Friday, February 22, 2019

Tech time/ How much is too much?

Tech Time/ How much is too much?

"Enjoy media, not too much, mostly together" - Anya Kamenetz (author of The Art of Screen Time)

Tech Time/ How much is too much?

In this ever changing world, the topic of how much screen time we should allow our children is one that affects most of us.

I am not alone in thinking that most kids have too much screen time and tend to be overscheduled in general. They need time to just be kids and have some free play. When a child is in front of a screen, they are not talking, running around, or playing. These activities are essential for cultivating some basic skills. While I understand that a bit of the peace and quiet we might get from the ‘electronic babysitter’ (for the purpose of this post I am referring to screen time as anything computer, tv or video related) is so tempting, I want kids outside when possible, not inside glued to a screen. I want my patients to know what it feels like to turn the pages of a real book, not just to swipe their fingers across an iPad. I want them to know how to get messy with finger paints, not just how to create virtual art. I want them to interact with friends in person, not with avatars online.
However, as much as we may be tempted to wrap the Luddite cloak around our households, is that really fair to our kids? Those who try to ignore all the technology may be at a disadvantage.

While they live under your roof, you are in charge of how much screen time your child gets.

I think that there is absolute value in getting some. It is a wonderful thing to be able to facetime with long distance friends and relatives. The instant gratification and ease of real time virtual visits is a game changer in the relationships that grandparents can now establish even when they are not local. It certainly beats our old method of sending VHS tapes in the mail. (I just rescued a box of those from my mom’s house. It is time to get those digitized!)

Technology also offers a vast array of education and entertainment. We can learn so much from computers. The games are fun. Television has some nice programs; Daniel Tiger is my favorite. Getting time while you get something else done and your child is happily engaged is essential for some busy parents. How many of you have been in the position when you want to strangle your partner because they voiced the "no computer or videos for you ALL week!" as a consequence for some errant behavior. Some of you need that down time more than the kids!

The key is figuring out how much is too much.

You might be surprised that some high tech names limit the amount that their kids were allowed. Several years ago when I ran a post about this topic, I opened with an article about Steve Jobs that ran in the NY Times:

He was onto something. There are more and more studies coming out that are a bit alarming. Some of these studies indicate that there are actual changes in the brain of young kids who are spending too much screen time:

Other studies are worrying about potential eye damage from too much time in front of a screen. Researchers are finding the exposure to the blue light prior to bedtime might impact sleep. We probably won’t really have firm data for many years, but common sense would come into play here. Unlimited time in front of a screen is not a good thing.

Dabney Ingram, who used to be a NVP mom but has since moved out of SF, let me know about this worthy organization that she is involved with:
ScreenSense is a great resource for any family grappling with this issue.

While we can all agree that too much is a problem, having a no tv/no computer environment is not something that I recommend either. When your child emerges from that protective bubble of a screen free existence, they may feel a bit like Alice in Wonderland. Back in the "olden days" when my kids were young, our screen was simply the TV. They had friends come for play dates who were not allowed any television at home. If I allowed it, the only thing those kids wanted to do was watch tv because it was such a treat for them. I give the same advise with candy. If it is forbidden completely, there are some kids that will seek it out as a treasure. So both tech time and dessert have some commonalities..They are enjoyable but too much is not healthy and we can’t forget about the main course.
My goal is for your child to have a healthy relationship with technology. Learning how to use it at a young age will keep them on the level playing field with others.

Not all tech time is equal.

There is a lot of research going on that describes the different pathways in the brain when you are producing something or learning while using tech versus simply playing or gaming. Andrea Dunn, a teacher up in Marin, sent me a list of some cool free activities that would fall under the "productive use" label.

  • Duolingo - learn a language
  • Koma Koma - make fun stop-action animations
  • Snapseed - take a photo and use lots of neat photo editing tools to jazz it up.
  • Adobe suite of productivity/creativity tools (Adobe Spark Video, Adobe Spark Post)
  • iMovie - make fun short creative movies
  • Pic Collage - make a collage with lots of backgrounds and design options (free but has annoying pop-up ads)
  • Blogger - create your own blog around any topic, invite readers and authors or keep it private just for you, as a virtual diary.

Each family should discuss what their tech usage plan will be. Some families will allow more than others. Your own family should be the only one to make rules that make sense to you, but please, set some sensible limits.
Dabney makes a good point. A family movie, with everyone snuggled together on the couch does not need to count towards the screen quota.

