Keeping Guns Away from Children

Twice this past week, students in New York City public schools have brought loaded guns to school. The New York Times notes that these two incidents - one involving a 15-year-old student at an "early college" high school with a strong academic reputation, and one involving an 11-year-old elementary school student -- were two of four times this year where guns were seized in New York City schools. Last year, The Times reported, there were nine such episodes. These latest incidents resulted in the arrest of the 15-year-old and the arrest of the gun-owner grandfather of the 11-year-old.

As far back as 2011, we blogged about efforts by pediatricians to address gun safety by asking parents whether there is a gun in their home as a first step to beginning a conversation about ways to keep that gun away from children. We followed up in later blogs to discuss efforts to block even this basic step towards gun safety and can now report that the Florida ban on asking about guns in the home was upheld by the 11th Circuit Court of Appeals. A look at this decision in The Miami Herald lays out the history of this law.

Let's pause for a moment to make it clear that we are not taking a stand on gun ownership. The issue of keeping guns out of our schools and out of the hands of kids is something else entirely.

Notably, neither of the schools in this week's events had metal detectors, which are common in many New York City public high schools and elsewhere. A report last September by WNYC noted that approximately 90,000 New York City public school students go through a scanning process each day. But there are real issues with metal detectors.  The likelihood of having to go through a scanner varies by borough, as well as by the racial and ethnic make-up of the student body. As the WNYC report noted, "getting scanned before school every day can mean earlier wake ups, long waits and lots of hassle." Having experienced scanning while visiting schools, your blogger can report that it is much like going through airport security every day. And while metal detectors and scanners may keep guns outside school buildings, they don't keep guns out of kids' hands elsewhere.

So, what can parents do to help make their children safer, in school and out? Our colleagues at The American Academy of Pediatrics have some common sense information and talking points about guns and kids that addresses families that have guns -- and those that don't. It includes statistics on how having a gun in the home affects family safety and questions to ask other parents before your child visits their home. It's worth reading.

photo credit: Ken via flickr cc

Combating Cyber-Bullying

Lots of adults today can remember being bullied as children. Years later, the sting of an unkind comment or others’ derisive laughter still hurts. But imagine that the witnesses to one’s shame were not limited to those within earshot of the slight. What if hundreds, thousands, or even millions of people, most of them strangers, could see what happened? And what if they could participate in the taunting? Cyber-bullying amplifies bullying to unimaginable levels, making its victims’ lives nearly unbearable.

And who better to talk about the topic of online humiliation that self-described “Patient Zero” Monica Lewinsky? Lewinsky’s scandal was a perfect storm in many ways: It was the most salacious political drama our country has ever experienced, and it happened just as internet technology was becoming ubiquitous. Instead of simply discussing her story among themselves after reading about her in the paper, people around the world could post comments about her for all to see.

Years later, Lewinsky is back in the spotlight, this time by choice. She is campaigning for a more compassionate online community, and she shares some excellent advice in a recent talk . Here are some of her key points, along with some of our own suggestions for parents struggling to help their children navigate these uncharted waters:

• Parents of young children should do what they can to supervise kids’ time online. Consider allowing kids to go online only on a desktop computer in a public place (e.g. the kitchen) whose screen faces the room, not a wall. Stop by often to talk with them about what they’re viewing and participating in. This can be an excellent opportunity to teach kids about dangerous online behavior, like connecting with strangers. 
• Parents who are more internet-savvy than their kids (and we know there are fewer and fewer of those out there) should be sure that they are connected with their little ones on any online network accounts their kids have. Whether it’s Facebook, Instagram, or Twitter, following your kids will serve two purposes: First, it will make them think twice about what they post, and second, it will give adults opportunities to talk with kids about what kind of posts they may consider appropriate for public knowledge. (“What do you think could happen if you share your address in your online profile?” “Do you think someone might misinterpret that picture if they don’t have any context?”)

Of course, parents can’t, and shouldn’t, monitor every facet of their kids’ online lives, especially as they get older. Instead, try to help kids see the people at the center of scandals as just that: people.

• ·Avoid talking excitedly about celebrity scandals. Instead of watching shows dedicated to gossip, passing judgment in kids’ hearing about the decisions of perfect strangers, or picking up tabloids, adults should model compassion. Pointing out how embarrassed the subject of a shocking headline must be enforces their humanity and shows kids how to be empathetic. Comment that you’re certainly glad none of your mistakes were shared with the world. 
• Lewinsky urges people to be “up-standers” instead of merely bystanders. Post positive, supportive comments, and make sure kids know you’re doing it. Compassionate responses can mean a lot to victims of online bullying, and your empathy can change the tone of an online thread. And report cyber-bullying when outlets have those options.

Lewinsky says, “We talk a lot about our right to freedom of expression, but we need to talk more about our responsibility to freedom of expression.” Help young people understand that the internet gives them great power, and along with power comes responsibility.

