TV Toppling Injuries

Between 2000 and 2010 169 children died from injuries sustained from television sets tipping over on them. Front heavy televisions can topple over on children and cause severe injuries. Children frequently are around television sets either reaching for a toy or a remote controller on top of the set or watching the television. They also can become tangled in or tug at TV or cable cords causing the TV to topple. These deaths are caused by severe trauma to the head or body or by suffocation. They do not need to happen and can be easily prevented.

An estimated 13,700 children were treated in emergency departments between 2008 and 2010 after being struck by a television. Younger children suffered greater injuries and were injured more frequently. The most common injuries were head injuries. Since this is the time of greatest neurodevelopmental change head injuries at a young age have dramatic and lasting effects.

To protect your child from such injuries follow these tips from the American Academy of Pediatrics:

  • Place your television on allow stand or base and push the television as far back from furniture as possible.
  • Make sure the stand is sturdy and can handle the weight of your TV.
  • Do not place your television on a piece of furniture that is not designed for this use.
  • Secure your TV and its stand to a wall stud with anchoring devices.
  • Check packaging to make sure the anchoring device can support the weight of your TV and the piece of furniture. Make sure the anchoring device is designed for the kind of TV you own. Older TV sets that are not flat screen are especially heavy and can injure your child severely.
  • Always follow manufacturer’s instructions on anchoring your TV.
  • Do not place toys, remote controls or other items that might attract your child’s attention on top of the stand or the TV.
  • Keep TV and cable cords out of sight and out of your child’s reach.
  • Be especially careful when you are at another person’s house with your child. Make sure their TV is anchored properly and all the safety issues discussed above have been dealt with. If there are concerns then do not allow your child near the TV.

Sun Damage

When your skin is exposed to sunlight that contains ultraviolet or visible light photosensitivity reactions can occur. The one you see most often is sunburn. Sunburn is seen on sun exposed skin surfaces with red areas and if severe swelling and blistering can also be seen. Pain and itching are also common. During the healing process skin peeling is often seen. The best treatment for mild injury is patience and cool compresses.

Acetaminophen can help with the pain. If there are more severe symptoms including blisters with associated fever, chills, headache and feeling sick then call your pediatrician. Severe sunburn needs to be treated like any other burn to the skin. Hydration is very important.

Other reactions include sun poisoning or sun allergy where a variety of skin changes can be seen. Skin changes begin within hours to days of exposure and can vary from redness and swelling to raise red areas with blistering. Another name is PMLE (polymorphous light eruption).

Skin rashes are also associated with the ingestion of various photosensitizing substances in combination with sun exposure. These are commonly due to drugs that induce photosensitivity reactions. These include antibiotics (sulfa/ tetracycline/ doxycycline), phenothiazines, griseofulvin (used for ringworm), thiazide diuretics and acne medication (retinoids).

Topical agents applied directly to the skin can also cause skin reactions with sun exposure. These include various fragrances, non-steroidal anti-inflammatory medication and various antimicrobial agents including hexachlorophene.

Photo allergic reactions are also seen due to skin contact with various plant substances during sun exposure. Limes and citrus fruits are common culprits. These skin changes are often delayed and appear 24 hours after sun exposure. The areas are not itchy but may be painful and after the redness fades an area of increased pigmentation is seen and can last for a long time.

If your child develops skin changes after sun exposure and it is not typical sunburn call your pediatrician.


What foods should I avoid giving my infant or toddler?

Infants and toddlers are unable to chew food as older children or adults.  Foods that are hard to chew should not be given to children until their molars (these are the chewing teeth in the back of the mouth) are in place, usually between the ages 3 to 4 years.  Examples of such foods to avoid are seeds and nuts, hard candy, raw carrots, or celery or popcorn (kernels).

Soft small foods can also be breathed in (stuck in windpipe) if slippery and small enough.  Examples of such foods to avoid include raisins, grapes, hot dogs and sausage until after age 3 to 4.

