Modern Adventures for Kids

In 2008, New York City mom Lenore Skenazy was shopping with her 9 year-old son.  They rode the subway, and that day he begged her to let him ride home alone.  Ms. Skenazy decided it was time for some independence and let him.  He returned home safely and was ecstatic with his feat.  But when Ms. Skenazy wrote about it in a newspaper column, she set off a storm of controversy.

Some called her the “world’s worst mom,” and child protection agencies took note.  Others praised her for not being afraid to give her child freedoms not allowed by  “helicopter parents,” so-called because they hover over their kids’ every move.  Ms. Skenazy recently completed a reality TV series where she coached such parents on letting their kids ride bikes or slice vegetables, to give the kids some independence.  The show’s title: World’s Worst Mom.

In the Pediatric Emergency Department, we often roll our eyes at what some kids are allowed to do- ride 4-wheelers or use the microwave.  But we only see the kids who get hurt; scads of kids use microwaves without spilling boiling water on themselves, and jump on trampolines without breaking something.  The key is teaching children to do these things safely.

Before Ms. Skenazy let her 9 year-old ride the subway alone, she had coached him on reading subway maps and identifying uptown versus downtown trains.  It’s the same with kids doing any risky thing, like riding bikes or 4-wheelers.  There’s rules and training before setting your kid loose.

Of course, learning to ride a bike requires teaching; kids can’t just get on and ride.  But the safety stuff requires more parenting- teaching the rules of the road and enforcing helmet use.  When my son wanted to ride to his friend’s house miles away, we went riding together to show how to stay on the right side of the road and cross busy streets safely, and to be sure he knew the way.  And we had him call when he arrived so we could relax.

When I was eight years-old, they built a hospital near my house.  Construction sites are as good as Disneyworld to a child: piles of dirt to play on, and those big yellow machines!  Fortunately the workers took the keys out of the bulldozer; otherwise we would have fired it up and gone for a spin.

One day I ran across the site and into a mud patch.  It was deep enough that I sank to my knees, stuck.  Remembering the quick-sand scenario in movies, I was scared that I might sink more.  I yelled to my buddy, but he stood helplessly at the edge of the patch, no rope or stick handy to save me.  Since no other rescue was likely, I decided I had to save myself and began to slog my way to a big rock nearby.  Three or four heaves in that direction and I was able to hug the rock and haul myself out.

Parents worry about letting their kids out into the world.  If my folks had known about that deep mud, would they have let me go to the site?  Perhaps not, but back then things seemed safer.  There wasn’t 24-hour cable news, needing to fill a whole day with attention-grabbing stories to scare parents.  Every child abduction in the country now gets breathless attention.  Before cable and internet there were only brief TV news programs and newspapers; no space to report every child tragedy in the nation.

In reality, back then children were actually less safe.  Crime was rising in the 1970s and 1980s, peaking in 1993.  Now there is 50% less crime than when I was a kid.  In addition to a more dangerous environment, kids went out without cell phones or bike helmets.  So the world turns out to be pretty safe for kids; the odds that your kid will be kidnapped or seriously hurt are very tiny.

And children yearn for freedom.  They want to explore, push boundaries, and be proud of their accomplishments.  Lenore Skenazy’s boy was beside himself with joy at going home alone on the New York subway.  While many think that’s extreme, even the FAA lets 14 year-olds fly gliders solo.  Makes a bike ride across town seem pretty tame.

The Running Of The Bulls

I was checking out The Running of the Bulls on the internet yesterday.  If you haven’t heard, that’s a festival in Pamplona, Spain where they set bulls loose in the streets of the city. Thrill-seekers get chased by the bulls, and every year the news shows someone getting gored by a bull’s horns and/or stomped on.  I found one site titled, “Running of the Bulls with Families,” and did a double-take.  They let kids run with the bulls too??!!

Fortunately, that website said children aren’t allowed in the streets when the bulls run, and discussed how families can reserve a balcony to see the fun.  It reminded me of our own Louisiana version of Running of The Bulls with Families which I call “Letting Kids Drive ATVs.”

ATVs (or 4-wheelers) and bulls have lots in common.  They are both over-powered.  Like bulls, ATVs are designed to go off road and pull farm wagons.  That requires a lot of power, too much for young children to handle.  Also like bulls, ATVs are difficult to control.  ATVs have high centers of gravity and go fast, making them easy to roll over.  They require hand-eye coordination and anticipation of hazards that children don’t have, which is why we don’t let kids drive cars before age 15.

And yet many parents put their children on ATVs anyway.  They even make 4-wheelers for kids!  I have treated ATV drivers as young as 5 years old in the Emergency Department.  It boggles the mind that these parents don’t see the potential for injuries.  Kids fly off them and hit their heads, sometimes sustaining severe brain injuries.  Kids roll the things, the heavy machine tumbling over the child, maybe causing organ rupture and internal bleeding.  Kids zip past trees and posts, smashing hands and ankles, knees and elbows.  Children who lose control sometimes run over their friends.

