According to Daniel Guzman, M.D., a pediatric emergency medicine physician with Cook Children’s Health Care System, children are treated in emergency departments every year for fireworks-related injuries, including burns, eye trauma and hand injuries. While many families associate these injuries with the person lighting the fireworks, children and other bystanders can also be at risk.

Although fireworks are a beloved Fourt of July tradition, Cook Children’s Health Care System, encourages families to celebrate safely and understand the risks fireworks can pose to children.

What type of fireworks injuries do children often experience?

Fireworks can cause serious injuries in a matter of seconds. Even legal consumer fireworks can burn at temperatures high enough to cause severe skin damage.

Some of the most common fireworks-related injuries include:

• Burns to the hands, fingers and face
• Eye injuries that can threaten vision
• Cuts and lacerations
• Hearing damage from loud explosions
• Falls or other injuries while running away from fireworks

Sparklers aren’t as safe as they seem

Sparklers are often considered a safer option for young children, but they can be surprisingly dangerous.

 “Many parents feel that sparklers are safe because they don’t explode, however, the risk for burns is significant because they can reach 2000˚F (1093˚C) which is hot enough to melt some metals and cause severe burns.” said Dr. Guzman.

 Young children may accidentally touch the hot wire, wave sparklers near others, or drop them onto bare feet. Using glow sticks instead of sparklers is a safer, brighter, and more fun way to celebrate.

Fireworks safety tips for families

The safest way for children to enjoy fireworks is by attending a professional public display rather than using fireworks at home according to Dr. Guzman.

If your family chooses to use legal consumer fireworks, help reduce the risk by following these safety tips:

• Never allow young children to handle or light fireworks.
• Keep children and pets a safe distance away from fireworks.
• Ensure a sober adult supervises all fireworks.
• Read and follow all instructions on the packaging.
• Never relight a firework that doesn’t ignite properly.
• Keep a bucket of water or a garden hose nearby.
• Never point or throw fireworks toward another person or pet.
• Never carry fireworks in your pocket.
• Soak used fireworks in water before throwing them away.
• Avoid homemade or illegal fireworks.

What should you do if a child is injured?

If a child is burned by fireworks, move them away from the source of the injury. Cool the burn with cool water as soon as possible, remove clothing from the burned areas and apply a gauze bandage or clean, soft cloth. Seek medical care attention right away, especially for burns involving the face, hands, feet, joints or large areas of skin.

If a child has an eye injury, “do not rub the eye or attempt to wash it out; call 911 or go to the nearest emergency department,” said Dr. Guzman.

Other Fourth of July safety reminders

Fireworks aren’t the only risk during Independence Day celebrations. Parents can also help keep children safe by:

• Never leaving children unattended near pools, lakes or other bodies of water.
• Making sure children wear properly fitted life jackets when appropriate.
• Keeping kids hydrated, especially during extreme heat.
• Taking frequent breaks from outdoor activities.
• Applying and reapplying sunscreen throughout the day.
• Grilling outdoors only, keeping children at least 3 feet away from hot grills.
• Keeping matches, lighters and lighter fluid out of children’s reach.

The safest celebration is a prepared one

The Fourth of July should be remembered for time with family, not a trip to the emergency department. Choosing professional fireworks displays, supervising children and practicing simple safety precautions can help families enjoy a fun and memorable holiday while reducing the risk of serious injuries.

Related Stories:

• Big Game, Big Responsibility: Water Safety

• Expert Tips for a Safe Spring Break: Aim for Safety

• Big Game, Big Safety: Preventing Hot Car Tragedies

As families and friends come together to celebrate Independence Day, it's important to keep safety in mind. According to experts at Cook Children's, drowning is the primary threat to children during this holiday. Drowning patients are commonly seen in the emergency room and these incidents can often have severe outcomes.

To ensure a safe and enjoyable holiday weekend, consider the following safety tips:

• Always supervise children when they are in or near water, even if they know how to swim.
• Designate a Water Watcher, an adult who will watch all children while they are in or around water with no distractions.
• Keep pool areas fenced and locked when not in use and remove all pool toys/floats. One to 4-year-olds are at the most risk to drown in a pool.

DROWNING PREVENTION

From June 1 to June 23, 2023, there were 10 drownings treated at Cook Children’s, two of which were fatal. Most of these patients have been in the 5 years old and under age group.

