive pollution
• to create safer routes for walking and bicycling

Participants are invited to register their event, map their route, and download materials on the event website.

Bike safely
Although bicycle riding is recommended by the Let’s Move initiative, many children don’t ride their bikes regularly. The National Wildlife Federation maintains a searchable database of trails that may be useful to parents planning family bike outings designed to help children develop biking skills. After all, according to one Boston initiative to bring bicycles to low-income children, two of the leading barriers to biking to school are not feeling comfortable on a bike in traffic and not understanding how to properly operate a bike.

If your children bike to school, you’ll want to keep some safety tips in mind:

• Use a proper fitting helmet. In the event of a crash, bike helmets can reduce the risk of head and brain injury by as much as 85–88 percent. Make sure your child’s helmet fits and that she knows how to put it on correctly. Teach your child the Eyes, Ears, and Mouth Test: (1) Eyes: With the helmet on their head, your child should be able to look up and see the bottom rim of the helmet; it should be one to two finger-widths above the eyebrows, (2) Ears: The straps must form a snug but comfortable “V” under your child’s ear when buckled, (3) Mouth: Have your child open her mouth as wide as she can. The helmet should “hug” her head, and the buckle should be flat against her skin.
• Use a proper fitting bike. An oversized bike is especially dangerous, since your child may not have the coordination needed to keep it under control. Sitting on the seat of her bike, your child should be able to put both of her hands on the handlebars and both of her feet on the ground. Bikes with footbrakes ensure better control for younger bike riders.
• Stay on sidewalks and bike paths. Safe Kids USA recommends that children should bike only on sidewalks and bike paths until they are 10 years of age and understand the rules of the road, including hand signals, riding on the right side of the road (with traffic), and interpreting and following traffic signals.
• Plan the safest route. Choose a route with the fewest street crossings, and whenever possible, plan crossings at intersections with crossing guards. Tell your children to obey all traffic signals, signs, and authorities.
• Supervise your child. Until you know your child is a skilled bicyclist, you should not let her ride to school on her own. Even older children who ride their bikes to school should use the “buddy system,” and ride with a friend.
• Don’t bike in the dark, or in low-visibility conditions. Equip your child’s bike with reflectors and have her wear light-colored clothes and accessories to improve her visibility to motorists.

For more tips about bike safety, check out Safe Kids USA or the American Academy of Pediatrics. Also see our school safety tips here on baby gooroo.

And remember: If you like Bike to School Day, you just might love National Bike to Work Week. That event kicks off Monday, May 14, 2012.

Still, in spite of the distress immunizations cause for children, parents, and health care providers, they’re widely accepted as a necessary part of preventive care. A recent study suggests that although childhood shots may be unavoidable, the pain they cause may be reduced by applying a set of strategies known collectively as “the 5 S’s”.

“Happiest babies” know 5 S’s
“The happiest baby on the block” is what Dr. Harvey Karp promises you’ll have if you apply his “5 S” approach to baby-calming, which has become the basis for a complete line of books, videos, and training products (and even a “happiest toddler” spin-off).

This strategy involves five steps—swaddling, side/stomach position, shushing, swinging, and sucking—delivered in a prescribed order. The steps must be delivered just so, according to Dr. Karp’s website, which asserts that the steps trigger a “calming reflex” and that while “centuries” of parents “have tried these methods,” they have “fail[ed] because … the calming reflex only works when it is triggered in exactly the right way.” [emphasis Karp’s]

The literature on Karp’s approach is sparse, and one recent study found the video training to be ineffective in reducing infant crying. Still, the program continues to draw attention for its baby-calming potential.

Could vaccinated babies be “happiest babies”?
For the purposes of this research study, a team led by pediatrician Dr. John Harrington of the Eastern Virginia University Medical School sought to assess the “analgesic, pain-relieving effectiveness of using [the 5 S’s] … during routine immunizations given to infants at 2 and 4 months of age.”

