Amanda Wilde (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Rady Children's Health. I'm Amanda Wilde with Amy Frias, community health educator at Rady Children's Health in Orange County. She is going to help us understand accidents that send kids to the ER and how to prevent them. Thank you for being here, Amy.

Amy Frias, BS: Thank you so much for having me, Amanda. ,I'm happy to be here.

Host: It's a really important topic that concerns everyone who has kids or works with kids. So, what are the most common accidents that send children to the ER and do those vary by age and developmental stage?

Amy Frias, BS: Absolutely. Great question. Well, I'll let you know that we really do try to avoid that word, accidents. And that's because, in injury prevention, accidents imply that there is something that is random, and it's not random. The things that typically send kids to the ER are usually predictable and they're actually preventable. So, it's really important to kind of switch on accident. Because again, that's not a random activity. We use the term injury not to cause blame, but instead to always know there's factors to it that can be fixed and that these injuries don't happen.

So, it's one of those things that we really kind of focus on the trauma data. And really, what it is, is when a kid visits an ER for an injury for a broken arm or a broken leg, you know, those things can heal. And broken bones And that kind of stuff In a childhood is so normal. It's just kind of the rough and tumble way that kids grow up. So, kids typically get hurt most often at home, at play, and on their way. If you break it down that way, it really kind of shows you what those higher incidences of trauma, which means life-threatening as opposed to going to an ER when it's not life-threatening, yet it's still an emergency.

So, the hot topic right now is e-bikes. We are seeing an influx of very traumatic injuries of kids of all ages, surprisingly, with riding on e-bikes. And again, there's just a lot of ways for parents to prevent stuff from happening. Also, falls. Falls are a leading cause of injury for kids and it's all over the map. But what people don't realize is it's something like window falls, that has a high incidence of traumatic injuries for kids. And all of these things again, and I can talk a little bit about that later, are preventable.

Another area of high incidents of injuries, and it's all ages and that's what's interesting, motor vehicle crashes. Motor vehicle crashes are a leading cause of traumatic injuries in kids. And it's something that we've done a lot of work in with car seats that have helped prevent some of those injuries. Also, motor versus pedestrian. We have a really big issue with distracted drivers, and pedestrians that are wearing headphones and nobody's paying attention, and it's just a very scary situation. There's also a good amount of sports injuries. But again, there are things that parents can do to help prevent those injuries.

Host: What are some simple changes parents can make at home that can make the biggest difference?

Amy Frias, BS: The biggest difference is environmental changes, education, and literally understanding what your kids are up to. When it comes to e-bikes, it's so important for parents to do their research and understand what an actual e-bike is. There's a difference between an e-bike and an e-motorcycle, and the biggest difference is speed. E-bikes are broken up into three classes: class 1, 2, and 3. Class 1 and 2 have no age limit. They go to 20 miles per hour. I mean, some people can ride their bike really fast, but normally eight miles per hour more than a regular bike. That's a pretty big jump. And then, class 3 can go up to 28 miles per hour and you have to be 16 to ride a class 3.

So, you really want to make sure that your child is physically and mentally ready to ride something that actually has speed, that they know the rules of the road, which what 11-year-old knows exactly what the rules of the road are? Not necessarily, you have to know what cars are doing and you have to know what pedestrians are doing, and you have to respect the bike riders. You have to respect everyone. So, it's a big responsibility to have an e-bike.

So, my suggestion to parents is go with your child and actually get on an e-bike as a parent and feel what that feels like to touch that throttle and to actually go forward quickly. It's kind of telling. It's like, "Whoa, I didn't realize it went that fast." And when you say 20 miles per hour, it doesn't, but what we're seeing is those injuries that are almost as if kids are riding on a motorcycle because of that speed in their bodies. Wearing protective gear, wearing a helmet, and making sure you wear a helmet on any wheel-based sports. It is the law. But to also remember, that with an e-bike, a MIPS helmet, which has a multi-impact—it helps move so that your head is fully protected. They are a little bit more, but that is what's important to wear on an e-bike. A typical bike helmet or all-sport kind of helmet will work, but it's not going to do the job that one with MIPS has, and you are considering a jump in that speed that it causes more injuries.