Since Jan. 1, 2023, there have been 25 drownings at Cook Children’s, three of which were fatal. Most drownings in 2023 have occurred in a swimming pool or hot tub.

While most patients survived these incidents, drowning injuries can result in severe effects, especially on a child’s brain development.

Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger

Drownings can occur even with many adults present. When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions. The Water Watcher should not use a cell phone, socialize, drink alcohol or do anything else that might be a distraction.

Parents can put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

Go here for more information on Water Watcher tags. Lifeguardyourchild.org shares many resources and tips for drowning prevention.

HEAT SAFETY

In very hot weather, high humidity, and other conditions, heat in the body can build to dangerous levels. This can cause heat illness, such as heat cramps, heat exhaustion, or heatstroke.

With highs in the upper 90s, be sure to keep these heat safety tips in mind. 

Wear appropriate clothing: Choose lightweight, light-colored, loose-fitting clothes. Wear a hat to shield yourself from the sun, until you feel yourself getting warm. Then remove any items covering your head that can trap heat close to the body.

Schedule outdoor activities carefully: Heatstroke can occur in less than an hour when you are participating in a strenuous activity on a hot day. Try to limit outdoor activity to when it’s coolest, like morning and evening hours. Rest often in shady areas so your child’s body has a chance to recover.

Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Be sure to drink water or a sports drink before, during and after any strenuous activity.

Wear sunscreen: If you go outside, use sunscreen, wear a wide-brimmed hat and sunglasses, and put on sunscreen of SPF 15 or higher 30 minutes before going outside. Continue to reapply according to the package directions.

FIREWORKS

Fireworks can cause severe injuries that are both harmful and painful to children. Children should never handle fireworks. Even seemingly harmless sparklers can heat up to more than 1,200 degrees, making them dangerous for young children. 

Some people light sparklers at home or even set off their own fireworks, but this is dangerous. Some of the people hurt each year aren't the ones setting off the fireworks, but people who are nearby.

The safest way to enjoy fireworks is at a professional display.

If setting off fireworks at home, adults should only set them off in a designated “kid-free” zone. Adults should not hold fireworks in their hands or keep any part of their body over them while lighting. Wear eye protection, and don't carry fireworks in your pocket — the friction could set them off.

Point fireworks away from homes, and keep away from brush and leaves and flammable substances. The National Fire Protection Association estimates that local fire departments respond to more 50,000 fires caused by fireworks each year.

It’s also important to keep children away from bonfires and grills to help prevent any accidental burns.

ATV SAFETY

Though often thrilling for children, off-road motorized vehicles — including all-terrain vehicles (ATVs), ATV mules, go-karts, and even golf carts — can be extremely dangerous for them to ride, especially if they don’t use safety measures once they get on board. Cook Children's sees many patients with injuries from ATV accidents every year.

To prevent such injuries among children, the American Academy of Pediatrics (AAP) recommends that children under 16 should not drive or ride as passengers in two- and four-wheeled off-road vehicles.

ATV Safety:

• Always wear protective gear such as:
• Helmet
• Eye Protection
• Boots, gloves, long pants, jacket
• Do not ride an ATV at night
• Take an ATV safety course
• Never ride on public roads
• Perform ATV safety checks

RELATED

A Cautionary Tale: The Misadventures of Summer & Top Injuries Seen at Cook Children's (checkupnewsroom.com)

Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)

A Pediatrician's Advice for a Safe and Fun Fourth of July (checkupnewsroom.com)

The Fourth of July is a time for celebration and getting together with family and friends. Cook Children’s experts are sharing safety tips and information to remember as people gather this weekend. Keep in mind that drowning is the leading threat for children, especially during the Fourth of July holiday.

In the emergency room, drowning patients are seen the most frequently and drownings most often lead to fatal outcomes, said Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department.

“Keep a close eye on your child any time there is water nearby,” Dr. Warmink said. “People are often in large groups and let down their guard thinking that someone else is watching the kids in or around the water. They should identify an official Water Watcher who is responsible for keeping track of everyone.”

DROWNINGS

In June 2022, there were 19 drownings treated at Cook Children’s, none were fatal. Seventeen of those children were 5 years old and under.