Don't sabotage each other. If you have a partner, figure out the rules that you both feel comfortable with. Be consistent. If your kids figure out that the rules are meaningless, you have significantly weakened your credibility.

At my solid foods class when I discuss "safe eating" I tell parents that they need to set a good example. If you shovel food in your mouth and talk with your mouth full, why would your child learn to eat any other way? Put in a small piece of food, chew and swallow. Set the standard.

When it comes to being a role model, technology is no different. I am no hero here, I have reached an embarrassingly high level on the time suck of a game Candy Crush. If you are always looking at a screen, if your forms of relaxation are all technology related, consider making some small changes.

Extra screen time (still with limits) can be a commodity that can be earned for good behavior. But because I don't want it elevated to the most important thing in their lives, I would rather make the rewards that they work towards be special non-tech activities with you.

Let kids enjoy their allotment of tech time, but focus on opportunities where they can have just as much fun reading a book, or doing other things that don't have a screen involved. There are so many options:

Board games are a wonderful way for a family to spend memorable hours together. I rescued a tattered box of the game RACKO back from my house-cleaning escapade last month in Pittsburgh, and brought it home. I have such warm memories of playing that with my dad and sisters. Marie Kondo would approve. It gives me joy.

If you are going to a restaurant, create a restaurant activity kit to take with you so that you are not all sitting on your phones. Or have some restaurant games at the ready.

  • I spy with my little eye...what do you see?
  • Find different letters on the menu.
  • Being at a restaurant is also the perfect place to play some math games. You could start with basic counting (how many peas are on the plate) and then up the skill level for your older kids and have them help you figure out the tip. Check out this very cool book that addresses getting your child comfortable with numbers and math: www.talkaboutmath.orgHaving kids have a basic understanding of numbers so that they don’t go through life depending on a calculator is a worthy goal.
  • Our family's all time favorite game was the “act out the emotion” game. The girls would hold the napkin over their face. We would call out "sad" or "scared" or "surprised", or "in love" and they would lower the napkin making the assigned face.

Make sure you put some child control limits on your device.

There are lots of apps out there, with more being developed all the time. Some can help you make sure that all the sites that your child can access are safe and appropriate, others can help you limit the time allowed.

As your child gets older, it becomes much trickier. It is reasonable for rules to be renegotiated with each age. When to get your child a cell phone is another layer to this discussion. A limited phone plan has tremendous benefit to you, but I emphasize the word limited. Starting younger kids with a basic phone that is not a smartphone is an option for those afraid of going down the slippery slope while still being able to reach each other throughout the day.

Have your child be part of the discussion and verbalize understanding of the family rules. Until they are a certain age, many experts agree that all computing should be done in a common room. Be clear from the start (if it isn’t too late) that while you are providing them with the digital tool and data plan, you have the right to go on to all accounts and check their texts if you have concerns that make that warranted. Changes in mood or behavior, as well as sudden ‘tanking’ grades would be reasons for checking. It is not breaking trust if you make it clear from the beginning that it is not just your option, but your job as the parent. This is also a time to remind them of another important lesson, that nothing that they put online is actually private. As Dabney suggested, “If they want privacy, they can write in an old fashion journal."

Friday, February 15, 2019

Talking to your kids about sex

Talking to your kids about the birds and the bees

While the majority of the calls we deal with are about little acute illnesses, we also field queries about all aspects of growth and development. Recently I have had several folks ask me my two cents about answering the "Where do babies come from" question. So here goes.

Comes the time in every family when it is time to have the talk about sex, but how and when? It varies with every child.

There is a story about a young boy visiting his grandparents’ house one summer. He came rushing in from outside where he had been playing with some new friends from the neighborhood. “Grandma, what’s it called when two people are in bed, but one is on top of the other one?”

Grandma was taken aback for a moment but sat him down and gave him a matter of fact talk about the birds and the bees, so to speak. The little boy listened carefully with his eyes open wide and then ran back out to join his friends. It wasn’t long before he ran back into the house saying, “Grandma, it’s called BUNK BEDS and Mrs. Wilson wants to talk to you!"

The all important moral of this story is to make sure that when your child presents you with a question, that you understand what they are actually asking before you launch into any complex explanations. You could start with a statement such as “ I am so glad that you asked me. I am always happy to help you find answers to things. Tell me more about what you are wondering about."

My sister Amy has her own tale. She and her husband are National Park rangers and they moved to Utah when her oldest son was in 4th grade. Even when reading the Harry Potter series, my nephew Asher covered his ears when they were reading any scenes that involved kissing, but now that they were living in a new place, he had a question.

