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Car Seat Directions: Don’t Rush Switching Your Child to a Forward-Facing Car Seat

Originally posted on my US News & World Report parenting blog (March 19)

IN THE WORLD OF parenting, we’re conditioned to treat anticipated transitions as cause for celebration – like when a child reaches a new developmental milestone or advances to the next grade. And we’re led to believe that sooner is usually better (think potty training). But this way of thinking has its limits and it’s particularly problematic when it comes to car seats, where the safest approach is to take time with each transition.

Whether you’re moving a child from a rear-facing seat to one that’s forward-facing or a child is “graduating” from a five-point harness to a booster seat and ultimately to vehicle seat belt use – it’s best to make these changes as late as possible. The same holds true, by the way, for moving older children from the back seat to the front – which, in case you’re wondering, isn’t generally recommended before age 13.

With respect to transitioning from rear-facing to forward-facing, the consensus of the American Academy of Pediatrics, Safe Kids Worldwide and the National Highway Traffic Safety Administration is that children are safest when kept rear-facing as long as possible within the height and weight limits of their rear-facing car seat, which typically translates to age 2 if not older. As with most aspects of parenting, however, actually committing to keep toddlers rear-facing longer and following through is easier said than done.

I was recently reminded of the additional practical challenges involved when a senator in my home state of Nebraska introduced new and improved car seat legislation requiring appropriate child safety seat use up until the age of 8 (instead of 6), rear-facing until the age of 2, and keeping children under the age of 13 in the back seat. In the spirit of helping this important bill become law, I made my way to the state capitol a couple of weeks ago armed with nearly two decades worth of professional insights and information about the life-saving benefits of the proposed changes.

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Kids & Cars Seats, Why Safety Shouldn’t Take a Back Seat When You Fasten in Your Kids

Originally posted on my US News & World Report parenting blog (Sept 22)

THIS WEEK HAPPENS TO BE Child Passenger Safety Week – a week specifically dedicated to ensuring that parents, as well as anyone else who transports children, use the correct car seat and properly buckle kids in each and every time children ride in motor vehicles.

As a pediatrician with 15 years of experience being a child passenger safety technician and instructor, I am most definitely a fan of this week-long focus. That’s because the stakes are high when it comes to buckling kids in properly. Motor vehicle-related injuries continue to be a leading cause of death for children in the U.S.; and buckling up is the best way to save lives and reduce injuries. Child safety seats, when used correctly, can reduce the risk of death by as much as 71 percent, according to SafeKids.org.

Yet, despite all we know about the importance of passenger safety, nearly three-fourths of cars seats are still not being used or installed correctly.

Adding to this problem is a second challenge that’s by no means exclusive to car seats, but which stands to seriously thwart our collective efforts to keep our children safe in them. I’m talking about the culture of “mommy-shaming.”

Consider the photo that just a few months ago managed to capture the attention of the parenting world. The photo I’m referring to wasn’t just any picture shared by any mom. It was a snapshot of the then 18-month-old son of pop culture royalty Kim Kardashian and Kanye West. It also just so happened to be a shot of a not-yet-2-year-old strapped into a car seat that was facing forward, rather than rear-facing seat as generally recommended for a child of this age.

The parenting and media response was fast and furious. While the virtual dust has settled, I still feel the need to weigh in on a couple lingering aspects of this cause celebre.

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Raising Healthy Kids: Reaching for the Low-Hanging Fruit of Parenthood

For good or for bad, parents today are faced with the fast paced nature of both the real world and a virtual one. Much of the virtually continuous stream of information, videos, tweets and texts we receive on a 24/7 basis relate in one way or another to what we can, should, and/or are expected to do to be good parents. And let’s face it – keeping up with all of the modern-day parenting advice would be hard enough even if all of it was fact-checked for us. Unfortunately, this is not often the case, as much of what we hear, see and read is unfiltered, potentially unfounded, and confusingly contradictory.

Having spent much of my professional career as a pediatrician increasingly committed to making sense of pediatric and parenting advice in both of these worlds, I have found that what parents often want to know from me is simply how to filter the good from the bad and separate fact from fiction.

Knowing that you all are probably as busy as I am, I decided that this week I would distill down to as few words as possible the handful of things I consider to be some of the most well-founded, important things you can do as parents can do to make your kids smarter, safer and healthier. In other words, the following is my list of the “low-hanging fruit” of parenting.