The researchers tested Karp’s strategies both alone and in combination with a small amount of sucrose (sugar water), which is itself widely recognized for its pain-relieving properties and recommended by an international committee of pediatricians.

Study participants included 230 infants during their 2- or 4-month well-child visit. None had received acetaminophen or ibuprofen within four hours of receiving their immunization. Participants were predominantly urban, Medicaid-enrolled, and African American. Nearly three-quarters were 2 months old at the time of the survey. All injections were given with the infants lying on the examination table.

Infants were randomized into one of four groups:

1. Group 1 (water only) received 2 ml of water two minutes before immunization. (Water has no analgesic quality, but was administered so that study participants and researchers would not be biased by knowledge of whether or not the child received sucrose.) Parents were able to comfort the babies in this group immediately after immunization.
2. Group 2 (sucrose only) received 2 ml of sucrose two minutes before immunization. Parents were able to comfort the babies in this group immediately after immunization.
3. Group 3 (S’s only) received 2 ml of water two minutes before immunization. A study researcher initiated Karp’s strategies immediately after immunization.
4. Group 4 (sucrose and S’s) received 2 ml of sucrose two minutes before immunization. A study researcher initiated Karp’s strategies immediately after immunization.

The researchers responsible for administering the 5 S’s learned the approach by watching a video, and practiced swaddling until they could wrap a baby in 15 seconds or less.

Those in groups 3 or 4, who were to be calmed by the researcher, were immediately swaddled. They were held in the side/stomach position with shushing and swinging/swaying, and offered a pacifier (for “sucking”) at 30 seconds. Many babies refused pacifiers, some because their parents had chosen not to use them (you can read more on the pacifier controversy here), but researchers were required to use at least four of the five S’s.

Assessing infant response
Babies’ responses were assessed using a pain scale that assigned numeric scores to three types of behaviors: verbal (no cry, whimpering/complaining, pain crying, screaming/high-pitched cry), facial (neutral/smiling, frowning/grimacing, clenched jaw/mouth, full cry expression), and body movement (calm/relaxed, restless/fidgeting, moderate agitation or mobility, thrashing/flailing or voluntary immobility). Babies’ behavior was scored every 15 seconds for the first two minutes, and then every 30 seconds until five minutes post-vaccination.

Four of the five S’s were completed by researchers for all of the intervention (groups 3 and 4) babies. No data were collected on comfort strategies employed by parents in the non-intervention (groups 1 and 2) babies.

Study findings
Not surprisingly, Harrington and colleagues found that the mean pain score was highest for the water-only group. The scores of the sucrose-only group were also higher than those of the “5 S” groups. The lowest mean pain scores were reported for the group that received both sucrose and the “5 S” strategies.

The researchers write that “the 5 S’s appear to be a viable option for clinics to implement when providing analgesia.” However, this study should be read with caution for several reasons:

1. Parent behavior is unknown. Researchers did not track the calming behaviors used by the parents in the non-intervention groups. It is probable that some parents incorporated some of the studied behaviors (swaying, shushing, swinging) with their babies.
2. Baby calming may have been a function of “who” rather than “what.” Some research suggests—as surprising as it may be—parents may be the least effective “calmers” of their children during vaccinations, since they tend to focus on reassurance rather than distraction.
3. Assessment included “body movement” even though swaddled babies—those in the intervention, 5 S groups—are hardly capable of free movement. As a result, the researchers may have overestimated pain response in unswaddled babies. Other research on infant pain has measured factors such as heart rate variability and salivary cortisol levels, in addition to crying time and behavior.
4. The 5 S approach seems counter to other, well-researched calming methods, such as breastfeeding, kangaroo care, facilitated tucking, and pressure at the injection site.
5. The infants in this study were all laid down on the exam table for their injections, a position which may unnecessarily heighten their anxiety before the first jab occurs.
6. The 5 S process is time-consuming. The researchers note that topical anesthetics are “generally not used in a busy practice” because of expense and time, making the 5 S approach especially untenable in light of the researchers’ observation that the approach was more difficult to implement with the “bigger and heavier” 4-month-olds.

