Recently, as the weather has gotten warmer, I have noticed an increase in four-wheeler ads on television. The commercials always show people having a lot of fun while riding all-terrain vehicles. Many children and their parents will spend Memorial Day weekend outside enjoying warmer weather and summer activities, including four-wheeling.

But as someone who works for the trauma department at the Monroe Carell Jr. Children’s Hospital, I know that as temperatures increase, the number of ATV-related injuries and deaths also increase. Injuries to the head, face and abdomen, as well as orthopaedic injuries, are among the most common.

Children are more prone to ATV injuries because of their lack of experience operating motorized vehicles, lack of psycho-motor control and coordination, and lack of judgment that can result in risk taking and poor decisions.

As fun as ATVs may appear, they are powerful machines. Common factors for ATV crashes and injuries include children riding an adult-sized ATV, riding with or behind a friend on the same vehicle and not wearing a helmet.

The American Academy of Pediatrics and the American College of Surgeons both recommend that children 16 and under should not ride ATVs because of the high risk of serious injuries. However, if you and your family choose to four-wheel, remember these safety precautions:

• Children younger than 16 should not ride adult-sized ATVs; those who do are twice as likely to be injured compared to those who ride youth-sized ATVs. Please refer to manufacturer recommendations for the appropriate size ATV.

• Always wear protective gear – especially a helmet – when riding ATVs. Head injuries are by far the leading cause of death and disability related to ATV crashes — helmets can reduce incidence of head injuries by 85 percent. Wear a motorcycle or motorized sports helmet and make sure it is certified by the U.S. Department of Transportation or the Snell Memorial Foundation.

• Remember, ATVs are meant for a single rider. They are not meant to carry passengers.

• Take a hands-on safety training course.  The 4-H ATV Rider Course is an excellent opportunity for proper training and education.

• ATVs are not meant to be driven on the road.  Traveling on the road decreases the stability of the vehicle.

• Do not drive an ATV while under the influence of alcohol or drugs.

For more information on ATV safety and the Tennessee Coalition on ATV Safety, click here.

Does your family ride ATVs and if so what safety precautions do you follow?

Warm summer weather and children playing outside are two things that naturally go together. Children playing without a few scrapes and bruises — not so much. There are a number of things that can harm your child on the playground, but Sarah Haverstick, our Safe Children Program Manager, has some simple tips to help your children enjoy a safe summer of playground bliss.

• Check the Playground – Playground equipment can become rusted, broken, covered by trash or damaged by debris that can blow into your child’s play area. Inspect each play station, every visit, to check for potential hazards. Avoid playgrounds that do not have protective surfaces underneath like sand, rubber or mulch.
• Supervise Your Children - OK, this one sounds simple, but in today’s technology driven world, it is easy to get get distracted by phones, laptops and mobile devices. Just being outside with your children is not enough. Make sure you are actively watching them so you can warn them if you see any potential safety hazards.
• Use Age-Appropriate Equipment – Would you send a 2-month-old flying down a water slide? Probably not, but you might let a small child play on monkey bars that are meant for older children with longer arms. Pay attention to age guidelines to prevent your child from tumbling to the ground.
• Remove Drawstrings – Your child may have the cutest outfit in the park, but some clothing can actually threaten your child’s safety on a playground. Make sure shoelaces are tied tightly to avoid tripping, and remove drawstrings from the clothing around your child’s head or neck to prevent choking.
• Teach Playground Rules – Sometimes the biggest hazard on a playground can be another child. Although they may not intend to harm each other, children can get caught up in the excitement of playing. This can lead to pushing, shoving and trying to use equipment at the same time, which increases the chance of injury. Tell your children to use equipment one at a time, and encourage them to walk to each play station instead of running.

Playing outdoors is a great way to keep children active and physically fit. Remember to give your children plenty of water to reduce the risk of heat exhaustion. Parents should also take children inside if lighting or thunderstorms are approaching. Read our health tips to learn more about keeping your child safe. We hope these quick reminders help you and your children have a safe, action-packed summer.

School’s nearly out for the summer and it won’t take long for most tweens to settle in and declare “I’m bored!” Never fear, there are tons of creative (and relatively inexpensive) activities to share with your tween to make the summer memorable.

Start a Summer Book Club – Encourage your tween to start a book club with their friends and meet weekly to discuss their selected book. There are tons of great young-adult authors to choose from such as science fiction authors like Rick Riordan (author of the Percy Jackson series). Or, select a classic such as The Hobbit.

