SAFETY AND SET UP

One of my one liners I have often used over the years applies to children's behavioral development, their self-value development and their safety.

"If we don't set it up (meaning their world they live in), we set them up."

This applies to safety as much as any other part of parenting. Many parents have trouble seeing and understanding that providing the proper fences and gates around the house is nothing more complicated than helping a child learn about boundaries in life. It has always been my impression that as soon as a baby leaves the womb, they are looking for the walls of the uterus and those boundaries that they have known for nine months. Most babies love to be swaddled and they will move themselves into the corner of the crib and wedge in there as soon as they can. In the office, babies are always most calm in their mother's lap (as close to the place where they loved the boundaries as they can get).

So, when we confine an infant to a playpen or to a play yard and put inside with them all the things

that they can do and can play with, we are setting up a place that they can be happy entertaining themselves and where they don't need our opinion about how they are doing. It also creates a place where they cannot misperceive what we say in trying to "redirect" their behavior if such boundaries do not exist. If a parent is continuously saying to you, "Don't touch that", "Come over here", "Get out of there" or "Stop doing that", I consider that they are micromanaging the baby and my impression is that there is a high likelihood that they baby may easily perceive that he is not doing a "good enough" job of being himself.

When it comes to safety, it's not even a question of helping a child learn about boundaries, it is about keeping her alive. Infants and toddlers and 3-5 year olds cannot be trusted because they have an intense curiosity which will get them into trouble every time they have the opportunity.

There should be no way that your child can open the front door of the house alone and they should not be able to reach the garage door opener or the latch on gates out of the back yard. There is no reason for any young child to be in the kitchen or the bathroom - fence them out. They can figure out most safety devices and we forget to latch them and they create a false sense of security regarding needing to know where the child is at all times. A fenced-in child is just one more layer of safety which protects us as parents as well as helping the child learn about boundaries. Safety must be an absolute boundary. We can't set them up for accidents and injury.

Finally, I continue to say that "Second boys following girls are the most dangerous children ever made." Girls tend to be much less physical than boys, but second boys learn by watching their sister and figure out how to do things much younger than the sister did. And as parents, we are not ready and can easily be caught off guard. So remember boys following girls are DANGEROUS and set-up is everything with them.

HOT OFF THE PRESS:

New advice: Rear-facing car seats safer for children until they are 2

Lori O’Keefe
Correspondent

Toddlers between the ages of 12 and 23 months who ride rear-facing in a car safety seat are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat.

Overall, children under the age of 2 are 75% less likely to die or experience a serious injury when they ride in a rear-facing car seat, according to the first U.S. data to substantiate the benefits of toddlers riding rear-facing until they are almost 2 years old

COMMENTARY

Rear-Facing Car Safety Seats: Getting the Message Right

Marilyn J. Bull, MD andDennis R. Durbin, MD, MSCE

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Information learned during medical training changes frequently with advances in nearly every field of medicine. Now we are asked to learn new advice to give parents and caregivers of infants and young children regarding the safest way for them to ride in a car.

Child fatalities and injuries in motor vehicles have been significantly reduced since initiation of occupant-protection measures in the 1970s.¹ The combined efforts of the counseling of primary medical care providers, the education and research provided by the National Highway Traffic Safety Administration, the carsafety seat manufacturers, and many research facilities, and the support of child passenger safety advocates across the country have been largely responsible for these results. Many challenges remain as we strive to continue to reduce the rates of injury to children on our nation's highways. It is critical to realize that, despite marked improvement in rates of restraint in all age groups, over half of children killed are improperly restrained or unrestrained. Our first priority must be to ensure that every child is restrained appropriately for his or her age and size for every trip in a car.

Helping parents make the best decisions for selection and proper use of car safety seats and seat belts is very important. Continual evolution of knowledge, safety information, and changes in car safety seat designs make this task extremely challenging for health care providers.

One significant change in counseling is now emerging that may greatly improve the safety of infants and young children. A recent analysis of the protection provided in rear-facing compared with forward-facing car safety seats has revealed that children under the age of 2 years are 75% less likely to die or sustain serious injury when they are in a rear-facing seat.² This finding was true regardless of direction of the crash, even those crashes with side impact, which typically are the most severe.

Although the study could not provide data dividing the ages by individual months, it is notable that rear-facing car safety seats were more effective than forward-facing car safety seats for both infants under 1 year and children aged 12 to 23 months. The odds of severe injury for forward-facing infants under 12 months of age were 1.79 times higher than for rear-facing infants; for children 12 to 23 months old, the odds were 5.32 times higher.

This information is additionally supported by data from Sweden, where children have ridden in rear-facing seats up to 4 years of age for many years, and very low death and injury rates have been documented³.

For many years the American Academy of Pediatrics has recommended that for best protection, children should ride in a rear-facing seat to the highest weight that is allowed for use by the manufacturer of the seat.⁴ Health care providers and many parents with older children, however, have learned the earlier message that children should ride in a rear-facing seat up to 1 year of age and 20lb,⁵ although that recommendation was later modified to "at least 1 year of age and... at least 20 lb."⁴

Now we are challenged by greater evidence to implement what we know to be best practice: Children should ride in a rear-facing seat to the highest weight or height allowed for use rear-facing by the manufacturer of the seat. As an infant approaches 20 lb, when his or her head is within an inch of the top of the seat, and at the 4-, 6-, or 9-month visit, it is appropriate to counsel families that they should transfer the infant to a convertible seat that is approved for rear-facing use to higher weight and height limits.⁶ Parents may be helped to understand the importance of using the convertible car safety seat in the rear-facing position longer than 1 year if they are counseled that children are 5 times safer than when riding in a forward-facing seat into the second year of life.

At this time, it is not possible to determine at what month of age, if any, that this is no longer true, but as more and more parents follow this advice, we hope it will be possible to elicit these data in the future.

Another barrier to implementation of this best-practice recommendation is the common myth that if a child's feet or legs reach the back of the vehicle seat, he or she is at increased risk for a lower-extremity injury. Current data do not substantiate that myth. Lower-extremity injuries are rare for children facing the rear, on the order of 1 per 1000 children (Partners for Child Passenger Safety Study, unpublished data, 2007). In addition, riding facing front does not eliminate a child's risk of lower-extremity injuries, because these injuries, as well as injuries to the head and spine, have been described among forward-facing children in child-restraint systems.⁷