Children, again, under 16 should only be writing class 1 or 2. but just remember that you have to make sure your kids are physically and mentally able to take on that responsibility, and then that 16 and over. So, it's just really important that they pay attention to the laws in their local area, that they follow those rules of the road, that they wear that protective gear. Something I'm very passionate about because we do see, unfortunately, a lot of very severe injuries with kids that haven't been doing those things.

Host: What other common injuries do you see that are most preventable?

Amy Frias, BS: Falls are another one. Like I had said, the falls from windows. Something as simple as those environmental changes and moving furniture away from the window, not having furniture next to it when you have young children, having a lock or a guard on the window so that it doesn't open more than four inches.

That's just little steps you can take to help prevent kids from falling out of the window. And keeping in mind that screens keep bugs out, knock kids in. So, it's one of those things if a child puts any weight on a screen, they're going to most likely push that screen out and fall out of the window. So, we know that our little toddlers are so top heavy, so anytime they lean over, the rest of their body tends to go with them. So, it's just another thing that you can do. We can't bubble wrap our kids, but just make those small changes and they can make a difference.

For motor vehicle crashes, following the law is the minimum. And we love that we have these laws. They really do help. Keeping your child rear facing from birth until the car seat allows, and that doesn't mean keep them in that infant carrier, and then move to a forward-facing seat. It means have them in an infant care, and then move them to a convertible that continues to rear face until they're at least two years old.

In addition, you want children to stay in a five-point harness that is in a car seat as long as possible. We're looking at car seat manufacturers that have up to 65 pounds with an internal harness. They don't have a stronger part of their body, so that five-point harness really spreads that crash force and helps protect them from being ejected from the car. And also, when they're rear facing, the car seat takes the brunt of the crash and not the child's head, neck, and spine. So, it's definitely using car seats, using the appropriate car seat and using them every single solitary time. You have probably people have seen on social media, there is a new addition to that law and I keep seeing people freaking out, because it says until age 16. We have to put things in laws that make sense. But no, you're not going to put a 16-year-old in a booster. They're hopefully going to be driving. And by that time, they'll probably be in the front seat.

The recommendation is that you don't have anyone in the front seat that's under 13. If you flip down your little sun visor, it says it right there—airbags are made for adults, not kids. That new part of the law just says that children under 16 need to be able to fit in the seatbelt. And people don't realize that they're made for 165-pound male. So when a kid sits in the seat with just a seatbelt, and it cuts them in the face, they'll want to put it behind their back or under their arm. And in a crash, the seatbelt's not positioned correctly and can cause very severe injuries. So if your child does that, they need to be in a booster seat if they're older. And that's not a bad thing, it just props them up so the seatbelt fits them better. It's not a punishment, it's a protection. And again, the backseat is the safest. So, those are some of the things that you can do.

Motor versus pedestrian, let's not wear headphones or be on our phone when we're crossing the street. That's our responsibility. Yes, we have the right of way, but cars are a lot bigger. And guess what? We're never going to win that. So, just always pause and allow a car to go, even though it's your turn. But look left, look right, look left again. Be aware of your surroundings. It's very important that parents teach kids about crossing at corners and using crosswalks, and they learn from watching us. So when we introduce bad habits, they'll pick up on those too. So just be very mindful about that.

Also, drivers are distracted. Put your phone down. When you're driving, focus on driving. I could go into a whole 'nother thing with teenagers and having all their friends in their car. Do not be distracted when you're driving. That is not a time to multitask. That is a time to focus on what you're doing and being aware of your surroundings. If we work together as motorists and pedestrians and bicyclists, we could reduce these injuries—a lot. But the problem is people are walking and driving distracted, so we just need to be more mindful when we're doing those things.

For the sports-related stuff, helmets, wearing the safety gear, being very aware of the rules of the game and playing safely. Knowing CPR. As a parent, I look at CPR as a tool for your toolbox. You most likely are not going to have to use it, but you have it if you do. And unfortunately, when traumas occur, most common is choking on something or drowning. CPR is going to be needed. So, being able to do a CPR class and learning how to do the compressions and the breaths correctly is another layer of protection for our kids.

