Staying Safe Around Pets

Luis A. Castagnini, MD, MPH, Infectious Disease Specialist

Marisol N. Lazarte, DVM, Veterinarian

Jendi Haug, MD, Emergency Services

This pandemic certainly has brought many changes to our lives. We have changed the way we interact with one another. We spend more time at home and many children around the country are adapting to distance learning. We now must wear masks while in public, stay six feet apart and wash our hands at every opportunity. These are all important measures to stay safe from COVID-19 and other infections. However, more time at home also means more time with our beloved four-legged friends. Whether a dog or a cat, many Texas households include a furry member. These longer and more frequent interactions with our pets increase the risk of a bite or a scratch. Since the beginning of the pandemic, The Children’s Hospital of San Antonio emergency departments downtown and at Westover Hills have seen an increased number of children who have experienced dog and cat bites. With this in mind, it is important that all members of the family follow safety measures around pets. This is particularly important for toddlers and school-aged children, as they are the most frequent age groups affected.

9 Tips for Staying Safe Around Pets

You can prevent bites and other injuries from animals by remembering these recommendations:

1. Never play or bother a pet while it is eating or drinking. This is one of the most common scenarios that lead to an attack.  A child or an adult can suffer a bite during the pet’s eating time.  Given the smaller size of a child, this type of attack is more likely to occur in the upper body, including the face.
2. Do not interrupt your pet’s sleep.
3. Do not try to ride on your pet or pull its tail.
4. If your pet recently had kittens or puppies, do not get near them as the protective instinct of the mother may lead to an attack.
5. Make sure your pet has all its vaccines.
6. Kids should be instructed not to pet strange or unfamiliar animals without the expressed consent of the owner. Even then, it is always a good idea to be careful and have an adult directly supervise. Some experts recommend staying away from strange animals or pets altogether.
7. If you are approaching your pet, talk first so it will know you are coming and will not be surprised. Please always respect pets as you respect people. 
8. Any sign of aggression (i.e. growling, hissing) or signs the pet might be scared (i.e. tail hiding between the legs, ears pinned back) should be taken as a sign of “alert.” A child should not approach such an animal that is showing signs of aggression or fear.
9. Never get close to a strange animal that is alone.

Teach your children not to bother pets when they are eating or drinking. Pets can become aggressive if they feel their food may be taken away.

What should you do if you or your child are attacked by an animal?

First, thoroughly wash the wound with soap and water. If the injury is minor, calling your physician may be all that is needed. However, your child might need emergency care if the wound continues to bleed, is large, or involves multiple locations. If the wound is located on the face, hands or if the animal is unknown to the patient, visit the closest emergency department for further management. Some bites, especially from cats, require the use of antibiotics to prevent infection. Others may require stitches and even preventative measures for rabies. Finding out the rabies vaccination status of the animal is important for your child’s health. If this information cannot be determined, please consider contacting Animal Control and seek medical attention. 

What to Expect in the ER by Dr. Jendi Haug

At the emergency room, we will ask about the rabies status of the animal. If this is unknown and Animal Control has not been contacted, we will have you fill out a form that will be sent to Animal Control. We will screen for rabies risk and the need for rabies prevention or observation. Also, we will provide pain control and clean and irrigate the wound. We might start antibiotics depending on the characteristics of the injury and stitches may be needed to close the wound. For complex or extensive wounds, such as wounds that involve the face or hands, a surgical specialist might be consulted to repair the wound in the operating room to reduce scarring.

We can all contribute to staying safe at home while loving our pets. Please always treat animals with kindness and respect.

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Fresh Ideas for Summertime Fun

Likhitha Reddy, MD, PGY2, Resident, Baylor College of Medicine – The Children’s Hospital of San Antonio

How many times have your school-age children told you they are bored today and that there was nothing to do? Have they given up asking, “What are we doing today?” because they know the answer? It’s tough being a kid – even tougher being a parent the past few months.  

We’ve compiled a list of things parents and caregivers can do to keep kids of all ages occupied and maybe even stimulate their curiosity and knowledge – helping you all get through the crazy summer of 2020.  