Move more. I feel the need to say this because it’s painfully obvious that it has become incredibly easy for our children (and for us) to barely move in the course of any given day. Whether it’s walking instead of driving to school (or work) or taking an evening walk around the block, getting out of the car instead of rolling your way through drive-thrus, or signing up for organized sports, joining a gym, or participating in more vigorous daily exercise regimens – every step counts towards an healthier life style.

Use restraint. Literally speaking, I’m simply referring to the use of car seats and seat belts in motor vehicles. With motor vehicle crashes clearly identified as the number one cause of death in children, and the correct use of car seats and seatbelts clearly shown to have a huge impact on reducing motor vehicle-related injuries and deaths, taking the time to buckle up comes with a huge return on your parenting investment.

Read. For every parent who has ever asked my opinion on what they can do to help their children become smarter, excel in school, or head down a path of success, reading always factors in to my answer. Reading aloud to babies, toddlers, young children and teens alike not only fosters improved language skills, but also a love of reading that will serve children well for their lifetime. One of my favorite sayings to emphasize this point is that children spend the first few years of school learning to read, and the rest of their lives reading to learn.

Sleep. For parents of infants and young children, this conversation usually focuses on getting children to fall asleep, stay asleep, sleep in their own room, and do so without requiring repeated interventions. For parents of teens, the conversation often shifts to too little and too late. But regardless of your child’s age, it is becoming convincingly clear that instilling your child with good sleep habits is not only a good thing for your own chances of getting a good night’s sleep, but your child’s overall health and well-being.

Wash your hands…and while you’re at it, remember to cover your cough (preferably with your arm rather than your hand) and vaccinate. The fact of the matter is that while modern day science and research is continually coming up with new medicines, treatments and technologies to improve our families’ health and more effectively treat disease, the simple act of teaching our children to wash their hands (which includes committing to consistently doing so ourselves) remains one of the single most effective things we can do to limit the spread of disease. So is protecting against all of the vaccine preventable diseases.

Originally posted on Omaha World Herald’s Live Well Nebraska

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From Earthquakes to Outbreaks: Keeping Kids Safe

In the wake of this week’s earthquake, I’ve noticed that there’s been lots of subsequent commentary – from TV to Twitter feeds – about just how uneducated and unprepared east coasters were/are when it comes to earthquakes. This has been repeatedly noted to be in stark contrast to anyone and everyone who has ever lived on the west coast, for whom the eventuality of earthquakes and the associated disaster preparedness has become an accepted way of life. To be fair, I must say that it certainly seems understandable, given what most of the general public has been taught about plate tectonics, that we cut those east coasters who mistakenly ran out of buildings rather than hiding under their desks some slack.

That said, I also firmly believe this week’s unlikely earthquake has the potential to serve as a powerful teachable moment. No, the lesson learned isn’t that everyone on the east coast needs to go take all the same precautionary measures as those who live on known fault lines, or that any of us in the Midwest (with a few geographic exceptions) need to hurriedly sign up for a remedial course on “what to do in the event that an earthquake hits the heartland.” Rather, all the talk about earthquake preparedness (or its lack thereof) gives me the opportunity to bring up many important instances in which parents can and should expect the unexpected and plan accordingly. As a pediatrician, I can think of countless ways in which parents can better insure their children’s health and well-being by simply understanding the risks and planning ahead. For the sake of today’s blog, I offer you the following examples.

Tornados. For us Midwesterners, tornadoes are naturally of much greater relevance than earthquakes or hurricanes. And just as bolting one’s bookshelves to the wall may be foreign to us, I’m not sure how many Californians would recognize the meaning of a tornado siren and know to immediately head to the center of an interior room on the lowest level of a building away from corners, windows, doors and outside walls if a pre-designated storm shelter or basement isn’t available. All of the 250 students and staff at my child care center know what to do, however, as we faithfully practice each month getting everyone down into our custom-built basement storm shelter…all in 8 minutes or less. Similarly, my family has a game plan in place at home. Now would be a good time to make sure yours does as well.