Ultimately, Harrington and colleagues call for further research on this approach, and this seems warranted. Research into use of the 5 S’s during vaccination by parents themselves would be helpful, since this strategy may be both unnatural to many parents and difficult for them to implement during the stress of vaccination. Given the small number of 4-month-olds included in this study, research into use of this approach with older infants also would be appropriate.

Tips for relieving vaccination pain
In light of this research, what can parents do to alleviate their babies’ distress during vaccinations?

• Breastfeed! Harrington and colleague note that research shows breastfeeding combines several analgesic effects “(a comforting person [mother], skin-to-skin contact, diversion of attention, and the sweetness of lactose)” as effective for procedural pain. They do not recommend the “5 S” approach when breastfeeding is an option.
• Distract and stimulate! It’s possible that Karp’s “5 S” approach appears to work because it fully consumes the baby’s attention. Parents can do that without following a step-by-step routine.
• Hang tight! Immunizations are an annoyance, but they’re an important part of building a child’s immune system and reducing their risk of contracting a vaccine-preventable disease. If you have any concerns, talk to your child’s pediatrician; otherwise, rest assured—you’ll get through this.

Above all, trust your instincts. Vaccinations can be difficult for babies and parents alike, but by responding to your baby with support and distraction—with or without a 5 S instructional—you’ll likely succeed in calming both your baby and yourself.

Is it time, as Time magazine asks, to “bring back the binky?”

A surprising finding
The study that’s getting so much attention was conducted recently at Doernbecher Children’s Hospital of Oregon Health & Sciences University (OHSU). It has not been published in a peer-reviewed journal yet, but was presented at the 2012 Pediatric Academic Societies conference. (Please note that since it hasn’t been published, our sources of information are limited to the abstract, a summary by the American Academy of Pediatrics (AAP), OHSU’s press release, and media accounts.)

Unfortunately, this means we can’t know the researcher’s methodology, inclusion or exclusion criteria, and other pertinent details.

In December 2010, the OHSU Mother-Baby Unit halted the routine distribution of pacifiers to breastfeeding newborns. Pacifiers were instead kept in a locked supply management system that required the health care provider to type in a code, the patient’s name, and a reason for checking out a pacifier. Pacifiers were allowed in special circumstances, such as in conjunction with a painful procedure. In addition, parents were able to bring pacifiers from home, and these were not tracked.

Dr. Carrie Phillipi, associate professor of pediatrics at OHSU and resident pediatrician Laura Kair analyzed data on feeding of 2,249 infants. They determined that when pacifiers were still being distributed (July 2010–November 2010), about 79 percent of infants were breastfed exclusively during their hospital stay, but once the locked-pacifier policy was initiated, over the subsequent eight-month period (January 2011–August 2011), the percentage of breastfeeding infants decreased significantly to 68 percent. At the same time, the proportion of breastfed infants who received supplemental formula increased from 18 percent to 28 percent. The percentage of infants fed formula-only remained statistically unchanged.

Dr. Phillipi explained to The Oregonian’s Kathy Hinson that she and Dr. Kair “had sort of taken it on faith … that (avoiding pacifier use) would increase breastfeeding rates.” According to MSNBC, Dr. Kair notes that their expectation was in line with “the common belief among medical providers and the general public that pacifier use negatively impacts breastfeeding,” but instead they “found limiting pacifier use in the Mother-Baby Unit was associated with decreased exclusive [breastfeeding] and increased supplemental formula feeds.”

The researchers suggest that the seeming relationship between pacifier availability and breastfeeding should be viewed “as an interesting observation.” Dr. Kair explains that they “do not claim a cause and effect relationship,” but publicize this data “to stimulate dialogue and scientific inquiry into the relationship between pacifiers and breastfeeding.”

“Our overall goal,” she continues, “is to increase breastfeeding rates.”