1. Schedule activities ahead of time While it may not be possible for children to physically attend camps, extracurricular activities or play dates in person, there are an abundance of activities available for your children to enjoy. Scheduling activities beforehand will help children maintain a routine and have something to look forward to every day.

2. Active play is a child’s best friend It is important to incorporate as much active play into children’s schedules as possible. Playing outside, riding bikes in the park, hiking, playing soccer, basketball, volleyball, or just going for a walk around the neighborhood are great ways to get exercise while also spending valuable time with your children.

3. Read, read, read As much as exercise and active play are necessary, it is just as important to make sure kids have time to keep their brains engaged and continue to learn through the summer. Schedule time for reading or listening to audio books or podcasts this summer. The San Antonio Public Library is a wonderful resource to achieve this goal.

4. Limit screen time as much as possible Electronic devices may seem like the easiest option to keep kids busy for most of the day. You can still find ways to make sure screen time includes interactive and educational components. As a parent, it’s important to make sure screen time doesn’t interfere with activities that engage the brain and keep children physically active. Also, make sure devices do not interfere with sleep and family relationships.

Let’s keep our brains active!

Google Arts & Culture has partnered with thousands of museums around the world to offer virtual tours from the comfort of your home. Click here for the complete list.

If you prefer a virtual zoo experience, the San Diego Zoo has set up virtual cams for children to watch the animals. San Diego Virtual Zoo

The San Diego Zoo offers a virtual experience. What are the elephants up to today?

From drawings to science experiments, NASA is providing lists of activities for kids to enjoy with their parents at home! Check out Outta This World!

For a low price of $5, Scholastic provides educational activities for children all summer long. Learn at Home

Chrome Music Lab is a hands on website that helps kids tap into their musical side

Texas Home Learning provides at-home resources for parents to help access educational activities for children. Let’s Learn!

Summer camp…Virtually!? Use Varsity Tutors to help kids (K-12) make the most of their break with interactive camps taught by expert instructors online.

Get your art on with Ms. Sue! Let you and your kids’ creative side flow with free online art classes on Youtube! Ms. Sue’s Art Studio is always open!

Story time is fun time!

Audible is one of the world’s largest collections of audio books and they are currently offering free stories in all different languages for kids! Start Listening Here!  

Podcasts especially for younger children between 2  and 6 years old! List of Podcasts

Storyline Online is a children’s literacy website that streams videos of celebrities reading children’s books along with illustrations.

Imagine a world of possibilities thru the San Antonio Public Library! Subscribe to the Youtube Channel to get more information. IMAGINE!  

Summer sunshine

• Go on family bike rides or hikes, try to see how many different animals they can identify.
• Go to the San Antonio Zoo.
• There are a number of parks still open in San Antonio and families can spend time there while safely social distancing:
  • Friedrich Wilderness Park – By far the most popular park in San Antonio!
  • Brackenridge Park – Great place for biking!
  • Government Canyon park
  • Woodlawn Lake Park – Great place for hikes and fishing!
  • Japanese tea garden
  • Botanical Gardens
  • Jenschke Orchards in Fredericksburg has peach picking tours available for the family. Pick Peaches here!
• Plan a picnic in the park on a nice sunny day.

Stay in and bond!

Garden in your own backyard.

Cook with your brand new planted garden crop! Explore new recipes with the help of local San Antonio CHEF program. Children as young as 3 can help you cook in the kitchen and it can be a fun adventure to get them to try new cuisines as well!

Camp out in your backyard and cook up some s’mores.

Shoot for the stars! Go stargazing outside on a nice clear night. How many different constellations can you identify?

Pick up some chalk at any local store and decorate the sidewalks. Maybe even play a game of hopscotch!

How about a good old fashioned game of hopscotch on the sidewalk? Hopping can be great exercise. Use sunscreen and stay hydrated when playing outside.

