“You’ll shoot your eye out,” she said.

Toy guns have changed since the release of that 1983 classic depicting a 1940s family. If Ralphie were a kid today, he may have his sights set on a water-based gel blaster—one of the popular toy guns of this generation. And Ralphie’s mom would likely say the same, for good reason.

Any toy with a projectile has the potential to cause an injury, especially to the eye. Dan Guzman, M.D., is a pediatric emergency medicine physician on the medical staff at Cook Children’s Medical Center. He also leads Cook Children’s Aim for Safety initiative, which is designed to reduce injuries through gun safety education. Dr. Guzman recently purchased a gel water ball gun to see for himself what hazards they pose to children. Also known as gel soft guns, these toy shooters are similar in design to airsoft guns, but their bullets are made of biodegradable water-filled beads.

“The bullets feel really squishy,” Dr. Guzman said. “But they’re definitely a projectile, and any projectile to the face or in the eye is going to hurt or may cause some injury. I shot them at a tree to see what they would do. Some of the bullets exploded into nothing, but there were some that seemed to be crystallized and actually turned into smaller projectiles once they exploded, which concerned me a little bit.”

A review of the Consumer Product Safety Commission’s electronic injury surveillance system found more than 6,500 cases of eye trauma from toy guns with projectiles between 2010 and 2019, according to a study published in the journal Investigative Ophthalmology and Visual Science. The most common injury was ocular contusion, better known as a black eye. The most serious wound was an open globe injury. Most of those injured were boys, and more injuries occured in December than any other month of the year.

“I haven't seen a lot of injuries from these gel guns just yet, because I think they are relatively new, but I suspect after the holiday, I will,” Dr. Guzman said.

If Santa leaves a projectile-firing toy gun under your tree, Dr. Guzman has a few tips to help keep your child, and those anywhere near the line of fire, safe from injury.

“I'm not going to tell you you shouldn't have one,” Dr. Guzman said. “But I’m definitely going to tell you how to do it safely to make sure your kid doesn't end up in my ER with some horrible injury where they've lost vision in one of their eyes and they'll never be able to see out of that eye again.”

Wear eye protection. Many manufacturers place this warning on their toy gun products, and some even come with eye protection.

Supervise your child and teen when playing with toy guns. They may not be as life threatening but they do shoot powerful projectiles and can cause significant and life-altering injury. Kids—especially teens—are naturally impulsive and don’t always think through the potential consequences of their actions, like what could happen if you aim at someone’s head, or turn the gun towards your face to look down the barrel, or shoot from too close of a distance.

“We just want people to be safe,” Dr. Guzman said. “With these eye injuries, many recover, but some don’t. You truly could put an eye out and nobody wants to be responsible for that.”

Teach kids to respect the danger. To some degree, toy guns that shoot projectiles, be them water-based gel beads or plastic pellets, need to be treated with the same respect and caution as a real gun. Closely monitoring your child while playing with a toy gun gives you the opportunity to see how they interact with the gun, correct concerning behavior and opens the door for conversations about safety that may translate to real guns.

As an emergency department physician, Dr. Guzman has witnessed first hand the devastation that can occur when a gun isn’t handled or stored properly. That’s what drives his passion for gun safety.

“I want to give families the tools to be able to make a great decision,” he said. “If we’re going to play with a toy gun that shoots a projectile, it’s important to know some basic safety steps to keep the entire family safe. Those key safety points then help to shape the conversation about real guns.”

It’s a good idea to practice the same safety measures with projectile firing toy guns as you would with a real gun. When not in use, toy guns should be stored away where kids can’t freely access them. And if they do happen upon one, be sure they know how to respond.

“That's another key point,” Dr. Guzman explained. “What do you do when you find something like this, even a toy, when you go to a friend's house? You don't just pick it up and start pointing at people and playing with it. They need to know to respect that object so they can respond safely.”

Make sure your child knows to keep toy guns at home. Never take them to school or a public place where they can be mistaken for a real gun.

While we love taking care of our patients, the last place you want to spend your holiday if you can avoid it is in the emergency department. Play smart and be safe. We “triple-dog-dare ya.”

“We went to PE, and we were playing on the playground like normal,” Crystal said. “I didn’t know they were gunshots, the popping sounded like fireworks.”

On that fateful day, a car filled with teenage boys opened fire on the playground. When Crystal noticed a friend was bleeding, she ran over to help. Quickly after, another classmate told her that she too was bleeding.

“All I remember was my granddaddy being the first person there, and my mom was out of it,” Crystal said. In “Once the first responders got there, I was in and out of it.”

Crystal was rushed to Cook Children’s Emergency Department with a gunshot wound to her hip.

“We got to Cook Children’s and the hospital was amazing for us to be in such a trauma state,” Crystal remembered. “They made us feel like we were having fun in trauma if that makes sense.”

Crystal recalls the medical staff at Cook Children’s making her and her family feel like they were the only family in the entire hospital. “The nurses and the doctors made sure we were good around the clock. I have never seen anything like it,” Crystal said.

Still, Crystal’s mother was afraid she wasn’t going to make it. She remembers the fear in her mother’s eyes as doctors and nurses were yelling orders and pulling tubes. She says she kept repeating, “God you’re going to have to work this out and keep me alive.” Even at a young age, she remembers her faith playing a big part in the whole experience.

Crystal and her mother spent several days at Cook Children’s. Because of where the bullet went in her hip, doctors did not perform surgery because they were afraid it could do more damage than good. They worried she could be paralyzed from the waist down because it was so close to her tailbone.

“The bullet is still in me 31 years later,” Crystal expressed. “They kept an eye on it for several years to make sure it didn’t go near my tailbone or to see if it would surface, but neither happened.”

Crystal says she periodically still feels a sharp pain in her hip.

After the incident, Crystal did not return to finish her school year at Sunrise Elementary. Her mother, a police officer at the time, was afraid of anything else happening to her child. Crystal says it wasn’t unusual to hear gunshots in her neighborhood, and it took a long time for her to adjust to hearing the “popping” sound.

“It took a long time for me to get over it and suppress it in the back of my mind and for everything to be okay,” Crystal said. She spent several years in counseling to process the shooting, deal with sound triggers and move past the event.

Years later, Crystal became a wife, mother, and nurse. She credits the care she received at Cook Children’s to pursuing a career in nursing, as well as her love for serving others. She says her biggest challenge was overcoming the fear she had when her children started school.

“I feared my daughter going to school and something happening to her. Especially now that people go into the schools and shoot students,” Crystal said. “It was especially hard for her going into third grade. I started praying every day for God to protect her and I’m doing the same for my son now who is in second grade.”

Crystal says the increase in school shootings over the years does trigger flashbacks. She always asks the question, “How do we protect our children in school from the playground to the classroom?”

While her shooting was an isolated incident, she believes children in every community deserve better. She also says ‘thank you’ would never be enough for the staff at Cook Children’s that saved her life.

“I appreciate the care that was given to me and my mom,” Crystal expressed. “I’ve never seen a staff work in unison the way they do at Cook Children’s, even over the years when I’ve brought in my children. There’s a culture at Cook Children’s that can’t be beaten, they set an example of what all hospitals should be like across the country. The nurses and doctors care about their patients and that’s something I have always appreciated.”

Crystal says the care she received at Cook Children’s is something she has always reciprocated in her nursing career.

“I always think back to how well they took care of me, and I value that and make sure to model that in my work.”