“Mom, where to babies come from”? Amy paused and then followed up appropriately. “Is there something specific that you are wondering about?”

“I heard that babies happen when a mommy and daddy love each other very much and their souls connect.”

My sister's family was now living in the heart of Mormon country where most families were quite a bit larger than he was used to seeing. He knew that his mom and dad seemed to love each other a lot, but they just had 2 kids, Asher and his brother Ben. The math wasn’t adding up. Amy went on to let him know that there was a little more to it than that, but it involved some more mechanics including some of that “Kissing stuff”. need to talk about it any more.

Get yourself as comfortable as you can with the discussion. What do you call body parts? Does your family use a nickname (perfectly fine) or is your child able to rattle of the anatomical names for all of their “parts"? Of course having discussions about bodies usually comes long before discussions about sex.

Many parents are a little shocked and uncomfortable when infant boys have erections or they notice young boys and girls masturbating. This is incredibly common (the human race is quite fortunate that masturbation doesn’t actually cause blindness.) While it is usually quite normal, if you notice that your child is constantly touching themselves to excess, I want to make sure there is no irritation or external cause. Maybe their underwear is too tight. It could even be something like pin worms! If there is no obvious underlying issue, consider having a discussion about that fact that, yes it feels good, but our bodies are delicate and it is important not to touch so much that things can get sore. Some families have a talk about family rules and theirs might be that gentle touching is a private activity. Beware, a true story - one of my families who made a point of having accurate vocabulary was caught off guard one night when their 4 year old son made an announcement at a fairly formal dinner party with mom’s boss. “ I am going to go into my room now so that I can touch my penis in private.”

This is also an important time to have a discussion about body ownership. No one should be able to touch any part of your child’s body without permission. Exceptions are parents and doctors (with parent present) and that should never be a secret! Empowering your child about their body early is important.

And then they get a little bit older….

I remember driving a van loaded with carpool kids to school many many years ago. I caught a piece of the conversation that was going on in the back seat and my ears perked up a bit as I tuned in.

“Yours have done it at least twice." “Yours have done it at least once” "Ours have done it at least twice...Oooh/Yuck”

As soon as you feel that your child is curious and is possibly going to be picking up odd or skewed information from their friends or classmates, it is important that you make an opportunity to have a chat. It is essential that your child sees you as the trusted source of correct information and is comfortable asking you questions. Unfortunately in this high tech world, it is becoming increasingly easy to kids to be exposed to all sorts of things with very adult content at a very young age.

You may want the help of a book. Amazon and libraries have an enormous amount of books that you can use as a resource. There are so many good ones out there. I would suggest that you read several until you find one that feels like it is the right comfort level for you. You may want to do this research a little ahead of time.

Liesel Harris-Boundy from the West Portal Branch of the San Francisco Public Library was kind enough to come up with a list of good books on the subject that she is familiar with. Liesel shared that an ObGyn friend recounted that her 7-year old son asked her, "Mom, what's a vagina?" and though she talks about vaginas all day, she was unprepared to tell her son and excused herself from answering! That reserved part of her upbringing came through in spite of all her medical training!

The following books should all available through the library. Perhaps go in and leaf through a few until you pick one that you like.

You want to make sure that the books are geared to the correct age. Some are guides for the parents and some are meant as a resource for the child.
In our practice we are fortunate to have many different kinds of families, it isn’t always mommy plus daddy equals baby. I was happy to find out about the book below.

What Makes a Baby is a children’s picture book about where babies come from that is written and illustrated to include all kinds of kids, adults, and families. Geared to readers from preschool to about 8 years old, it teaches curious kids about conception, gestation, and birth in a way that works regardless of whether or not the child in question was adopted, conceived using reproductive technologies at home or in a clinic, through surrogacy, or the old fashioned way; and regardless of how many people were involved, their orientation, gender and other identity, or family composition. Just as important, the story doesn’t gender identify people or body parts, so most parents and families will find that it leaves room for them to educate their child without having to erase their own experience.

Once you do pick your book that you feel comfortable using as a resource,go ahead and buy a copy so that there isn’t a time limit.

If your child is embarking on puberty and you are looking for something more interactive than a book, check out the Heart to Heart seminars hosted by Stanford. They hold these in multiple locations. The San Francisco class is held at CPMC on California street.

A list of other classes they offer are here:

One mom in our practice who went to the session thought it was very worthwhile, but she wished she had taken it earlier. She thought ten or eleven would have been perfect.