• In June 2021, there were 22 drownings, one was fatal.
• In June 2020, there were 8 drownings.
• In June 2019, there were 13 drownings.
• In June 2018, there were 16 drownings. Three were fatal.

While most patients survived these incidents, drowning injuries can result in severe effects, especially on a child’s brain development.

Many of the drownings so far in 2022 have occurred during unplanned swim time. This is when parents didn’t expect their child to be in or around the water.

Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger.

Drownings can occur even with many adults present. When there are children around water, always designate a Water Watcher, an adult who is in charge of watching all children without any distractions.

Drownings on July 3 and 4:

• 2018: one drowning on July 3 and two on July 4
• 2019: four drownings on July 3
• 2020: one drowning on July 4
• 2021: one drowning on July 3 and one drowning on July 4

None of these drownings listed above were fatal, but parents and caregivers must remain vigilant.

Parents can also put barriers in place to help prevent a child from accessing the water or make it more difficult to access when an adult is not present. Barriers – such as locks, alarms and fencing – can help keep unsupervised young children from getting into swimming pools.

For more information and resource, including Water Watcher tags, visit: LifeguardYourChild.org

HEAT SAFETY

There are other threats during the Fourth of July holiday that can lead to severe injuries.

“Boating, jet ski and watercraft accidents are very frequent and often very tragic injuries. Burns from fireworks and cookouts are also very common,” Dr. Warmink said. “Snake bites and other bites are also common because a lot of people are outdoors along with very severe sunburns and heat exhaustion.” 

With the highs in the upper 90s and triple-digits, be sure to keep these heat safety tips in mind.

“Sunscreen is important and it should be reapplied every few hours. Drinking plenty of water and hydrating drinks throughout the day,” Dr. Warmink said.

Wear appropriate clothing: Choose lightweight, light-colored, loose-fitting clothes. Wear a hat to shield yourself from the sun, until you feel yourself getting warm. Then remove any items covering your head that can trap heat close to the body.

Schedule outdoor activities carefully: Heatstroke can occur in less than an hour when you are participating in a strenuous activity on a hot day. Try to limit outdoor activity to when it’s coolest, like morning and evening hours. Rest often in shady areas so your child’s body has a chance to recover.

Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Be sure to drink water or a sports drink before, during and after any strenuous activity.

Wear sunscreen: If you got outside, use sunscreen, wear a wide-brimmed hat, and sunglasses, and put on sunscreen of SPF 15 or higher 30 minutes before going outside. Continue to reapply according to the package directions.

FIREWORKS

Severe injuries from fireworks can be harmful and painful to a child. Even sparklers can heat up to more than 1,200 degrees and are dangerous for young children.

“Kids should not shoot off fireworks and they should be shot off in a ‘kid-free’ zone," Dr. Warmink said. "Keep kids away from grills and bonfires also.”

ATV SAFETY

Though often thrilling for children, off-road motorized vehicles — including all-terrain vehicles (ATVs), ATV mules, go-karts, and even golf carts — can be extremely dangerous for them to ride, especially if they don’t use safety measures once they get on board.

To prevent such injuries among children, the American Academy of Pediatrics (AAP) recommends children under 16 do not drive or ride as passengers in two- and four-wheeled off-road vehicles.

ATV Safety:

• Always wear protective gear such as:
• o Helmet
• o Eye Protection
• o Boots, gloves, long pants, jacket
• Do not ride an ATV at night
• Take an ATV safety course
• Never ride on public roads
• Perform ATV safety checks

Over the past five years, the Cook Children’s Emergency Department has seen over 50 fall-related injuries and more than 20 drownings during the July Fourth weekend. Parties, lake trips and higher amounts of people on the road are often the sources of injuries in children around the Fourth of July. With more distraction comes more risk of accidents such as motor vehicle, ATV/golf carts and snake bites. Many of these injuries are preventable and can be avoided with proper safety equipment and watchful eyes of parents.

In 2018, there were five drownings associated with the July Fourth weekend alone. Children in or around water should be watched by a responsible adult using the mindset of a lifeguard.

Corwin Warmink, M.D., medical director of Emergency Services, says adults should be within arm’s reach of young swimmers, especially in open water.