Study raises questions
While the study raises some interesting questions about the researcher’s unexpected finding, it must be considered with caution in light of several facts:

• There’s a lot we don’t know about the research. As noted above, we don’t know the methodology, or the inclusion or exclusion criteria for this study. We also don’t know what process the hospital undertook in launching its “pacifier lockdown” initiative or staff response/compliance.
• There’s a lot we don’t know about the hospital environment. Dr. Kair has observed that this was an initial step in the hospital’s pursuit of Baby-Friendly status: “As our hospital is trying to get Baby-Friendly status, we anticipated that removing pacifiers would improve exclusive breastfeeding,” says Kair in an interview with the TODAY show. “Pacifiers were a low-hanging fruit, removing them was an easy thing to do.” Some previous research suggests that the steps of the Baby-Friendly Hospital initiative don’t work in isolation but rather in concert. For example, one study of maternity-care practices found that more of the practices led to better improvements in rates of breastfeeding assessed at six weeks. Another recent study of baby-friendly practices in a Hong Kong hospital found that mothers who experienced just one or fewer baby-friendly practices were almost three times more likely to discontinue breastfeeding by eight weeks postpartum.
• It’s unclear whether the hospital engaged in any parent education. Parental use of pacifiers as “hushers” to calm a crying baby, as the World Health Organization (WHO) explains, may inadvertently be used as a substitute for a feeding. This may lead infants who use them regularly to have fewer daily breastfeeds. Thus any effort to support breastfeeding ought to involve some education with regard to normal newborn behavior (including the meaning of different cries), infant feeding cues, and the need to put the baby to the breast as soon as possible in the first days postpartum to build the mother’s milk supply.
• Analysis is limited to the hospital stay. It seems the researchers looked only at infant feeding data in the hospital. A more complete analysis might follow the mother-baby dyads into the postpartum period, assessing breastfeeding behavior at a number of weeks or months.
• Analysis doesn’t address “why.” In November 2011, the AAP revised and reissued its SIDS policy statement, a primary component of which is a call for parents to give their babies pacifiers during sleep. This event was widely covered by the popular media, but it’s possible that the timing of this event—alone or in combination with other social messages in the community—influenced parents’ choices.
• It’s an observational study and cannot prove causality. As Dr. Phillipi has noted, no conclusions can be reached as to which came first: pacifier use leading to decreased breastfeeding, or decreased breastfeeding leading to increased pacifier use.
• It doesn’t account for parents who brought pacifiers in themselves, either before or after the lock-down policy was instituted.

Pacifier role still unclear
As explained elsewhere on baby gooroo, WHO and UNICEF recommend parents skip pacifiers since they may make it harder for parents to respond to their babies’ feeding cues, leading to a reduced milk supply and early cessation of breastfeeding. Meanwhile, the AAP continues to recommend pacifier use, on a restricted basis (e.g., when the baby is going to sleep), to reduce the risk of SIDS.

When it comes right down to it, each parent will need to weigh the risks and benefits of pacifier use and make a decision that feels right for their family. Breastfeeding mothers should remember that their baby’s sucking instincts are the “demand” that affects their milk “supply.” Some tips:

• Be attuned to your baby’s cues. Rather than reaching for the “husher” when your baby cries, recognize that this is one way your baby is trying to communicate with you. If she’s hungry—or if she just wants the comfort breastfeeding can provide—consider offering the breast before you offer a pacifier.
• Limit pacifier time to when your baby sleeps. In accord with the AAP’s recommendation, put your baby to bed with a pacifier to reduce the risk of SIDS, but don’t replace it if it falls out of your baby’s mouth.
• If you choose to give your baby a pacifier, take care of it. Check it often for cracks and tears. Clean it regularly and replace it as needed.
• Delay pacifier use until four to six weeks postpartum. Breastfeeding—and your milk supply—should be well-established by 4-6 weeks and use of a pacifier at that time should not interfere with your baby’s ability to breastfeed.

While many parents steer their toddlers and preschoolers away from the dangers of active equipment intended for older children (such as monkey bars), they often adopt a more hands-on approach to playground slides, placing their child on their lap to ride down together. This way, many parents reason, their child won’t topple from the top of the slide. Safe from the risk of falling, the child—and parent—can be free to enjoy the thrill of the swooping ride to the ground. Or so the reasoning goes.