Grow a Specialty Garden – Plan, plant, and nurture a specialty garden, such as a flower garden designed to attract butterflies or a salad garden with basil and tomatoes and cucumbers. Don’t have a large yard? Your tween can easily showcase his or her green thumb with a container garden.

Host a Car Wash – Encourage your tween to organize, publicize, and coordinate a car wash. Benefits could support their favorite local charity. This is a great way for tweens to learn about event planning, cool off on a hot day, and work on their marketing skills.

Roller Skating – Both my girls love to skate and I guarantee you the music and lights will transport you back to your own days at the skating rink. Skating is great exercise AND a great way to beat the heat.

Sleep Under the Stars – If your tweens want to go camping, look no further than your back yard. Set up a tent, roll out your sleeping bags, and tell ghost stories by LED lantern. (OK, we’re not totally roughing it here, but it’s all about the novelty factor.)

Spelunking – When it’s hot outside, there’s nothing cooler than exploring a local cave. Mammoth Cave in Kentucky offers several tours that are a great way for tweens to beat the heat and learn about geography and geology and all the cool wonders (pun intended) beneath the Earth’s surface.

Head to a Water Park – There are several great water parks within driving distance of Middle Tennessee, from Nashville Shores to Beech Bend in Bowling Green, Ky. Pack your sunscreen and plan to make a day and night of it because your tweens won’t want to leave until closing time. Trust me, I speak from experience.

Be an entrepreneur – Many tweens are responsible enough to take on a very simple part-time job a few hours a week, such as a being mother’s helper or dog walker. This is a great way for your tween to earn extra money for something they’ve been wanting to buy.

Volunteer – Many local charities and churches post volunteer events that are suitable for the entire family. Hands on Nashville frequently posts volunteer opportunities that are appropriate for tweens, such as helping stock the shelves at Second Harvest Food Bank.

Play Ball – Organize a regular neighborhood sport in your community park. One of my older daughter’s classmates organized a Friday afternoon dodgeball game last summer. Make sure everyone has water and sunscreen and encourage your tweens to get outdoors and active.

These are just a few ideas to help you get creative and banish the “Mom, I’m boreds.” Do you have other ideas? Share them in the comments below.

I am often called the “Safety Lady” in my neighborhood and I take great pride in that, despite my girl’s embarrassment. I am a pediatric trauma injury prevention coordinator for Children’s Hospital, and summer is the hardest time of year for me. Now that the weather is getting warmer and school is almost out, we will unfortunately begin to see a lot more kids being admitted to the hospital.

One area of concern for those in field is the use of trampolines.

Are trampolines something to have fun on or something to be feared?  According to the American Academy of Pediatrics, trampolines are simply too dangerous for children to use outside of a structured sports training program with proper supervision. Citing nearly 100,000 trampoline-related injuries in 2009, the Academy noted that installing safety nets and having adults nearby do not seem to affect the occurrence of injuries.

Parents often view trampolines simply as recreational equipment that keeps children busy, but trampolines are not toys. Injuries on trampolines can have very dangerous ramifications. Research shows that 75 percent of trampoline injuries occur when more than one person is jumping on the mat. The youngest kids are at greatest risk for significant injury, including fractures of the legs and spine.

To repeat: the AAP recommends avoiding recreational trampoline use entirely.

In spite of these warnings, kids love bouncing on them and in my neighborhood almost every other home has them. Trampoline injuries are not just freak accidents. They follow a pattern and may be prevented.

If parents choose to allow their children to jump on trampolines, the academy says that:

• Trampoline use should be restricted to a single jumper on the mat at any given time.
• Trampolines should have adequate protective padding that is in good condition and appropriately placed.
• Trampolines should be set at ground level whenever possible or on a level surface and in an area cleared of any surrounding hazards.
• Frequent inspection and appropriate replacement of protective padding, net enclosure, and any other damaged parts should occur.
• Trampolines should be discarded if replacement parts are unavailable and the product is worn or damaged.
• Children should not perform somersaults and flips in the recreational setting; these are among the most common causes of permanent and devastating cervical spine injuries.
• Children should be actively supervised at all times by adults familiar with these safety guidelines.
• Homeowners should verify that their insurance policies cover trampoline-related claims. Coverage is highly variable.

If you do decide to purchase or use a trampoline this summer, remember that it is not as harmless as it may seem.

Read the complete AAP policy.