Bottom line, honesty and communication are essential. As awkward as this conversation may feel to some of you, you really don’t want your kids to be getting their sex education from the neighborhood kids (or even worse, the internet!) Don't force too much information on a younger child who isn't interested. Letting them know that you are always open and willing to talk about "grown up" stuff with them is a great start.

Friday, February 8, 2019

Hepatitis A: Are you protected?

Hepatitis A: Are you protected?
Scroll to the bottom for a new vaccination recommendation

Parents, have you gotten your Hepatitis A vaccine?

Hepatitis A is an inflammatory disease of the liver that is caused by a virus. Some people consider the Hep A shot a travel vaccine because it is the most common vaccine-preventable illness that folks get infected with when traveling. We think that everyone over a year old should get it even if you aren't going anywhere. Hepatitis A is certainly more common in countries with lower standards of sanitation, but this virus doesn’t care about borders. There are plenty of cases right here in this country.

Transmission occurs through direct person-to-person contact (fecal-oral transmission), contaminated water, ice, or shellfish harvested from sewage-contaminated water. You can also get it from contaminated raw, inadequately cooked, frozen fruits, vegetables, or other foods. Hepatitis A is quite hardy and can live outside the body for quite a while. It can survive being frozen. This is a nasty virus. Hand washing is important and can stop you from spreading it, but won't protect you from catching it. It makes no sense not to get the vaccine if eligible.

Poor hand washing and then handling food is a common mode of transmission, but so is changing a diaper. Thus diaper age children, infected with the virus, are a large reservoir for spreading it. People are most infectious 1–2 weeks before the onset of clinical signs and symptoms, and can shed the virus in the stool for months and months. Dr. Schwanke had read somewhere that in some cases poop can remain contagious for up to a year!

The incubation period averages 28 days (range 15–50 days). Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months. Most common symptoms include the abrupt onset of fever, malaise, poor appetite, nausea, and abdominal discomfort, followed within a few days by jaundice. Urine may be very dark colored and stool is often clay colored or freakishly light. The likelihood of having symptoms with a Hep-A infection is related to the age of the infected person. Fortunately, although it is rarely fatal, adults with this can become quite SICK!

Here is one of the most important facts worth emphasizing: In children aged <6 years, most (70%) infections are asymptomatic. In the young children who are actually acting ill, jaundice is not a common symptom, so it might be awhile until someone figures out that they are dealing with a form of Hepatitis. Most of the time,young children don’t usually exhibit many symptoms at all, or appear too ill, but they pass the virus along to their caregivers who get walloped. We have seen it sweep through a daycare, with many of the caregivers and parents catching it.

The vaccine first became available in Europe back in 1993 and started getting phased in to our vaccine schedule in 1996. It has been a routine childhood vaccine in the United States since 2005. It is nearly 100% effective. Interestingly, although it is recommended, it is not one of the vaccines that are required for school entry. It can be given as soon as a child reaches their first birthday and should be followed by a booster six to twelve months later. Protection against hepatitis A begins approximately two to four weeks after the initial vaccination. Because the protection isn’t instant, the recommendation for travelers is to get it at least 2 weeks before your trip, so plan accordingly. The vaccine comes only in preservative free form (no thimerosal concerns). I rarely see any side effects at all. Once in awhile a baby post vaccine might be extra fussy, but that is rare and not necessarily shot related.

This one requires little thought. You should make sure that Hepatitis A vaccine is included in your child’s immunization schedule. Parents, also please check your own health records and make sure that you are protected. Adults are often quite clueless about their own vaccination status!

This is new! Recommendations for Preexposure Protection Against Hep A Infection for Travelers

Infants aged 6–11 months: Hep A vaccine should be administered to infants aged 6–11 months traveling outside the United States when protection against Hepatitis A Virus is recommended. This travel related dose for infants aged 6–11 months should not be counted toward the routine 2-dose series! Therefore, the routine 2 - dose Hep A vaccination series should be initiated between age 12-15 months according to the routine, age-appropriate vaccination schedule. High risk travel zones include all parts of the world except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.

Friday, February 1, 2019

From mild Head Injury to traumatic Brain Injury/ when to you need attention?

Head Injuries/Traumatic Brain Injury

Kids fall. I can safely say that not a week goes by at work when I don't get the ‘call’. The mom or dad is in tears as they recount in horror that their baby just fell. Sometimes the baby was left on an unprotected surface for a moment, not imagining that the infant could manage to roll off. That thud is an awful sound. Sometimes the caregiver is right there watching it happen, but can't move fast enough to catch them. Of course it isn't just babies who fall. Children and adults have accidents and sports injuries all the time. 