It may have been a while since the kids saw their elderly loved ones. Have them write and decorate homemade letters to the grandparents! Plan time to visit with them through windows or glass doors. If it’s hard to hear each other, use your mobile phone to chat at the same time. They will love seeing how big you’ve grown … and they miss you more than you know!

We hope this list has given you some new ideas and resources to make it through the summer, get some exercise, and keep the boredom blues away!

If your child is having a tough time coping during the pandemic, talk to your pediatrician. If you need a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Pediatricians

Keep calm and parent on

By Nancy Kellogg, MD, Child Abuse Specialist, and the team at the Center for Miracles at The Children’s Hospital of San Antonio

The COVID-19 pandemic has created a new work force: stay-at-home parents who are faced with the 24/7 job of child care.   The additional stresses of isolation, buying food, and keeping children happy and safe can be exhausting and frustrating.  Here are a few tips:

1. Try to keep a routine for mealtimes and activities so children are engaged and less likely to get bored and irritable. 

2. Invent some new activity/game. For example, older children may enjoy a different scavenger hunt each day for a favorite toy. There are plenty of websites to explore ideas: https://time.com/5803373/coronavirus-kids-at-home-activities/

3. Limit screen time for yourself and your children.  Social media content is more stressful now and children need to stay healthy and balanced with physical and interpersonal activity. Play outside whenever possible.

4. If you use a babysitter, be sure you speak to references first and ask for frequent updates when you are away. Make sure your children know to call you if they ever feel uncomfortable or scared.

4. Know your triggers.

*A baby who won’t stop crying. Put him in the crib, walk away, and take a few minutes of “time out” for yourself in another room

*A toddler with tantrums. Distract her, redirect attention, and use time out so everyone can calm down.

*Potty training.  Have lots of patience and if it is too stressful for you or your child, stop.

5. Be kind to yourself and others.  Everyone has been affected by COVID-19.           

6. Video chat with friends and family or try a hotline: Counselors are available 24 hours a day at Childhelp’s National Child Abuse Hotline: 1-809.4.A.CHILD

To report suspected child abuse: 1-800-252-5400

TINY TECHNOLOGY PRESENTS GIANT RISK

Andrew Gledhill M.D., PGY2, Baylor College of Medicine Residency Program, The Children’s Hospital of San Antonio

As technology advances, it can be challenging to keep up with all the latest gadgets. Handheld devices can do just about anything we want done. While these advances bring countless benefits, they also present a sometimes-unfamiliar hazard to children. Powering many of these devices – TV remotes, garage door openers, watches, toys, and even musical greeting cards to name a few – are button batteries. 

The Center for Poison Control reports that every year in the United States, more than 3,500 children swallow a button battery. Infants who are learning to crawl, and are increasingly curious and able to get into things, are at greatest risk.  Toddlers and young children are also at a higher risk, as they may be able to open battery cases on toys and electronics, and can still be curious enough to put things into their mouths. 

The danger associated with button batteries occurs when a child swallows the battery and it becomes lodged in their throat.  When this happens, secretions from the mouth and throat cover the battery and allow electricity to pass from the battery into the surrounding tissue. If left long enough, the battery destroys surrounding tissue, which can lead to serious burns, bleeding, scarring, perforation of the throat, and even death. The scariest part about this process is that it can happen within a few hours of swallowing the battery.

A child who swallows a button battery needs immediate medical attention. If you ever suspect your child has swallowed a button battery, take them to the emergency room immediately, where doctors can perform a chest X-ray to see if a battery is lodged in their throat. Be sure to bring whatever package or item the battery was in, so the battery can be identified. Signs that something is lodged in the throat include wheezing, noisy breathing, drooling, chest pain, coughing, gagging, or choking; but a child who has swallowed a button battery may not show any immediate symptoms, so if there is any suspicion that they may have swallowed one, take them to the emergency room to make sure. If your child has swallowed a button battery then doctors will use a special camera to look down the throat and remove the battery.

Although the risks associated with button batteries are scary, a lot can be done to prevent these complications. The best prevention is to simply look around and identify which items in your home use button batteries, and then make sure children can’t get to these devices. To do this, tighten screws on any devices holding button batteries, put those devices out of reach of children when possible, and keep extra batteries locked away altogether. Keep in mind that many toys today come with button batteries already installed. To learn more about this topic visit www.thebatterycontrolled.com.