Imagine you are 4 years old (or 8 or 12 or 16, for that matter) and you have to come to the hospital. You have to leave your regular routine to go to a place that is perhaps scary or lonely and you aren’t exactly sure what is going on. You might be feeling emotionally anxious and fearful or physically in pain or discomfort.  Now imagine that you are that child’s parent, knowing that you will do just about anything to help them cope well and feel better.  Well, in the infamous words from the movie, Ghostbusters, “Who are you gonna call?” The music therapist!

Our music therapists are board-certified and trained to meet the child where they are by using their knowledge, creativity and skills to create an individualized treatment plan for that patient.  Here are some reasons for using music therapy and examples of how it works:

Pain Management/Relaxation:  The music therapist sits at the bedside of a 4-year-old boy while she strums her guitar to the rhythm of his breathing.  She helps him to visualize what his abdominal pain might looks like in order to help guide him in imagining that this pain is getting smaller. The strum of the guitar slows the rhythm of his breath until he is able to relax enough to fall asleep.

Emotional Expression:  A 17-year-old girl relies heavily on her faith to get her through a difficult diagnosis. The music therapist encourages her to write her favorite passages from the scripture and helps set these lyrics to music, creating a song entitled, “Keeps Me Going,” which eventually serves as a legacy by which her family can remember her.

Normalization/Socialization: A group of young children sit around a table choosing and playing a variety of instruments. The music therapist names each child in the opening “Hello Song,” and invites each one to choose and sing their favorite song.  The children are a part of a music group like they might encounter in school, but can’t because they are in the hospital.  “Wheel on the Bus” and “Ants Go Marching” serve the same purpose, to bring children and music together in a fun, normal and social environment.

Distraction: A drum and a xylophone go a long way to distract a child. Using musical improvisation and/or exploration can help a child focus on the sound he is creating rather than a procedure that is going on or will happen soon. The child can play a simple melody on the xylophone as the music therapist sings a familiar song while he is getting stitches.  Or the music therapist can engage the child in a non-verbal drum “conversation” alternating back and forth in response to the other’s drum beat. Before the child knows it, time has passed and it was not spent worrying. Check out this short video of a music therapy session.

Music therapy helps the children cope with all aspects of their hospitalization.  Music is something that most children and families have experience with and thus is familiar and welcome in the healing process.

A symphony rainbow, a chorus so bright
Music is healing us all through the night

Editor’s note: Learn the story behind the CD Everybody Has a Story, which is a compilation of songs written by children in music therapy sessions and sung by some of the industry’s top singers: Kix Brooks, Melinda Doolittle, Fisk Jubilee Singers, Vince Gill, Amy Grant, Faith Hill, Alison Krauss, Maura O’Connell, Johnny Reid, SHEL and Phil Vassar.

A decade ago, just before I married, two of our closest friends lost their youngest daughter in a drowning accident. She was 3 years old and had managed to sneak away from a group of children and slip into a pool without her mother’s knowledge. She had spent lots of time in pools that summer, always wearing water wings, and she probably thought she could swim in that pool without them.

She was wrong.

I’m a writer, but I could never capture in words the horror and grief of the months that followed her death. The agony her parents suffered was excruciating to watch, and frankly, I still don’t know they got through it. My husband and I will never forget that time. It has made us far more cautious with our children than we might have been otherwise.

In particular, it has made me ridiculously paranoid about swimming.

You would probably laugh if you had seen my husband and me over the years when our kids were in the water. I still remember a day when my son was around 2 and we were playing with him in a kiddie pool. He was wearing a life jacket, but somehow he toppled and went face first in the water. Because of the life jacket, he couldn’t regain his footing, and he floated for a helpless second or two, face down. My husband was right beside him and quickly set him upright. Still, we both shouted as if my son had fallen into the deep end of the pool, and we were on the other side. Later, I realized that the other parents around us must have thought we were nuts.

Our paranoia may have rubbed off on our kids. They are now 9 and 6 and we are still struggling to get them to swim on their own. We’ve spent hundreds and hundreds of dollars over the last five years on swimming lessons. At this point I’m (FINALLY) confident that the kids could at least swim to the side of a pool if they fell in, but they are by no means strong swimmers. My daughter honestly hates it.

At her latest lesson last week, she panicked when her instructor wanted her to practice going under water, something that terrifies her. She climbed out of the pool, sodden and crying, so that I could have a serious talk with her.

“Punky, you’re 9 years old,” I told her. “It’s time to suck it up and do this. You have got to learn to swim. There’s no other option.”