Foods that are “sticky” and thus difficult to swallow should be avoided.  These foods include caramels, peanut butter, fudge, etc.  Peanut butter can be mixed with jelly.

What other articles can be aspirated (stuck in windpipe)?

Small toy parts, balloons, marbles, styrofoam, plastic bags and pen caps, are some common household items that small children can pick up and put in their mouths.  Be sure to keep all such items out of children’s reach.

What can I do to prevent choking?

  • Do not allow your child to eat and talk at the same time.
  • Cut up foods into small pieces that he is able to chew.
  • Do not allow your child to eat and run or walk around at the same time.
  • Examine all toys for small removable parts and avoid using or purchasing such toys for your child.
  • Teach your child to eat slowly and chew properly.

Are Car Seats for Children Necessary?

How many children and infants are injured or killed in auto accidents?

Each year between 600-700 child passengers are killed and over 500,000 under the age of 5 are injured.

What is the major cause of death and serious injury threatening children today?

According to the American Academy of Pediatrics it is trauma suffered by children riding unprotected in cars involved in accidents.

Can proper car safety use help?

60-70% of the deaths and injuries children suffer in auto accidents can be prevented with proper car safety.

How much force is exerted on a 10 pound infant in 30 mph crash?

The infant is slammed forward with the force of 300 pounds. This is the same as falling from three story building.

Is it safe to hold an infant instead of using a car seat?

No. This is called the “child crusher” position. At 30 mph a 125 pound adult is thrown forward with the force of almost two tons.

Are there any hints in selecting a car seat?

Select one which is comfortable for your child. Test the seat in your car to make certain it fits correctly and is compatible with your seat belt system. Make certain your seat has passed dynamic “crash” testing and meets applicable Federal Motor Vehicle Safety Standard 213, effective January 1, 1981.

What is an infant seat?

These seats are designed for a baby weighing under 20 pounds. It must be installed so the infant rides facing rear.

What are toddler seats?

These are designed for the child who can sit up unassisted and weighs over 20 pounds but less than 50 pounds. These seats face forward.

Are there any other kinds of seats?

Yes. There are convertible seats which can be used for birth to age 3 or 4 years. They can be inclined and face backwards when the child is an infant and then be turned around and moved upright when the child is older.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) is the leading cause of death in healthy infants under age 1 year. It is the terms used to describe the sudden death of an infant under one year of age when a cause cannot be found when a thorough postmortem examination is performed. 20% of all episodes of SIDS occur when a child is being cared for by someone other than the parent. This is the time when protective strategies such as the “Back to Sleep” position is not used and the infant is placed on their tummy to fall asleep. Infants is accustomed to sleeping on their backs are 18 times more likely to die from SIDS if they are placed to sleep on their tummies. SIDS is not caused by immunizations, vomiting or choking and the risk can be limited by maintaining safe sleep practices and a safe sleep environment.

The peak age range is from 1-4 months and males infants are at greater risk than females. Premature or low birth weight infants and those infants with a history of apnea are at greatest risk. Other risk factors include infants born to mothers who smoke or use drugs, African Americans or those with Native American or Native Alaskan heritage. The fall and winter months are the highest risk periods and siblings of a baby who died from SIDS are at greater risk.

The use of a “Back to Sleep” position and the avoidance of soft bedding will alleviate some of the risk as will the avoidance of an excessively warm room or being over swaddled. Do not let your infant get too hot. If you notice your infant has damp hair, is flushed or has been sweating then dress your infant lighter. Set the room temperature in a range that is comfortable for a lightly clothed adult. Babies do not need warm rooms. Environmental tobacco smoke must also be avoided. The rate of SIDS decreased by more than 50% after the “Back to Sleep” campaign was started. One of the new risk factors, especially for infants under age 2 months, is bed-sharing or sleeping in an adult bed with soft bedding or a soft mattress. Side sleeping is not as safe as back sleeping and should be avoided. Infants can easily roll over to a face down position and the use of special equipment to position your infant on the side is unsafe. Keep all quilts, pillows, and stuffed animals out of cribs.

