Keeping your children safe — a plastic surgeon’s perspective.

Over the years, I have seen a variety of unusual and unfortunate injuries in the Emergency Department that have required my care as a plastic surgeon.  Boat propeller injury to the legs of a child, non-lethal gunshot wound to the face and bear mauling injuries to name a few.

Over the years, I have also seen patterns of common injuries.

The following is a list of causes for injury that may require a plastic surgeon.  This list is created from my experience.  There are of course many other types of childhood injuries that are notably not listed such as motor vehicle accidents, suffocation, and drowning.

1. Falls (2.8 million children require medical attention/ year)
   • Preventing falls in children is obviously futile.  Kids fall.
   • Take measures to protect them where you can.
   • Make sure the home playground is adequately padded and safe.
   • Use home safety devices such as stair gates.
   • Avoid sources of tripping such as rugs near a fireplace.
   • Keep heavy objects off the top of unstable furniture.
2. Dog bite injuries. (800,000 dog bites requiring medical attention/ year)
   • This is the 5th most common reason for a child to visit the Emergency Department.
   • “That dog is usually great with kids”, is what parents often say.
   • Parents should avoid letting their children near dogs that are play fighting, sleeping or while they are eating.
   • Children should be trained to ask the dog owner before touching a dog.
   • Children should not feel comfortable with their face near a dogs mouth.
   • These types of injuries can be severely deforming as the tissue is crushed in addition to being torn.
   • There is a high risk of infection associated with dog bite injuries.
3. Toy related injuries (165,000 trips to the ER/ year)
   • Riding toys are the number one cause.
   • Unrelated to plastic surgery, 54% of toy related fatalities were from choking.  Of these, balloons were responsible for almost half.
4. Door injury (45,000 child emergency room visits/ year), 15,000 amputation injuries per year.
   • Car doors, house doors and less commonly elevator doors.
   • The “hinge” side of the door is particularly likely to result in injury.
   • The hinge side of the door has a more forceful “pinch” up to 40 tons per square inch.
   • Keep children from playing with doors.  Teach children it is wrong to slam doors.
   • I have personally seen more than a dozen child finger tip amputation injuries from this type of injury.
5. Treadmill injuries (about 25,000 injuries/ year)
   • A child, wanting to be with mom who is running on a treadmill, puts his/ her hand on the treadmill.
   • It can be caught between the moving belt and stationary treadmill.
   • This results in a deep burn injury, usually to the fingers.
   • This may require skin grafts or other surgical options to heal.
   • If able, make sure the treadmill faces children who are playing.
   • Better yet, use the treadmill only when children are not nearby.
6. Lawn mower injury (18,000 children/ year)
   • These are generally severe injuries and completely preventable.
   • Children younger that 12 should never operate a lawn mower, (16 if a riding mower).
   • Children should stay an appropriate distance from the mower, in my opinion not in the yard period.
   • Debris such as rocks can become missiles at short range.
7. Bathtub burn injury
   • 67% of injuries occur in children 2 years or younger
   • Burns occur most commonly from a parent or sibling adjusting the temperature (turning on the hot or turning off the cold) while the baby is in the tub.
   • Keep the temperature on the hot water heater less than 120 degrees.
   • Check the temperature of the water with the back of the hand.
   • Recheck the temperature after adjustments.
   • Some of these injuries are the result of abuse, I assume anyone reading this would not be such a parent.
8. Fireworks (7,000 injuries requiring medical attention/ year), over half are children.
   • The injury pattern is commonly a burn, or occasionally blast related injuries.
   • Sparklers cause most of the injuries in children
   • The number of injuries is particularly high considering there are only a few days of the year where fireworks are generally used
9. Electrical cord bite injury
   • The child bites through the electrical cord insulation
   • Electrocution is the most significant concern
   • Often a severe burn injury occurs at the corner of the mouth
   • This can result in disfigurement and narrowing of the corner of the mouth with healing
   • Surgery and oral splinting are often necessary.

Being the proud father of two beautiful little girls with a boy on the way, I understand the instinct to keep kids safe.   Injuries cannot be completely prevented.  Understanding common causes can help a parent prevent many of these injuries.