Unfortunately, the ride doesn’t always end with a laugh. As explained in a recent New York Times article, when toddlers go down slides on their caregivers’ laps, falls don’t happen, but broken legs sometimes do.

Injury data not collected
Data on playground injuries are scarce, but the Centers for Disease Control and Prevention (CDC) estimates that more than 200,000 children 14 years and younger visit the emergency room annually as a result of playground-related injuries.

A 2009 study of tibia fractures among children ages 17 years and younger seen during an 11-month period at an emergency room or doctor’s office in New York state found that 14 percent involved children younger than 3 years old, and that all of the studied injuries resulted from riding down a slide on a caregiver’s lap.

Parents unaware of risk
The physician who conducted that study, Dr. John Gaffney, reports that he has treated three such fractures within the past month for children sliding in the lap of a grandparent, a parent, and a babysitter. Such cases are common “as soon as the weather gets warm,” Gaffney observes in the New York Times article, because parents think they are “doing something good” for their child by “having them sit on [a] lap.”

If parents are aware of the risks, the injury is “entirely preventable,” says Dr. Edward Holt, the orthopedic surgeon at Maryland’s Anne Arundel Medical Center. In the New York Times article, he explains injury typically occurs when the child’s shoe catches on the side of the playground slide. When a child is sliding down on his own, the friction will slow or stop his progress, allowing him to lift his limb or twist his foot free before continuing down the slide. But when he is on the lap of a caregiver, the friction is not enough to overcome the downward force of their combined body weight. The limb is twisted and the leg bone broken as the pair continues down the slide.

The fracture may not be obvious right away, but the child will complain of pain and may be unable to put weight on the leg. Treatment is a cast from the foot to above the knee for 4–6 weeks.

In an effort to raise awareness, Dr. Holt developed a two-minute YouTube video on the problem and its prevention. To date, the video has over 60,000 views. He also designed a poster for use in doctor’s offices.

As summer approaches and families spend even more time at their neighborhood playgrounds, there remains a widespread need for heightened awareness of this particular playground risk.

What parents can do
Although playground injuries will never be eliminated, parents of young children can reduce the risk of injury while still enabling their children to have fun at the playground. Here are a few tips for keeping toddlers and preschoolers safe on slides:

• Supervise young children. There’s a backlash against “helicopter parents” in the popular media, but parents of young children need to be ever-present, especially on the playground. According to the American Academy of Orthopaedic Surgery (AAOS), “close supervision by a responsible adult may be the most important factor in preventing playground injuries.”
• Choose age-appropriate equipment. Some playgrounds have toddler-size playground equipment, including shorter slides, and young children can be steered to those items. If shorter slides aren’t available, baby swings or sandboxes can be a safer option.
• Assist, but don’t ride. Dr. Gaffney suggests that children not be allowed to use playground slides until they are able to do so independently, climbing stairs or ladders on their own and maintaining a sitting position while sliding downward. Another option is to place young children on the slide at the halfway point and stand alongside while they ride to prevent toppling.
• Consider the footwear. To reduce the risk of friction-related stops while your child is sliding, remove his shoes before he slides. Of course, running around in socks or bare feet at a public playground can pose other risks (such as hot or sharp surfaces), so you’ll have to weigh those risks.
• Talk about the dangers. Dr. Holt’s Maryland-based poster campaign is a good start, but too few parents have heard about the dangers of riding down a slide with a young child in their lap. Tell other parents about the risks; share this article. The first step to preventing slide injuries is awareness.

For more about summer safety concerns, read “Sail Into Summer Safely”. For more about public playground safety, see the Consumer Protection Safety Commission (CPSC)’s handbook or the AAOS guidelines.

“We’re very concerned about the continued rapid increase in reported cases,” says Secretary of Health Mary Selecky in a statement. “This disease can be very serious for young babies, who often get whooping cough from adults and other family members.”