If your baby just fell or you are the first responder at any kind of accident, take a deep breath. You need to remain calm. You can have a glass of wine later. 

Medical personnel will want to know:

  • How far do you think they fell? (rule of thumb, if it is a height taller than the child, they need to be seen)
  • What kind of surface did they fall onto?
  • What was the immediate reaction?
  • How long did it take until they stopped crying?

Of course, if there is a loss of consciousness, or any possible neck injury, don’t move them, CALL 911!

Most of the time, after a moment or two of stunned silence, your child will be vigorously crying. Dr. Hurd adds that even if you were in the other room, if you heard the thud and then immediately hear the scream, there is probably no loss of consciousness.

Do a quick head to toe assessment. Is there any obvious bleeding, bruising, sprains or fractures that need to be tended to? Put immediate pressure on any bleeding wounds. Check the mouth and make sure there are no loose teeth (this is the reason that you already have a relationship with a pediatric dentist.)

If your child will cooperate, get a cold pack on any bruises. If you are out of the house, a cold can from a vending machine is a good option. If you are near a freezer, a bag of frozen peas makes a nice ice pack. For toddlers and preschoolers, playing doctor before anything happens can be very useful. “Uh oh, we have a boo boo, quick, let’s put the cold pack on there to help make it feel better.” There are some cute little pediatric friendly cold packs available that might elicit cooperation.

I also have had good results with the use of Arnica. Arnica is a homeopathic treatment that comes as a topical ointment or little pellets that are taken by mouth. Many parents swear that it significantly decreases bruises (roll your eyes if you must, but I have seen it work.) It is worth having some around. Kids often like to have ‘cream’ applied to a little ‘owie’. Arnica is perfect for that.

Be aware that head wounds can create a huge amount of blood if there is even a tiny little break in the skin. If the skin remains intact, all of that blood can rapidly collect into an enormous goose egg. These can look fairly alarming and can turn all sorts of lovely colors, but they do resolve. A big goose egg should be checked out to make sure there is no fracture. Mild bruises and bumps by themselves are not typically a concern if the child is acting fine otherwise. While I am not worried about some visible bleeding, any bleeding that is taking place underneath the skull is a different story. Any accumulation of fluid or swelling can cause potential pressure on the brain. If this is happening, your child will NOT be behaving as usual.

Most of the time the kids are indeed fine following a mild to moderate fall or whack on the head, but we always need to be on the lookout to make sure there isn’t a concussion. A concussion is a type of traumatic brain injury that stems from an impact to the head that causes the head and the brain to move quickly back and forth. The brain may bounce or twist in the skull from this sudden movement. This in turn can cause stretching and damage to the brain cells as well as chemical changes in the brain.

If your child is acting perfectly well after a fall, they are likely just fine. It is appropriate to call the doctor's office just to be on the safe side, but most of the time you will likely be told that you can just keep a close eye on them at home.

All of the experts agree that once your child has calmed down and seems mostly okay, it is fine to let them take their normal nap. An overtired baby will be cranky and may be near impossible to assess. If they are nodding off, it is likely because they are tired, and not from the head injury. Do not let them take a nap that is significantly longer than the typical nap time. Depending on how far and hard they fell, I would also check on your child every couple of hours during the night. You can set your clock to make sure you get up to do this.

With an infant you can offer them a dream feed. They don't need to be fully roused. With an older child, let them know you will be checking on them during the night. You can offer them a sip of water or just have them mumble “I love you”. You are simply establishing consciousness; you often don't need to wake them completely up. Keep in mind that if your child is in a deep sleep stage, a gentle whisper might not be enough to wake them up. For older kids, if they know ahead of time that you will be coming in, they are easier to wake up.

If there is a TBI ( traumatic brain injury) you are going to have clues that something is not right. Physical symptoms would include dizziness or balance problems, headaches, vision problems, light sensitivity, sleepiness, and/or nausea and vomiting. I actually give the kids "one free vomit". Often they have cried hard enough that they might spit up a little. Let's not worry about that first emesis. If they vomit a second time, it’s time to call your doctor. Vomiting could simply be a sign that they are coming down with a tummy bug, but nonetheless, if they whacked their heads and are now vomiting, they need to be checked out.