Tummy time is important for your infant but should be used when your infant is supervised and awake. It should be integrated into your daily activities. Tummy time helps to build strong neck and shoulder muscles. This position allows your infant to develop new skills which will allow a proper progression of developmental milestones.

Parents often raise the question of home apnea monitors to prevent SIDS. Home apnea monitors are not prescribed to prevent SIDS. They are used for infants who are at risk for apnea or bradycardia due to an underlying condition. Apnea is the name given to a pause in breathing and bradycardia is a slowing of the heart rate below a normal level for your infant. Apnea and bradycardia may be associated with cyanosis. Cyanosis is the name given to a bluish hue to your child’s lips or skin. Possible physical causes for apnea include prematurity, anemia, gastroesophageal reflux (GER), bronchospasm, lung disease and seizures. Infants with these conditions may be treated with medication and discharged home on a home apnea monitor. They also may have a a sleep study performed. It is called polysomnography or a pneumogram and it monitors your infant’s breathing and heart rate over a 12 or 24 hour period. If your infant is prescribed a home apnea monitor then you will be instructed in its use. You will want to use it whenever your baby is sleeping and when you are busy and not directly with your infant. During alert periods or when you are with your baby or when you are in an active play activity or bathing your infant the monitor is not needed.

Influenza Vaccine Tips and Hints for Parents

Does my child need to be vaccinated?

  • Everyone 6 months of age and older should be immunized if they do not have a contraindication to the vaccine.

When should the vaccination be given?

  • The vaccine should be given as soon as it is available in late summer and should be given through fall, winter and into spring.
  • How many doses will my child need?
  • 2 doses of influenza vaccine separated by at least 4 weeks should be given to all children age 6 months through 8 years of age who are receiving influenza vaccine for the first time.

What about the intranasal vaccine?

  • The intranasal influenza vaccine can be used for healthy non-pregnant people from age 2 through 49 years.
  • If my child has a minor illness can she still be immunized?
  • Minor illnesses with or without fever do not prevent your child from receiving the influenza vaccine.

If my child has had a serious systemic or anaphylactic reaction to a prior dose of vaccine should she receive the influenza vaccine?

  • No. A prior reaction of this type prevents further influenza vaccine administration.

What if my child has an egg allergy?

  • The regular influenza vaccine may be given to some children with egg allergy. This needs to be discussed with your doctor.
  • Do not give nasal spray influenza vaccine to people who have a hypersensitivity reaction of any type to eggs.

What are the most common side effects of the flu shot?

  • Soreness, redness and rare itching at the injection site for 1-2 days.

What are the most common side effects of the intranasal flu vaccine?

  • Runny nose and nasal congestion are the most common side effects.

What if my child has asthma?

  • If your child has asthma she can receive the regular influenza vaccine.
  • Children over age 4 years with asthma can receive the nasal spray vaccine.

Sunscreen 101

Sunburn, skin cancer and the use of sunscreens are common concerns for parents. Recent FDA guidelines support the benefits of using sunscreen in conjunction with other sun protection measures to decrease the risk of skin cancers, premature aging of the skin and to help prevent sunburn.

Proposed FDA guidelines support all sunscreens protecting against both UVA and UVB rays. UVA rays cause aging and UVB rays burning. Both types have been implicated in damage and the accumulation of ionizing radiation that leads to skin cancers. These guidelines also indicate whether a product is water resistant for 40 or 80 minutes based on testing. The maximum rating will be SPF 50+ and to be listed as broad spectrum the SPF must be at least 15. The enactment of these standards has been delayed until winter 2012.

The key is to use a product that is SPF 30 or greater with reapplication every 3 hours.