I have seen all these injuries in all degrees of severity. I have seen ATVs put children in the Operating Room and in Intensive Care.  I have warned in this blog, in the newspaper, and on TV about letting kids drive them.  Yet some parents can’t stop from indulging their children with 4-wheelers, no matter what experts say.

In fact, Federal Consumer Product Safety Commission (CPSC) seems to have given up cautioning against putting kids on ATVs, and instead has posted recommendations for “safe” ATV operation for kids.  As I list these recommendations, it feels like giving children safety instructions on smoking cigarettes (“Hey kids, be sure to smoke only filter tips!”).

The first tip on the CPSC fact sheet is to stay off paved roads.  ATVs are for off-road.  They go too fast, get harder to control, and are easier to roll over on pavement.  Also, roads are where the cars and truck are, and I’ve seen too many kids crash into the bigger, faster moving vehicles.  Another tip: never allow children younger than 16 on adult ATVs.  The CPSC states that more than 90% of child ATV injuries happen when they drive adult machines, given kids’ lack of size and developmental skills.  Thus companies make ”age-appropriate youth models.”  (Maybe It’s time cigarette companies come out with age-appropriate youth models too).  To be fair, the kid models have adjustable speed limiters, making it harder to go unsafe speeds.  Please keep the adjuster to a safe setting!

Kids (and adults) should wear helmets, goggles, gloves, long pants and sleeves, and over-the-ankle boots.  Going off road means tree branches, fence posts, and rocks, so wearing that stuff makes good sense.  Allow only one rider on single-rider ATVs.  Safe operation of ATVs requires the driver to be able to shift weight freely and a passsenger gets in the way, increasing the risk of roll-over or other crashes. Finally, if you must let your child drive an ATV, get them training!  Deaths and injuries happen when inexperienced drivers lose control, get thrown, roll over, or run into things.  Hands-on training can help your kid avoid bad situations.  FInd a course at the ATV Safety Institute, the ATV dealer, or the National 4-H Council.

Even better, save lots of money and heartache by getting your kid a really good bicycle instead.

Deadly Machines

The parents got our attention by banging on the Ambulance Entrance doors.  In their panic they had stopped there and did not read the signs about the walk-in entrance.  They were panicking for good reason.

The father had his three-year old daughter in his arms.  Her hair was matted with dry and fresh blood, her face was gray, and she was limp.  Her eyes were half-open and lifeless.

“Her cousin lost control and ran her over with the 4-wheeler.”  This, unfortunately, is an all too common story.  We piled into the trauma room- monitors on, IVs going in, stethoscopes on chest, hands feeling all body parts for injuries.  Within a minute it was clear that the girl had only a  head injury, but a bad one.  She was breathing, but unconscious and unresponsive.  She had only a few deep cuts on her scalp to account for all the blood- with most head injuries the real problem is much deeper.  In a few minutes we would take her to the CT scanner to look at her brain.

The parents clung to each other in a corner of the trauma room, tears streaming down their faces.  As we talked about what was happening, the rest of the story came out.  The cousin driving the 4-wheeler was twelve years old and had just gotten it for his birthday.  His parents thought it was safe because the 4-wheeler was a “kid-sized” one.  We bundled the IV pump, portable monitor, and oxygen tank onto the trauma bed and wheeled off to CT.

The CT revealed multiple skull fractures, brain bleeding, and brain swelling.  After we finished stabilizing her, off she went to the Pediatric Intensive Care Unit under the care of the neurosurgeon and pediatric intensive care doctor.  I tried to be optimistic with the parents, but that was hard because the true possibilities were not good.  The child died two days later.

For generations in Louisiana and other farming states, children and teenagers have had to help out on the farm.  It is almost impossible to manage without letting the kids run the farm machines.  The invention of the ATV, particularly the 4-wheeler, gave rise to a cheap, easy-to-operate vehicle for farming and hunting.  Their affordability, ease-to-drive, and power naturally lead to their use for recreation.

The drawback to 4-wheelers is their instability.  They are top-heavy and overpowered.  Their drivability lead inexperienced operators (like children, or teenagers with their inherent immature judgement) to lose control.  The drivers either roll them over and get injured when the heavy machine rolls on top of them, or the drivers run over playmates.

There is a good reason that we do not routinely let kids younger than sixteen drive cars.  The hand-eye coordination to operate heavy, powerful vehicles and the maturity to choose to be safe are not developed yet.  The twelve year old in our story above was having fun that he thought was care-free.  However, toys should not be gas-powered.

Every once in a while, especially when I see a 4-wheeler snorting along side the road, driven by a kid, often with another kid on back, I think of that morning in the trauma room.  I get angry, or sad, as I think of the guilt that the twelve-year old boy and his parents have to live with, or the pain of the girl’s parents.