Fire. Although tens of thousands of Americans die or are injured in fires each year – with a vast majority caused by house fires – I consider my family fortunate to have never personally experienced one. And I certainly never hope to. I don’t smoke, so the likelihood of cigarette ashes or a lighter starting a fire aren’t of concern. Nor are lit candles or the flames from a gas stove, since we don’t have either in our house. But that doesn’t mean that I don’t bother to take extra precautions, because I do. I have smoke detectors installed on every level of my home, and yes….they all have new batteries in them that I make a concerted effort to replace every year. These and other home prevention measures require minimal time or expense, and are more than worth the effort. While you’re at it, I also suggest inquiring as to what fire prevention and response measures your children’s child care and/or school have in place, and make sure they include regular fire drills and appropriately placed fire extinguishers/ sprinkler systems.

Vaccine-preventable diseases. Natural disasters, as well as man-made ones, shouldn’t be the only focus of your preventive efforts. Considered to be one of the greatest public health discoveries of all time, vaccines now offer us the opportunity to prevent diseases that in generations past claimed the lives of millions. Now I know that the threat of a disease such as polio (which until recently was all but eradicated) may not seem as real as it used to in the days of iron lungs, but the fact of the matter is that the threat of vaccine-preventable-diseases has proven itself time and again to be anything but hypothetical. And the likelihood of an outbreak of measles or pertussis, for example, is much greater than, say, an earthquake on the east coast, given that exposure to these diseases is only a plane-ride away.

Transportation Safety. I won’t belabor the importance of parents being committed to understanding, promoting, and enforcing transportation safety principles, except to say that injury-prevention innovations such as bike helmets, car seats and seatbelts should be considered worth their weight in gold. I don’t care if you’re the world’s best driver and your child is the world’s safest bike rider – you still need to prepare for the unexpected. I am also well aware that even if I convince you, you may well be faced with resistance from your children, as I have three helmet-resistant children of my own (who nevertheless have always been required to wear a bike helmet since the day they were introduced to tricycles). While lots of kids loudly and often successfully protest the use of booster seats, mine didn’t, because they knew it would fall on deaf ears.

Given that there are many, many more worthwhile preventive measures that you can take, I hope that your own pediatricians continue sharing these and other tips with you. I also want to leave you with several useful resources that will allow you to hope for the best for your children while pro-actively avoiding the worst.

Originally posted on Omaha World Herald’s Live Well Nebraska

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A Parent’s Guide to Safe Holiday Travel with Kids

The season for holiday travel is almost upon us, so I thought it best to get down to basics and share some safe and practical travel tips for everyone facing the prospect of packing up the family car or heading off to the airport this holiday season. While I’m all about practicality, I also want to make sure that safety doesn’t inadvertently get left behind (or just plain forgotten) as you set out to share the holidays with family and friends.

Avoid flying objects. While car travel certainly eliminates some of the stress of figuring out how to fit everything you and your children will need for your holiday vacation into a single suitcase (or two), don’t lose sight of the fact that anything in the car that isn’t safely secured can, in the blink of an eye, become a dangerous projectile in the event of a crash. This not only includes unrestrained passengers, but any suitcases and other holiday “essentials” you bring along. To keep all passengers safe, keep all loose objects out of the passenger area of the car – tucked in the trunk or otherwise secured.

Use appropriate restraint. All too often, parents are tempted to compromise on car seats in the name of streamlined travel and efficiency. But the fact of the matter is child passenger safety never takes a holiday. That means that for anyone traveling by car, each and every passenger needs to be appropriately restrained.

  • For infants and children, this includes age-appropriate, correctly installed car seats.
  • Lap-shoulder belts need to be available for all adult passengers, as well as any children riding in booster seats. Simply using a lap belt alone doesn’t suffice when it comes to safety.
  • For those traveling by air, not only should you plan carefully so that your child can be safely restrained on the airplane (which means an FAA approved car safety seat or restraint for all children under 40 pounds), but also at your destination.
  • While most car rental agencies can arrange in advance to have car seats available, it always safest to plan on bringing your own. It may mean more to carry, but car seats are a must-have for holiday travel.

Dress for the occasion. It’s obviously important to make sure that you pack plenty of clothing to suit the climate of wherever you’re headed – especially given that young children are known to be more susceptible to both hot and cold temperatures.