Meanwhile, the number of people diagnosed with measles in the United States reached a 15-year high last year, according to a new CDC report. There were 222 cases of measles in the U.S. in 2011, more than triple the usual number of about 66 over the past decade.

Why do these outbreaks happen?
The cause is twofold: a decrease in immunization rates and a decrease in immunity over time.

When fewer people are immunized, disease rates go up. In 2002, researchers found that unvaccinated people in a highly vaccinated community were less likely to get measles than vaccinated people in a community with low vaccination rates. More information on this phenomenon known as herd immunity can be found here.

Despite the availability of a vaccine to prevent whooping cough, epidemics occur every three to five years, according to the CDC. Vaccines you get in childhood may not fully protect you when you are an adult. (Learn more here.)

“Many adults don’t realize they need to be vaccinated, or they assume they have been,” warns Washington State Health Officer Dr. Maxine Hayes.

As more people lose their immunity and become infected with whooping cough and other infectious diseases, everyone they contact is now vulnerable to infection.

Should parents be worried?
Measles is particularly concerning because it is highly contagious. In 1980, before vaccination was widespread, measles caused an estimated 2.6 million deaths annually, according to the World Health Organization (WHO). Fortunately, immunization has greatly reduced the number of measles deaths.

Pertussis or whooping cough is also highly contagious but typically results in far fewer deaths. (You can find more detailed information on whooping cough here.)

Infectious diseases are seldom cause for concern in otherwise healthy adults and children. On the other hand, the disease can be problematic in individuals with immature or impaired immune systems, such as babies and young children, resulting in serious illness and death.

Newborns are immune to many diseases because of the antibodies they received from their mothers, but young children do not have maternal immunity against some vaccine-preventable diseases, such as whooping cough, according to the CDC.

Ten California infants died of whooping cough in 2010. They were among the 9,143 cases of the disease reported in California that year—the highest prevalence in 63 years. Across the U.S., a total of 27,550 cases of the disease were reported. The CDC notes many more cases likely went undiagnosed or unreported.

Similarly, in 2008, there were measles outbreaks reported in four states. Most of the cases occurred in unvaccinated individuals—13 of them were infants under 12 months of age (too young to be vaccinated routinely), and seven were toddlers ages 12­­–15 months (not yet vaccinated).

Fortunately, no one has died from measles in the U.S. since 2008. The CDC explains that 90 percent of the cases can be traced to other countries with lower immunization rates.

What should parents do?
Get vaccinated! Immunization slows down or stops disease outbreaks, the CDC advises. (Read about the measles vaccine here and the whooping cough vaccine here.)

A booster shot for pertussis is available for older children and adults so they can maintain their immunity. It’s essential that individuals who care for or live with children under the age of 1 year receive this vaccine. Pregnant women who have not been immunized are also at risk and should receive a single dose of whooping cough vaccine during their third trimester, late second trimester, or right after birth.

When family members and caregivers are immunized, children who are too young and individuals who are too sick to be vaccinated are protected as well.

Aside from getting fully vaccinated, the following steps will ensure that infants, older children, and adults are protected from these preventable diseases:

• Avoid contact with infected individuals
• Avoid contact with infants if unvaccinated, or get vaccinated at least two weeks prior to having contact with infants

Most children are diagnosed with ASD around 4 years of age, but the CDC now recommends screening at a younger age to ensure early intervention and better developmental outcomes.

Despite widespread research, the cause(s) of ASD is unclear, making efforts to inform parents about early signs and symptoms challenging. Authors Julia Cook and Dr. Laura Jana (illustrations by Allison Valentine) take a novel approach with their picture book, Amazing Me—It’s Busy Being 3!

Amazing Me can be downloaded online for free as part of the CDC’s “Learn the Signs. Act Early” campaign, designed to teach parents about child development and early warning signs of autism and other developmental disorders.