“But why do I have to learn to swim?” she sobbed. “Why? Why can’t I just stay away from water?”

“Because it’s something every child has to be able to do,” I told her. “I know you can’t understand it now, but sometimes I have to do things that I know are best for you. Even if I know you’re scared and it’s going to be hard, and you don’t want to do it. You’ve just got to know how to swim.”

And I know that’s true, although I hate to see her suffer. My husband  and I both have older relatives who can’t swim. For their entire lives,  they have avoided boats. And swimming pools. And the lake. And the beach. Not being able to swim means missing out on so many wonderful life experiences. It means being fearful in situations that should be enjoyable. It means that if my children for some reason find themselves in deep water, they may not be able to make it out. The thought of that is unacceptable.

So we will continue working to make our kids strong swimmers, no matter how long it takes and how many trips to the pool we have to make and how much it ends up costing us. (Trust me, I don’t like to even THINK about how much it’s costing us!) We owe it to them. And I hope every parent who reads this post feels exactly same way.

I also want you to know that if you’re a parent with children who seem to be taking FOREVER to learn to swim, you’re not alone. Don’t give up.

I promise that I won’t, either.

The young girl was coming in to the emergency department for stitches. One look in her eyes told me she was scared.

As I watched, the child life specialist quickly established rapport, and I could see the little girl start to relax. As they played together on an iPad, the child life specialist explained that her job is to help kids understand a little more about the hospital – and sometimes find some fun things to do too. 

The little girl smiled.

 “First the doctor is going to clean your owie with this bottle,” the specialist said. “What does it look like to you?”

“Water.”

The child life specialist then described the “special water” and let the girl squirt it. Together, along with the child’s parents, they talked about the process of getting a cut stitched up: how instruments feel, what they sound like and what they are for. The child even practiced on a medical play doll she could later take home. They came up with a plan for being still when the doctor did the stitches using the “special string holders” and paper towels to keep the area clean. The little girl did an incredible job holding still while watching a movie on the iPad. When it was over, she was no longer scared but proud.

I recently observed this scene in our emergency department but similar situations occur throughout our hospital every day as these trained professionals help children and families cope with illness, injury and hospitalization through play, preparation, education and normalization of the hospital environment.

Using play, we help children learn and understand their world. Children who are prepared for medical procedures often experience less distress and cope better in the long run. Our job is to individualize for each child and family what is happening and offer age- and developmentally appropriate explanations to promote understanding. Child life specialists also help patients and siblings with support and positive coping in the face of a new diagnosis or injury.

If you ask a child what we do, they will likely tell you we help them understand, be less afraid and have more fun while they are here.  I believe our role is to meet children and families wherever they are in their journeys and provide an individualized, family-centered care approach to coping with what for many is the worst time in their lives.

The field of child life continues to grow with more than 4,000 certified child life specialists in North America and beyond.  These specialists have a bachelor’s or master’s degree in child life or a related field, complete a clinical internship and pass an examination.  I am proud to have been one of them since I lucked into being hired during college to work in a hospital playroom. I don’t know if I discovered child life or it discovered me, but 20 years later, I am grateful.

Jodi Bauers, MM, CCLS is the Manager of Child Life Services at Monroe Carell Jr. Children’s Hospital at Vanderbilt.  She “accidently” discovered the field of Child Life years ago in college at the University of Iowa, when her former volunteer services supervisor offered to hire her to work in the playroom one summer as an activity therapy assistant.  She shares, “I am not sure if I discovered Child Life or it discovered me, but as a Certified Child life Specialist now more than twenty years later, I am grateful.”

When we think of distracted driving, it is easy to think first of young and inexperienced drivers. The character in the video is a teen-aged girl. At the premiere on Monday, McGraw noted that his daughter had gotten her driver’s license that very day so this is a topic that is top of mind for him. About 16 percent of distracted driving crashes involve drivers under age 20, according to the federal government’s website about distracted driving (Distraction.gov), but they aren’t the only ones taking risks. At any one time, an estimated 800,000 vehicles in this country are being operated by a driver using a hand-held cell phone. Are you sometimes one of them?

In observance of National Trauma Awareness Month, our trauma nurses are joining with others across the country in encouraging you to keep yourself, your family and those with whom you share the road safe by pledging to avoid being distracted while driving. That includes all distractions: from your cell phone, changing the radio station, putting on make-up, fussing at your children in the back seat — anything that takes your hands off the wheels, your eyes off the road and your mind off driving.