Traumatic Brain Injury symptoms are not only physical.
We need to keep an eye out for social or emotional changes as well. If the head injury patient is having issues with anxiety, nervousness, irritability, or trouble with memory, that is worth bringing up to your medical team and having them seen.

There is no downside to getting your child evaluated if you are even the least bit concerned. Most pediatric emergency rooms will do a thorough assessment without automatically jumping to a cat scan. Current practice does not usually do routine imaging unless there is loss of consciousness, there is suspicion for a skull fracture, or the patient is under the age of two. Doctors will use their clinical judgement and make a case by case decision. A basic neurological exam might include the following (of course some of these are age dependent):

  • Can they answer simple questions?
  • Is there any complaint of blurry vision
  • Do the pupils react to light at the same speed (generally if a penlight is shined into the eyes, the pupil will get smaller) Pupil changes would be of immense concern but would happen only with a serious injury and would NOT be the only symptom. Some folks, as their baseline have pupils that are not exactly the same size. They were born this way but no one noticed. I would suggest checking your child's eyes before they fall so that you don't get freaked out if they seem off to you after a fall if you are noticing that for the first time. 
  • Can they touch their finger to their nose? Do this with each hand.
  • Is there any clear drainage from the nose or ears? Of course what toddler doesn't have a runny nose?

If the patient is diagnosed with a concussion, high risk activities need to be avoided for several weeks  Aside from that provision, the newer protocols for concussion care are not as restrictive as they used to be.

Right after the injury
Rest right after the injury. Take it easy the first few days when symptoms are more severe. Avoid any activities that seem to be making symptoms worsen. Screen time, reading or anything that can cause eye strain is not a good idea. Find activities that are quiet and relaxing and don’t require a lot of mental stimulation. It is okay for you to read to them.

Within a few days
As your child starts to feel better he or she can gradually return to regular (non-strenuous) activities

Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated. Encourage outside time, such as taking short walks if the weather cooperates. Make sure they are getting a good night's sleep. It is especially important to avoid screen time and loud music before bed.

After a solid knock to the head you are not out of the woods right away. Any dizziness or headaches that occur within a week or two following the head trauma need to be paid attention to. Any time there is an increase in vomiting or confusion, get immediate medical attention! Discuss return to sports with your medical team.

The large majority (70-80%) of people with Traumatic Brain Injuries are for the most part fully recovered by 3 months post-injury. Every child’s recovery period is unique.

Misery loves company
My husband came pretty close to dropping Lauren, our first born, when she was very young. He just barely caught her by grabbing the bottom of the sleep sack she was wearing; there she was, hanging upside down, her head a few inches from the ground. He had nightmares about that one for awhile.

Last year I got the call about a Selfie accident! Mom was holding the phone way out for a photo op, She is the first to admit that she was more focused on posing than her grip on the baby. The poor baby’s head flopped back and gave a thump (he was fine.)

I actually remember in my own case, what I describe as the definition of absolute ambivalence. My four year old Alana had a friend over and they were playing upstairs. I heard the unmistakable sound of someone tumbling down the steps. As I ran to the scene I recall thinking, "who do I want that to be? My child or the friend?" It turned out that it was my kid. They had been playing dress-up and she was wearing a pair of high heels (Satan's shoes.) She stood up with a giggle and brushed herself off, but it took me a moment before I could take a breath and then we made a new rule about dress up shoes and steps.

Sometimes a parent falls when holding the baby and they both get injured. Beware of trying to manage a baby along with armloads of groceries.

Never leave your baby on a surface that they can fall from; they will! I have had babies who are too young to roll, manage to wiggle themselves off edge of a king size bed, when they had started out in the middle.

Watch out for wet squirmy babies right out of the tub. Using a towel or terry cloth robe can help give you traction. Skin to skin is especially slippery.

Make sure your kids wear helmets when using bikes, scooters or skates. Model good behavior!

Make sure your child is in the appropriate car seat.

Make sure your house is childproofed with appropriate safety gates.

Make sure that stairs are free from clutter.

Choose playgrounds that have a safer ground to fall onto. Sand beats concrete anytime!

Please exercise common sense precautions to avoid being the person who has to call about a fall, but remember that most of the time it is harder on the traumatized parent than it is for the patient. Accidents happen on the watch of even the most vigilant care giver.
Stay safe!

Thanks so much to my friend Amy who is the program manager at the UCSF TRACK-TBI/TED Research Network for helping make sure I had access to all the current research.

If you are interested, their first two articles have now been published . These are articles written by doctors and TBI researchers, reviewed by kids/adolescents, and geared for kids