Amazing Me features Joey the kangaroo demonstrating developmental milestones appropriate for 3-year-olds. These include social/emotional skills (taking turns in games), language/communication skills (following instructions with two or three steps), cognitive skills (playing make believe), and movement/physical skills (climbing and running). A milestone checklist appears at the end of the book. Parents can also find tips for spotting delays, talking to doctors, and getting referrals on the CDC website.

Read here for more information on ASD or visit the Autism Society.

Researchers at Yale and Johns Hopkins University recently found that serious physical abuse accounts for 58 out of 100,000 reports of child abuse, making it a greater threat to babies than sudden infant death syndrome (SIDS). Hospitalization rates for serious physical abuse are twice those for abusive head trauma associated with shaken baby syndrome. The economic cost of child abuse and neglect is approximately $104 billion annually.

Researchers at Yale and Johns Hopkins caution that their analysis included only hospitalized children. Children with serious physical abuse who were not seen in a hospital or died before they could be admitted were not included, making it likely that their findings grossly understate the severity of the problem.

Tracking serious cases of abuse
Until recently, child abuse was monitored through case reports at state and local Child Protective Services (CPS) agencies or through congressionally mandated National Incidence Studies (NIS).

The latest NIS examined data from 2005 to 2006. Cases of physical abuse with at least a moderate injury totaled 323,000. A prior report revealed only 142,000 cases of substantiated physical abuse.

Neither reporting system specifically identifies cases of serious physical child abuse, such as hospitalizations for head injuries, fractures, or burns. By determining the number of instances of serious physical child abuse, researchers aim to shed light on the threat and determine whether preventative measures actually work.

Focusing on prevention
The National Institutes of Health still lists SIDS as the leading cause of death in children between 1 month and 1 year of age. However, SIDS rates have been cut in half from 100 of every 100,000 live births to 50, as a result of the “Back to Sleep” campaign (named for its recommendation that healthy babies be placed on their backs to sleep). Sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the American Academy of Pediatrics (AAP), the campaign was launched in 1994 as a way to inform parents and caregivers about how they can reduce the risk of SIDS.

Yale and Johns Hopkins researchers argue a national campaign aimed at reducing serious abusive injuries could have similar success. In order to be effective, according to the researchers, prevention efforts need to target high-risk groups. For example, cases of serious abuse are six times higher among children on Medicaid compared to other children.

In 2006, 1 in 752 babies covered by Medicaid was hospitalized due to serious physical abuse. “This very high rate,” the authors write, “speaks to the importance of poverty as a major risk factor for serious abuse and for the need to prevent these serious injuries.”

The U.S. Department of Health and Human Services (DHHS) reports that prevention programs are in place to reduce risk factors or conditions thought to be associated with child abuse and neglect. For instance, parents who may be at risk for abusing or neglecting their children are provided with support, assistance, or coping strategies that hopefully allow them to parent effectively, even under stress, says the DHHS says.

Being aware of child abuse is merely a first step in addressing this growing problem. The Protect Our Children Committee says more attention needs to be placed on prevention and making laws about reporting child abuse clear and consistent.

The AAP lists the following signs as indications of possible child abuse:

• repeated unusual injuries

• withdrawn, passive, depressed, and cries a lot

• unusually aggressive or violent

• overly tired and trouble sleeping or frequent nightmares

• genuinely afraid of a parent or other caregiver

The AAP says parents and children may benefit from guidance and counseling, which can help break the cycle of abuse by teaching parents to better deal with their emotions without resorting to violence.

There are also a number of resources available for parents who need help managing their aggression and frustration. The American Psychological Association provides guidance on how to control anger. Prevent Child Abuse America also has tips for parents on how to parent effectively without harming their children.

The U.S. Department of Health and Human Service also provides information on how to prevent child abuse. Specifically, the agency offers advice on where parents can turn for support in their local communities.

Concerned citizens are urged to report suspected cases of child abuse to their local child welfare department. But reporting cases of child abuse after the fact isn’t enough. These disturbing statistics make it clear that a national effort akin to the “Back to Sleep” campaign is needed in order to prevent child abuse before it happens.