Some concerns have been raised about compounds in sunscreens. Overall the risk of any of the ingredients is much less than the risk of not using sunscreen. Other concerns have been raised about sunscreen decreasing Vitamin D levels. Studies do not support this. Those who use sunscreen actually go out in the sun more and have higher levels of Vitamin D.

Every American has a 1 in 5 risk to develop skin cancer during their lifetime. The current lifetime risk in the US of developing invasive melanoma is 1 in 58. Skin cancer rates are on the rise and sunscreen use has been shown to lower this risk. The highest groups at risk are women and people with fair skin. Everyone, especially those in these at risks, should use sunscreen.

Throughout the year consider using sunscreen as a moisturizer and remember to do full body exams, including your scalp to look for any skin changes that warrant seeing your doctor. Awareness and prevention are the best medicines.

Sunburn Protection

Ultraviolet light exposure is dangerous. UV light radiation (UVR) exposure is the most important risk factor you can manage to decrease your risk of melanoma. Melanoma cases are increasing. In the year 2011 it is estimated almost 9,000 people died from melanoma. Studies have shown that recurrent sunburns and sunburns at a young age place you at highest risk for developing melanoma. The risk for melanoma later in life doubles if there is a history of a single sun burn during childhood.

There have been numerous education programs in schools, in doctor’s office and in the media but children and adolescents have not changed their habits. Children and adolescents continue to report sun burn episodes and are not wary of the proven life threatening risks. Most adults are much more aware of the risks and willing to curtail UVR exposure to decrease their risk. The younger age groups do not look at the long terms risks. Due to their age they feel immortal and are preferentially influenced by short term social, behavioral and brain mediated benefits. Many adolescents seek a “tan”. They are not interested in spray on tan options. They seek the social benefits and enjoy the sensation of well-being they feel from a tanning session or lying in the sun. New studies support the activation of centers in the brain that are normally activated by addictive substances including cigarettes and alcohol.

It is imperative that all children and adolescent, not just those with fair skin be protected. Try to avoid the highest periods of midday sun exposure and avoid behaviors, such as tanning beds that further increase UVR exposure. Parents need to emphasize the importance of safe skin care. The routine use of products that block both kinds of cancer causing rays is essential. UVA and UVB protection both are needed. SPF numbers in the past only reflected UVB protection. The FDA has recently released new rules for sunscreen. The new rules list “broad spectrum” coverage as applying to both UVA and UVB protection. UVA penetrates the skin deeply and causes wrinkles. UVB is the type that causes sunburn. Both cause cancer. The FDA has also replaced the word waterproof with water resistant (40 minutes) or water resistant (80 minutes). This supports the need to reapply protection frequently.

Always apply enough sunscreen to cover all exposed areas of skin. Try to apply 1-2 ounces of sunscreen every 2 hours and wear clothes that provide high SPF protection. All clothing screens out some sun but darker colors and a tighter weave protect you more than others. You can increase the UV-blocking capability of any washable garment by using a laundry aid like SunGaurd that can boost a clothing items protection manifold. Sunglasses that block 99-100% of UVA and UVB are also a must and should be worn all day even though light hits the eyes more directly in the morning and the afternoon.

Burn and Electrical Safety

What can I do to prevent my child from getting burned?
  • Do not handle hot liquids (coffee/tea/coca) if your child has easy access to it.  This includes trying to carry both your child and a hot liquid at the same time.
  • Protect your child from “hot” appliances such as fireplaces, irons, space heaters and stoves by either removing them from the area or by strict supervision if access is available.
  • Turn your hot water heater to 125 degrees.  Children can turn on hot water faucets very easily, but 125 water temperatures will prevent an immediate scald.
  • Do not let your child have access to matches, lighter or burning cigarettes. Be sure all such objects are stored away from sight and out of reach of children.
  • Make sure your home has functioning smoke alarms in hallways and sleeping quarters. Check the alarms monthly for battery charge.
  • Fire drills should be conducted by families to know where to go and what to do in case of a fire in your home.
  • Prevent electrical burns by covering all electrical outlets with plastic safety caps and keeping electrical cords away from children.
  • Protect children from scalds by keeping hot pots and pans back burners and turning pot handles inward and out of reach.
  • Use flame retardant sleepwear and blankets.