August is Children’s Eye Health and Safety Month

Matthew Sattler, M.D., PGY-2 Resident, Baylor College of Medicine at The Children’s Hospital of San Antonio

Vision assessment is an important component of the routine care of all children. Most children are able to participate in a formal vision screen at their well-child visit when they are 4 years old. Between five and ten percent of preschool children have an undetected problem with their vision. Here are some warning signs that your child may have difficulty seeing:

• Wandering or crossed eyes
• A family history of childhood vision problems
• Disinterest in reading or viewing distant objects
• Squinting or turning the head in an unusual manner
• Eyes that flutter quickly from side to side or up and down
• White or grayish-white color in the pupil

Discuss any concerns about your child’s vision with his or her pediatrician as your child may need to be referred to an eye doctor (ophthalmologist) for treatment. You can read more about common eye problems at HealthyChildren.org, a website approved by the American Academy of Pediatrics.

Taking care of your child’s eyes also means keeping them safe from injury. Did you know there are more than 19,000 children treated in emergency rooms for eye injuries every year? Most eye injuries in children are the result of sports injury, especially basketball, baseball or softball, and non-powder guns (e.g. paintball, BB guns). The American Academy of Pediatrics and the American Academy of Ophthalmology recommend the following for each sport:

• Basketball: protective eyewear with polycarbonate lenses
• Baseball or softball: facemask attached to batting helmet when batting, polycarbonate faceguard for fielders
• Non-powder gun: Eye protection meeting ASTM standard F1766

Another way to prevent eye injuries in children who are too young to play sports is to ensure that all toys are age-appropriate and do not contain sharp edges that could damage the eye.

As always, if you have any questions or concerns about the health of your child’s eyes, please schedule an appointment to talk with your child’s pediatrician. If your child experiences a serious eye injury or eye infection, visit one of our 24/7 emergency centers in San Antonio:

• The Children’s Hospital of San Antonio, 333 N. Santa Rosa Street
• The Children’s Hospital of San Antonio Emergency Center – Stone Oak, 1434 E. Sonterra Blvd.
• The Children’s Hospital of San Antonio Emergency Center – Westover Hills, 11130 CHRISTUS Hills, Medical Plaza 3, First Floor

Look Before You Lock

Jacqueline Khalaf, BSN, RN, CPST, Injury Prevention and Community Outreach Coordinator, Trauma Department, Certified Child Passenger Safety Technician

The stories in the news are becoming too common:  “Child left alone in car dies.” 

Most parents believe it can never happen to them, but even the slightest change in routine or stress level can be a distraction that leads to the unthinkable.  Sleeping babies are so peaceful and it can be tempting to think that you can just run inside the store for a quick errand.  Never leave a child alone in a car.  Even a quick errand inside can lead to injury or death from heatstroke, even when the weather cools off.

Every 10 days, a child dies from heatstroke after being left in a car.  Last year alone, Texas tied with Florida for the number of cases of vehicular exhaustion. 

Here’s what you need to know about heat strokes in kids:

• The temperature inside a car can rise 19 degrees or more in 10 minutes. 
• Cracking windows does not help.
• A child’s body heats up four to five times faster than an adult’s.

There are simple tips that can help:

• Leave a cue in the back seat – a purse, work bag, or phone.
• Have a plan with your daycare to check on your child.
• Keep your car locked when you are not in it.
• Don’t leave car remotes around children as they can get trapped in hot vehicles.
• And always look before you lock!

Keep Your Kids Safe Around Water

Tracy McCallin, M.D., F.A.A.P, Emergency Physician, The Children’s Hospital of San Antonio

Did you know drowning is the second highest cause of death for children under 14 years of age, and is the leading cause of death from preventable injury in children between 1-4 years? As a pediatrician working in the pediatric emergency department for the past eight years, I treat victims of drowning every year. Seeing even one child who has drowned is one too many. Every drowning is a preventable tragedy, and as a co-author for the recent American Academy of Pediatrics (AAP) policy statement “Prevention of Drowning,” I am spreading the word on water safety to give parents the knowledge they need to keep children safe around water.