  • For car travel, remember to consider what you’d want to have on hand should your car break down or get stuck along the way. While it’s not recommended that children wear bulky winter coats under their car seat harness straps (since this just adds slack into the harness system), you absolutely want to have coats on hand for any planned (or unplanned) stops along the way.
  • And as someone very accustomed to airplane travel, I can assure you that the most predictable thing about the temperature in the airplane cabin is its unpredictability. Not only is it wise to dress your child (and yourself) in layers, but bring a few extra items in your carry on.

Keep close tabs. Holiday travel inevitably throws off parenting routines. This means that you’ll want to pay extra attention to keeping a close eye on your child.

  • When traveling by car, never leave your child alone or unattended – even for a minute, no matter how much extra time or effort it may take to have the whole family pile out of the car for what you were hoping would be a very quick pit stop.
  • Whether on the road or in the air, also make sure your children have some form of identification with them, that preschoolers (and older) ideally know their own names (first and last) and a phone number, and that you have discussed with your children what to do in the event that you become separated.
  • If your children have already entered the digital age and have cell phones, this is a great time to have them on hand as well.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Giving Thanks: Things the Whole Family Can be Thankful For

I bought my turkey this past weekend. Not only did I buy it, but I even took a moment to think about how thankful I am for it. Sure I’m thankful because I love turkey, but also simply because I am fortunate enough to be able to afford a turkey. As a parent, I know full well that taking a simple weekend task like grocery shopping and turning it into a shared reflection on what our family has to be thankful for is likely to lead to some eye-rolling from my tween- and teenage children.

But the fact of the matter is that there’s no better time than the present (i.e. Thanksgiving week) to take a few moments – whether waiting in line at the grocery store or gathered with family and friends around the Thanksgiving table – and reflect on those things in your life for which you’re truly thankful. While trips to Disneyland, ipods, and the latest greatest toddler toys will understandably spring to mind first, I suggest you challenge your children, and yourself, to dig deeper. As a pediatrician and parent, I figured I’d get you started by sharing some of my own, all-too often taken for granted things to be thankful for.

Breathing through your nose. Spoken like a true pediatrician, right? But years of tending to snotty nose colds (my own, my children’s, and others’) has taught me that it’s hard to take time to stop and smell the roses if you can’t breath through your nose. You may think I’m kidding, but I’m not. Just think how many times your child’s (or your own) stuffy nose cold has kept you up at night and caused you misery. Instead of being frustrated by the annual average 6-10 colds that kids catch each year and the fact that we still don’t have a cure for the common cold, I suggest that we all remember to be grateful for each day that we wake up healthy.

Shots. I figure while we’re on the subject of waking up healthy, I’d take this opportunity to give my thanks to modern medicine and all of the medical pioneers that have given us vaccines. No, I’m not a huge fan of needles, and neither are my children. But I have such a healthy respect for the dreadful diseases we are now able to prevent by simply making sure that our children’s (and our own) immunizations are up-to-date that I count each and every shot a blessing, needles and all.

Car Seats. As someone who had 3 kids in just over 3 years – the youngest of whom only just outgrew the need for a car seat at age 10 – I am certainly aware of the parental challenges inherent in the purchasing, installing, and juggling of car seats, especially during holiday travel season. Yet despite having spent every day of the past 10 years overseeing the use of numerous seats of my own, I’m exceedingly grateful for the fact that car seats even exist, much less that they are so incredibly effective in protecting kids from harm. With nothing more important than my children’s health and safety, car seats (and all those who contribute to making sure that children are secured safely) deserve my thanks.

Cell Phones. Yes, I do have tween- and teenage children of my own. And yes, I do face the daily parental challenge posed by a world now dominated by texting tots and teens and threatened by everything from cyberbullying to sexting. But having just returned from a mobile health summit in Washington DC, I am now very, very grateful for cell phones. World thought leaders the likes of Bill Gates, Director of the National Institutes of Health Francis Collins, and the president of the Rockefeller Foundation joined over 2500 attendees from around the world who all share the belief that cell phone technology is the tool by which we will be able to reach the world’s poorest and provide them with access to better health.

Here in the United States, innovative programs like text4baby are making use of the ubiquitous nature of cell phones to put valuable health information and access to local resources right at the fingertips of pregnant women and new moms.

While I will absolutely not be thankful for any cell phones that make their way to my family’s Thanksgiving table, I will nevertheless be grateful that they exist, not just to make my life easier, but improve the health and well-being of those less fortunate than me.

Originally posted on Omaha World Herald’s Live Well Nebraska