Safety for Working Teens

As school lets out for the summer many teens head to their summer jobs. But the kinds of work that many teens are able to get -- such as in restaurants with slippery floors and dangerous cooking equipment, or doing landscaping or construction work -- combined with lack of training for these temporary workers, can lead to increased likelihood of injuries on the job.

According to the federal Centers for Disease Control and Prevention, in 2010, there were approximately 17.5 million workers less than 24 years of age, and these workers represented 13% of the workforce. While some of these workers are young adults, many are still in their teens, so it is particularly concerning that the rate for emergency department-treated occupational injuries of young workers was approximately two times higher than among workers 25 years and older.

If your teen has a summer job, it might be helpful to share the information in a publication from the National Institute for Occupational Safety and Health, Are You a Teen Worker? which contains information about the age limitations for many jobs, what a young worker should expect in terms of training and safety from their employer, and what hours teens of different ages are permitted to work under federal law. Teens should also be reminded that certain rules about their employment may be impacted by laws specific to their state -- minimum wages, for example, can be higher than the federal minimum, just not lower. You should check with your State Department of Labor for specific information and for instructions for obtaining working papers, which many young teens need to obtain a job.

Photo Credit: Sugarfrizz via Flickr CC

Monitoring Screen Time

Most parents agree that kids need some degree of monitoring when it comes to technology. Whether it’s time limits on games, supervision when using social networking sites, or established bans on some sites until kids are old enough, protective measures are important to keep kids safe. But many parents struggle to find the time to hover over kids as they hover over screens. Luckily, there’s a techy solution for this techy problem: enter parental control software.

Daniel X. O'Neil

There are a multitude of options available when it comes to this sort of software, and parents must first decide what’s right for their families. Do they want to block certain sites from kids altogether? Limit the amount of time spent on sites? Monitor where their kids spend time? Here are some of the best options out there:

Kids Watch Time Management 6.5: This highly reviewed software allows parents to establish time limits for certain types of sites and block others altogether. The software is highly customizable and will send an email detailing the activity of each registered account user (i.e. your kids) daily, weekly, or monthly, prompting busy parents to remember to glance over their kids’ computer records. For more information, check out this review.

iDetective: Download iDetective to keep tabs on youngsters’ use of tablets (Mac or PC) to get detailed reports and summaries on the way a remote computer is being used. iDetective can even allow a parent to send messages to the device from another computer. Imagine the look on your child’s face when “I thought we agreed no Minecraft after 8:00…” pops up in the middle of his game!

StayFocused: This Google Chrome plug-in restricts time for specific websites or certain types of websites. Once a user has used up all the time allotted, the plug-in will block the site for the rest of the day. StayFocused goes beyond the basics to give clever options, like blocking all subdomains (i.e. all social media) or specific in-page content (i.e. all videos).

And remember, there are no-tech solutions that can help kids manage their screen habits, too.

• Some parents choose to keep a record of their children’s email and social media passwords so as to monitor their accounts. Expert advice is split on this policy: some advocate it, while others view it as an unforgivable violation of a child’s privacy, so be sure you know where you stand before taking action.
• Establish areas of the house in which technology is not welcome (like the dining room, perhaps) to make room for real (what’s-it-called?) conversation. Another tack: forbid technology in all but certain rooms in your home. Remember that you have to abide by your own laws, however, so don’t make changes you’re not prepared to live with!
• We’ve saved the best for last: Talk to kids about their online interactions. It could get uncomfortable, but they might learn something valuable. Discuss the choices made by their friends on Facebook, Twitter, Instagram, etc. Raise questions like, “What do you think she’s trying to communicate by posting a picture like that?”, “What reaction do you think he’s hoping that post will get?”, or “How do you think this status message could backfire?” For an interesting take on opaque social networking, check out one mom’s policy on keeping her teenage boys, and their friends, in check.

Children, Football, and Concussions

As a parent, pediatrician, and lifelong football fan, I was naturally drawn to the article on the first page of yesterday’s New York Times, “A 5-Concussion Pee Wee Game Leads To Penalties for the Adults.” The article was particularly timely as we embark on a major initiative at The Yellin Center to better understand and address how concussions affect academic performance. As I read the Times article, I followed the narrative as the litany of concussions in this single football game in Massachusetts unfolded. As Chris Nowinski, president of the Sports Legacy Institute aptly noted, there were undoubtedly many more concussions than those that were diagnosed. While I do believe that adults need to be held accountable for their decisions when they are responsible for children’s safety, I think we are fooling ourselves if we believe that this alone is an effective way to address this problem.