Another fact you may not know is that toddlers are at highest risk of drowning during non-swim times. The biggest risk to these young children is unexpected access to water, including swimming pools, hot tubs and spas, bathtubs, toilets, and natural bodies of water. The Consumer Product Safety Commission (CPSC) reports 69 percent of children under 5 were not expected to be at or in the pool at the time of a drowning incident. Developmentally, toddlers and preschoolers are curious and lack the awareness of the dangers of water. Drowning is quiet and can take less than a minute. By the time a parent realizes the child has slipped away and fell into a backyard pool, pond or other body of water, it is often too late.

Physical barriers must be in place to prevent unintended access of children to water during non-swim times. Based on the most current evidence, installing four-sided fencing (at least 4 feet high) with self-closing and self-latching gates that completely separates the pool from the house and yard is the most effective way to prevent drowning in young children, preventing more than half of swimming-pool drownings in this age group. These safeguards are vitally important in preventing access to the water when a parent is distracted by other children, making dinner or answering the phone.

The AAP also recommends doing a “walk through” whenever you take your child to a new environment such as a friend or neighbor’s home or a vacation rental, to check for bodies of water and what barriers may or may not be in place to protect your child.

Close, constant, and attentive supervision is a critical layer of protection against drowning when children are expected to be around the water. Adults should provide “touch supervision” within arm’s reach of all children in or near the water by designating a “water watcher” who will take on this task. The watcher needs to be free from distraction including talking on the cell phone, social media and alcohol use. For infants and children up to age 6 years, always supervise when bathing and never leave a younger child in the care of an older child. Remember that children can drown in less than one minute in two inches of water or less; the time it takes for a parent to answer the door, check on dinner or get a towel. Parents should also know that teenagers are the group at second highest risk of drowning, and should be counseled about alcohol use around the water and life jacket use when boating.

Another strategy that may decrease drowning risk, which is now recommended by the AAP, is swim lessons beginning at 1 year of age. The decision of when to start swim lessons must be personalized for each child, considering your child’s comfort in the water, overall health status, developmental stage, emotional maturity, and physical ability. The AAP policy statement recommends infants younger than 1 year are developmentally unable to learn the complex movements, such as breathing, needed to swim. While they may show reflexive swimming movement under water, they cannot lift their heads well enough to breathe and there is no current evidence to suggest a benefit of infant swimming programs under 1 year of age.

Other ways to prevent drowning include wearing U.S. Coast Guard approved life jackets when boating and for non-swimmers or young children when in or near water. The AAP advises everyone should have CPR training and learn basic swimming skills, as well as swimming at sites with lifeguards especially for open water recreation.

There has been much fear, confusion and misinformation in the media during recent years about something called ‘’dry drowning” or “secondary drowning.” One of my jobs as a pediatrician doing drowning prevention work is to help worried families understand what drowning is and what it is not. Although you have likely read some scary stories out there, let me reassure you there is no such thing as dry drowning or secondary drowning. These are not actual medical conditions and the AAP recommends using the terms “nonfatal drowning” to describe a child who did not die from a drowning event, and “fatal drowning” to describe a death from drowning.  

Current evidence has shown children with a drowning event will have symptoms such as trouble breathing or lethargy within one to two hours of the event. Drowning does not occur at a later time in children who had previously looked well. Incidents where a “dry drowning” death was reported in the media were most likely a coincidental event later thought to be related to water exposure days or a week before. If your child has no problems one to two hours after coughing, sputtering or swallowing water, you can feel reassured they will not develop symptoms of a drowning event at a later time.

So when do you need to worry if your child has drowned? Based on American Heart Association (AHA) recommendations, if your child needed any type of rescue breathing or CPR at the scene of a drowning event, they should always be taken to the emergency department (ED) for evaluation. If your child is having trouble breathing or other serious problems after a drowning, he or she will need to stay in the hospital for specialized care and treatment. However, if your child is looking well with normal vital signs and exam after observation in the ED, he or she can be safely sent home and will not suffer a drowning related death days or a week later.