I do want to mention drowning. Drowning is not a trauma incident, but our numbers are so high and it is so heartbreaking to me to see kids that come into our hospital that have been pulled out of a pool and weren't given CPR in the right amount of time, and to see what happens to those families. It is important that you have layers of barrier protection around your pool that you are always supervising your kids when they are in water. Assign a water watcher, someone that's in charge. Because it's not easy to just sit there and watch the kids in the pool all day. We get distracted, we have to go to the bathroom. But if you assign a water watcher and I have to leave, I'm telling you, "Hey, I'm going to go to the restroom. It's your turn to watch the water." Preferably that person knows how to swim and know CPR.

There are ways to prevent unintentional injuries. And I think as parents, we are basically bodyguards for our kids in our own little way, and we do the best we can. And things are going to happen. But what I really want for us is that traumatic things aren't happening, and sharing these preventable tips or ways that parents can protect their kids, and not having something so tragic happen.

Host: Thank you for highlighting many of those everyday situations that are easy to overlook or underestimate. You mentioned teens as well. How can parents balance trying to give kids more independence as they grow into different stages with keeping them safe, especially with teens who are bound to take more risks?

Amy Frias, BS: You're speaking my truth right now. I have a 16, almost 17-year-old who has had his license for a short time. We went through that e-bike thing and they weren't as popular, so I got lucky. And at 15, I said, "Do you want an e-bike or do you want a car?" So, I never had to deal with that. Yay.

 But I am the Safe Kids Orange County Coordinator, so I have injury prevention in my blood. But at the end of the day, we give our kids two things. We give them roots And we give them wings. And nobody talks about the fact that roots are hard. That's when you're pulling up your sleeves and you're not sleeping and you're getting dirty and you got poopy diapers. And you're really kind of grounding them and it's hard work. But that moment that you start to give your kids the wings, that's harder. And nobody tells us that. It's scary.

With driving, I got a contract that I had my kid, and I'll go through that rules are rules, always wearing your seatbelt. Never getting into a car with someone who has been drinking or using any kind of drugs. There's things that we don't think we have to talk to our kids about that sometimes are uncomfortable, but have those conversations. Because as much as you think they're not listening, it does impact them. That moment where you're child is getting older and they're trying to get that independence, but they still need you, just be that soft place to land. Don't tell them I told you so. Just say, "Man, we all make mistakes." And the bottom line is we just don't want to do anything to hurt you or to hurt someone else. So, following the rules, the laws, or doing things that can help you not get hurt or hurt someone else, then let's do them.

Host: Well then, when an injury does happen, how do parents gauge whether it's something they can manage at home or they need to call their doctor or pediatrician or go straight to the ER?

Amy Frias, BS: The bottom line is, if you have any gut feeling that something is not right, go to the ER. If someone's not breathing, chest pain, you just have to navigate what's important to you or what is the most scary thing. When you have a new baby, those high fevers freak you out. So be it. You go to the ER when you feel like you need to go to the ER, but just know that you can. We have a lot of urgent cares and things like that that can actually be less expensive and get treatment there. And we also have our GET-CHOC phone number that has nurses that can answer your calls. "Hey, my kid fell off the bed. Do I need to take him to the ER?"

The bottom line is, when in doubt, take them to the ER. If you don't know if they hit their head, you don't want to take those chances that something severe could have happened to your baby or your child.

Host: Amy, thank you for a great education on safety for children.

Amy Frias, BS: Thank you so much for having me. It's just kids don't get hurt doing dangerous things, they really don't necessarily. They get hurt by doing familiar things and that's something to kind of think about. Because we think about the worst thing, we just have to keep them a little safer, kind of guard them with those tools that we have as parents.

Host: Amy Frias is Community Health Educator at Rady Children's Health in Orange County. For more information, visit health.choc.org/guide/safety. Thank you for tuning into Long Live Childhood, a pediatric health and wellness podcast, brought to you by Rady Children's Health. For more insightful conversations about kids health and wellbeing, be sure to subscribe wherever you listen to your podcasts. Together, we can help keep kids happy, healthy, and thriving.

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