Car Safety

What can I do to protect my child while riding in our car?
  • Children should never travel in a car without fitting properly into a car seat, or an appropriate lap or shoulder restraint.
  • Make sure our care seat is approved by Federal Motor Vehicle Safety Standards.  The date of a manufacture should be after January 1981.
  • Infant car seats are used from birth to 1 year and should always face rearward.
  • Toddler and convertible seats for toddlers from 20 lbs. to 40 lbs. can be forward facing.
  • Follow installation instruction of the car seat very carefully.  Not all car seats match all cars and not all car seats match to seats belts the same way. Make an appointment with your local State Police Office to inspect your car seat.
  • Cover your car seat with a towel or covering in hot weather to prevent metal clips from burning your child’s skin.
  • Try to praise your child for using the car seat.  If your child is bored or is fussy, do not remove him from the car seat.  It is better to stop and take a break instead of reinforcing the idea that he can get out of the seat if he makes a fuss.
  • The infant car seat shoulder harness should be securely tightened allowing only 2 fingers widths of space between the hardness and the baby.
  • The car seat should be securely fastened to the car with the seat belt.  A locking clip may be required to tighten the seat belt to prevent movement of the car seat.  Give a hard “tug” in the lap portion of the belt.  If it pulls loose, a locking clip may be the solution.
  • Ask your physician for instructions or information on how to properly install and use a car seat.

Pennsylvania’s Seat Belt Law

  • Under Pennsylvania´s primary child passenger safety law, children under the age of four must be properly restrained in an approved child safety seat anywhere in the vehicle.
  • Children from age four up to age eight must be restrained in an appropriate booster seat.
  • Children from age 8 up to age 18 must be in a seat belt.

Car Seat Recommendations for Children

  • Select a car seat based on your child´s age and size, and choose a seat that fits in your vehicle and use it every time.
  • Always refer to your specific car seat manufacturer´s instructions; read the vehicle owner´s manual on how to install the car seat using the seat belt or LATCH system; and check height and weight limits.
  • To maximize safety, keep your child in the car seat for as long as possible, as long as the child fits within the manufacturer´s height and weight requirements.
  • Keep your child in the back seat at least through age 12.
  • Visit a PennDOT approved Child Safety Seat Fitting Station for advice.

The following information can be found at

Birth-12 Months

Your child under age 1 should always ride in a rear-facing car seat. There are different types of rear-facing car seats: Infant-only seats can only be used rear-facing. Convertible and 3-in-1 car seats typically have higher height and weight limits for the rear-facing position, allowing you to keep your child rear-facing for a longer period of time.

1-3 Years

Keep your child rear-facing as long as possible. It´s the best way to keep him or her safe. Your child should remain in a rear-facing car seat until he or she reaches the top height or weight limit allowed by your car seat´s manufacturer. Once your child outgrows the rear-facing car seat, your child is ready to travel in a forward-facing car seat with a harness.

4-7 Years

Keep your child in a forward-facing car seat with a harness until he or she reaches the top height or weight limit allowed by your car seat´s manufacturer. Once your child outgrows the forward-facing car seat with a harness, it´s time to travel in a booster seat, but still in the back seat.

8-12 Years

Keep your child in a booster seat until he or she is big enough to fit in a seat belt properly. For a seat belt to fit properly the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember: your child should still ride in the back seat because it´s safer there.

Child Safety Seat Fitting Stations:

PennDOT provides funding for more than 75 fitting stations where trained technicians will check that the child safety seat is properly installed. To find a fitting station near you, search the Fitting Station directory. Use your city and state to find a certified child passenger safety technician through the Safe Kids Website.