The best way to keep your child safe around the water is to remember there is no single way to “drown-proof” a child, and multiple layers of protection must be used against drowning. You now have the knowledge you need to keep your child and other important children in your life safe, so please share this information with others.

For more information on drowning prevention, please visit the AAP Drowning Prevention Campaign toolkit at https://www.aap.org/en-us/about-the-aap/aap-press-room/campaigns/drowning-prevention/Pages/default.aspx

Also, you can visit the AAP site for parent education at https://www.healthychildren.org to read helpful articles on water safety such as:

• Infant Water Safety: Protect Your New Baby from Drowning
• Drowning Prevention for Curious Toddlers: What Parents Need to Know
• Swim Lessons: When to Start & What Parents Should Know
• Safety Barrier Guidelines for Residential Pools: Preventing Child Drownings

Playing it safe

Playgrounds are great places for children to exercise, but you want to be sure your children are safe while they’re having fun.

More than 200,000 children visit the emergency room every year after being injured on playgrounds. While the swing set can seem terrifying in the face of that statistic, rest assured that you can keep your children safe on the playground by following these guidelines from the National Safety Council and the American Academy of Pediatrics:

Anchors away — All playground equipment should be anchored in the ground and have no sharp edges.

Trick-or-treating with food allergies

by Lindsay Lambarth, DO
Baylor College of Medicine, PGY-2
The Children’s Hospital of San Antonio

Did you know that almost 40 percent of children with food allergies have experienced severe reactions? And that in the United States, 170 different foods and ingredients have been identified as the cause of allergic reactions?

Halloween can be a difficult time for children with food allergies due to the high risk of reaction when ingredients are not monitored closely.  To help keep trick-or-treating safe for children with food allergies, the Teal Pumpkin Project was created.  Teal pumpkins serve as a symbol of safety during Halloween for children with food allergies and indicate that non-food items are available.

How can you participate?

1. Place a teal pumpkin in front of your home (classroom, office, or wherever treats are provided this season) to show that you have non-food items available.
2. Provide non-food treats such as pencils or stickers for trick-or-treaters.
3. Display a flyer or poster to inform others of what the teal pumpkin stands for. Follow the link below for free resources and flyers to print.

https://www.foodallergy.org/education-awareness/teal-pumpkin-project/free-resources

Walk to school safely with these 10 tips

October is Walk to School Month

By Jacqueline Khalaf, RN
Injury Prevention and Community Outreach Coordinator
Trauma Department, The Children’s Hospital of San Antonio

Walking to and from school can be great exercise for children of all ages. If you’re lucky enough to live only a few blocks from your child’s school, here are a few tips to consider to make sure your child is safe when walking to and from school:

1. Walk on sidewalks when possible. If there are no sidewalks, walk facing traffic and as far from traffic as possible.
2. Children under 10 should not cross the street without an adult.
3. Don’t be distracted by phones and other devices. Eyes up!
4. Be aware of your surroundings. Be on the lookout for loose animals, strangers, and traffic.
5. Always cross as crosswalks. Don’t run. You are more likely to fall if you are running.
6. Look left-right-left and ensure vehicles stop at crosswalks before you cross the street.
7. Make eye contact and wave to the motorist. If they wave back, this indicates they have seen you.
8. Consider your second-edge — sometimes crossing happens mid-block instead of at crosswalks, such as between two parked cars. Make sure to stop at the edge of the vehicle (second edge) to look left-right-left again so that you see approaching traffic and drivers see you.
9. Hold the hands of little ones when crossing the street. Young children may play or run, not understanding the dangers of crossing the street.
10. Make sure children are visible using reflective equipment, lights, or wearing bright colors when it is darker outside.

Source: Safe Kids Worldwide. (2016). Safety Tips. Retrieved from https:/www.safekids.org/safetytips.