Will you and the other drivers in your family take the pledge?

On Sundays, the 9-year-old and I put on our aprons to make and bake snacks she will take to school.

Too much work, you say? Not at all! Get ready to be inspired to stay out of the boxed and bagged snack aisle – even if you think you can’t bake.

We spend about an hour on Sundays whirring nuts, dates, chocolate chips and dried fruit and rolling them into sticky power balls. We measure whole wheat flour, wheat germ and berries with pantry baking staples and produce muffins that bring forth lunch room envy. We use the pizza cutter to slice an easy combination of rolled-out cheddar cheese, flour and salt into crispy crackers, saying an easy goodbye the kind filled with preservatives and food coloring.

We also roll our own flour tortillas or press corn tortillas, which require nothing more than mixing water and corn masa you can buy at any local grocery. And truly, nothing is better than warm, homemade, preservative-free tortillas.

A quick how-to:

• Keep an online inspiration board and then print out the tried-and-true ones.
• Search “homemade fruit bars” online or search by the brand name of the store-bought bars you best like and add “homemade” to the search keywords. There is a homemade version for practically everything in the store.
• Search “easy homemade crackers” and add terms like “whole wheat” or “cheddar cheese” or even “gluten-free” — whatever you like.
• Don’t complicate your life. Look for quick and simple recipes that include things you normally have in your pantry and use regularly.
• Freeze extras. Muffins can defrost overnight or after just a few seconds in the microwave.
• Watch online videos on making tortillas, which also freeze really well. You can buy a cast iron tortilla griddle, a “comal,” or use your own pan.

Would I rather take a Sunday nap instead of making things I could buy cheap? Yes, sometimes. But I love that I am buying less packaged food and sending less to the recycling bin. I am especially gratified the 9-year-old in the apron is getting mom time and life lessons at the kitchen counter. Among them:

• She can feed herself well.
• She can feed others with love and thoughtfulness.
• She can make healthy choices for herself and the grandchildren I hope she one day produces for me.

And that’s worth getting the hands sticky for.

Spring is a welcome break for most after the gray and colder days of winter. Even those who have spring allergies can enjoy the warmer weather and outdoor activities, if they are prepared for the allergic symptoms that the season can bring.

Most early spring allergies are due to allergy to tree pollen. Trees begin their blooming early, sometimes even before any spring flowers can be seen. Many who have allergy to tree pollen believe that they may be allergic to the spring flowers, when in fact, those plants that have pretty flowers or smell good are likely to be pollinated by bees and do not have the type of pollen that travels well in the wind.  Wind-borne pollen is the culprit in most cases, and these include most of the larger deciduous trees whose leaves have not yet started to form. Later spring allergy symptoms (May and beyond) are likely due to allergy to grass pollen.

If a previous spring season caused symptoms of itchy nose or eyes, runny nose, nasal congestion/sneezing, red or watery eyes, or swollen eyelids, it is wise to begin treating for these allergy symptoms even before they begin. Think about this once the start of the season has arrived.  Usually a daily antihistamine that lasts 12-24 hours will help to control symptoms. If this alone doesn’t help, and the child is over the age of 2 or 3 years, a physician may also prescribe a daily nasal steroid spray to reduce nasal inflammation, and possibly a daily or twice daily antihistamine eye drop to reduce eye inflammation. It is always wise to consult a physician when available over-the-counter antihistamines taken for symptoms do not seem to be effective, as there are other medications that may help.

Other suggestions to avoid allergy symptoms in the spring include:

• Play outdoors later in the day since pollen counts tend to be highest in the morning hours.
• Keep windows closed to avoid having pollen enter the home or car.
• Use a clothes dryer rather than putting wash out to dry, as they may pick up outdoor pollen.
• Change clothing after playing outdoors to reduce having pollen spread around in the home.
• Take time to brush off pets outdoors before they enter the home to keep them from bringing pollen in on their fur.

If you or your child has eczema that flares during the pollen season, be sure to have a protective layer of lotion or cream on the skin to keep the pollen from directly contacting the skin. Wash this off when entering and staying indoors and then reapply.

Does your child suffer from allergies? How do you beat them?

Donna S. Hummell, M.D. is an Associate Professor of Pediatrics with specialties in Pediatric Rheumatology, Immunology, and Allergy. Having graduated, interned and held residency and fellowships at John Hopkins University and also a fellowship at Vanderbilt, she has a patient care emphasis in allergic disorder, host defense and immunodeficiency states.