As a former Chief Medical Officer of a hospital, this football game is what we would call a “sentinel event.” Like the canary in the coal mine, sentinel events often tell us that there are big problems that need to be confronted. In almost every case, individual errors in judgment can be identified. However, when one looks closely through a process called a “root cause analysis” one usually finds that these kinds of errors in judgment are often more widespread and that the sentinel event represents a “perfect storm” of causes. Taking an immediate punitive approach often short-circuits the root cause analysis and discourages people from coming forward in the future to report minor problems before they become major ones.

It’s clear that concussions are not only a problem for the youngest players. A follow-up article in today’s paper about concussions in high school football refers to a study from the Pediatric Brain Trauma Lab at Massachusetts General Hospital that found that 486,000 combined head impacts had been recorded over a five-year period among players from the football teams at Brown, Dartmouth and Virginia Tech, as well as two men’s and two women’s hockey teams.

Was I the only one that was stunned when I read that based on the rules of “safety” the weight limit for 10 year olds in the Pee Wee game was 120 pounds? 120 pounds is more than 20 pounds above the 95th percentile for 10 year olds! Furthermore, as the Times notes, “rules are only as effective as the adults charged with enforcing them. Four of the five injured boys have resumed playing football…”

So, I think that we all have some serious work ahead of us in examining the safety of contact sports for young children. We need to begin with a root cause analysis of the Massachusetts sentinel event. And we have to seriously entertain the question about whether it is ever possible to make these contact sports safe enough for young children.

Photo: woodleywonderworks / Creative Commons (modified)

Study Raises Concerns on Crossing Streets for Children with ADHD

A new study reported in Pediatrics, the journal of the American Academy of Pediatrics, looks at a potentially dangerous consequence for children with Attention Deficit Hyperactivity Disorder -- the simple act of crossing the street.

The study looked at a total of 78 children, from 7-10 years of age, half of whom had been diagnosed with ADHD-Combined Type, which includes symptoms of both inattention and hyperactivity-impulsivity. The researchers compared the behaviors of the children with attention difficulties with the control group to determine if there were differences in their behavior before crossing the street and while they were actually in the act of crossing. Those children who customarily took medication for their attention issues were not taking their medication at the time they were studied.

The researchers found that while the children with attention difficulties "evaluated the crossing environment" and began to cross the street in the same way as the control group, they crossed when there were smaller gaps in traffic and had significantly less time to spare when they reached the other side of the street. The dangers of this situation in a real life situation are clear to every parent.

When the researchers looked at the possible reasons for this dangerous difference in how children with attention difficulties crossed the street, they determined that it was weakness in executive function, specifically difficulties in managing time. They discounted inattention itself, or oppositional behaviors, as the key factors impacting poor decisions as to when it was safe to cross.

While the researchers note that work needs to be done to remediate the executive deficits that are the basis for this danger, it is on parents -- through practice with their children, hand-holding where appropriate, and modeling safe crossing behaviors, to whom the task of keeping their kids safe will fall. School opens in a few weeks. Please drive carefully.


Photo used under Creative Commons by Elizabeth/Table4Five

Protecting Children from Gun Violence

Our colleagues at the American Academy of Pediatrics (AAP) have been working for years to ensure the safety of children in countless ways -- by advocating for such fundamental safety issues as automobile car seats, bike helmets, prevention of sports injuries, and avoiding dog bites -- just to name a few issues. Now, they and the pediatricians and family physicians who care for children, are under fire (pun intentional!) from the State of Florida, for promoting gun safety.

Let's be very clear about what is going on here. There is no action proposed by the AAP or its gun safety partners to limit gun ownership. There is a strong move to have parents ASK if there is a gun present in a home where their children play. Think about it. Even if you can control what goes on in your own home, what about your child's friend down the street? Might there be a gun in that household? And, if so, is it properly secured so that it is impossible for children to find it, and use it? Wouldn't you want someone offering advice on that issue to other parents?

The Florida House of Representatives and Senate have both passed a bill that would prohibit physicians from asking parents about whether there are guns in their homes, if that could in any way be considered "harassment." The question, when asked by a pediatrician or family physician, can open the topic of gun safety and allow the doctor to counsel the parent about what is needed to make sure that their own and other people's children are kept safe. Proponents of the bill, which is expected to be signed shortly by Governor Rick Scott, believe it is needed to prohibit doctors from recording which of their patients own guns and from refusing to accept patients into their practices who won't discuss gun safety issues. The numerous opponents of the law, including the AAP and Pax, which partners with the AAP to raise awareness of gun safety concerns, point to limits on a physician's judgment, freedom of speech issues, and the appalling number of children injured or killed by playing with guns found in their home or another house at which they play.

The statistics are staggering. According to research from the last decade compiled by PAX:

• Nearly 1.7 million children, under the age of 18, live in homes with firearms that are both loaded and unlocked in the United States
• Over 40% of American households with children have guns
• 8 children and teens were killed by firearms every day in 2006

We are deeply concerned about this effort to keep doctors from doing their primary job -- keeping our children safe.