“The lakes are jam-packed and people are celebrating and not always using their best judgment. Overloading of boats is a recurring theme, everyone in a boat should have a life jacket within hands reach if not on,” Dr. Warmink said. “Letting children swim or out on open water during the Fourth of July is inviting trouble. We’ve had multiple injuries and deaths from people struck by boats while in the water and on kayaks or jet skis.”

In comparison, over the past five years, Cook Children’s has only seen three burns related to fireworks during the holiday weekend. Still, these injuries can be harmful and painful to a child. Dr. Warmink warns parents to be attentive especially during down times when activities are finished. Many injuries and deaths are preventable but can happen to anyone in 30 seconds or less of distraction.

“Fireworks rarely cause death but we often do see serious burns and occasionally injuries that could cause loss of an eye, finger or hand,” Dr. Warmink said. “Every year we have at least one tragic story that ruins not just a family's holiday, but their entire life.”

Top Injuries Seen at Cook Children’s During July Fourth Weekend

For More On This Topic:

• Lifeguard Your Child (Drowning Prevention)
• Aim For Safety (Protecting Our Children From Firearm Accidents)
• Vehicle/Car Safety
• Firework Safety Tips from SafeKids
• Is This an Emergency?

As we have reported throughout multiple summers, drowning remains a leading threat to children during the holiday. Last year, two children were rushed to Cook Children’s after being pulled from that water at pool parties on the Fourth of July. One of those children died from their injuries. For the entire month of July in 2017 there were 27 drownings, with two deaths.

Cook Children’s safety experts remind parents and adults to watch children near water with the mindset of a lifeguard.

Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s, says adults should be within arms reach of child swimmers.

“Don’t let your child out of your sight and be there to grab children out of the water at any sign of trouble,” Evans said.

Drowning prevention around the pool begins with adult supervision, but there are other steps parents can take at home to help protect their children from drowning.

Use these safety techniques and layers of protection whenever children are around the pool:

• Require adult Water Watchers to stay close and actively watch children in water. Water Watchers must be sober, stay off cell phones and not talk to other guests during their 15 minutes shift.
• If you are alone with your child, stay with your child. Get in the water with your child and be in arm's reach. If you have to get out of the water for any reason or leave the pool, take your child or children with you.
• Swim with U.S. Coast Guard-approved life vests. Don't use floaties filled with air.
• Learn to swim at any age.
• Learn CPR.
• Install a fence on all sides of a backyard pool or spa. Secure the fence with a self-latching gate.
• Use alarms that can be put on children's wrists. Also, install alarms in pools and on doors that lead to pools.
• Update pool/spa drain covers.
• Follow pool rules and signs.
• A fence with a locking gate should surround the pool.

Although drowning remains at the top of our mind throughout the summer, our Trauma department saw falls, car crashes, dog bites and snake bites from July 2 through July 8 2017.

The Trauma registry reports during that time frame:

• 19 Falls
• 7 Car Crashes
• 4 Blunt Mechanism Injuries (Finger smashed in the door type injuries)
• 3 Dog Bites
• 3 Snake Bites
• 2 Motorcyles or Dirt Bike Crashes

Rounding out the injury lists were ATV crashes, bike crashes and trampoline injuries with one each during the holiday week.

The safety experts at Cook Children’s remind parents to take the extra time to make sure their kids are safe during the holidays. History shows the most severe injuries seen during Fourth of July remain ATV/4Wheeler accidents and motor vehicle crashes. For the entire month of July last year, there were 27 motor vehicle crashes and 12 ATV accidents.

"If it can accelerate your body, it can injure you," said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children's. "Vehicular accidents, including boats, ATVs, cars, scooters and bikes are all too common on holiday weekends during the summer."

For more information on this topic

• Drowning Prevention
• Vehicle/Car Safety
• Bicyle Safety
• Child Safety Center

Through our Trauma department registry, here are the top four causes of injuries we’ve seen from 2011 to 2016 during the Fourth of July weekend (from July 2 through 6).

1. Drownings

#LifeguardYouChild.

We hope you’ve seen that hash tag or heard us talk about it by now because we aren’t going to stop saying it any time soon.

Last year, four kids were seen as a result of a near drowning. Since 2011, the number rises to 24 kids.

“We hope this campaign sends a clear message to parents and adults when they are at the pool or lake,” Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “Adult supervision is critical to the safety of a child in the water and is the difference between life and death for many kids.

"We’re asking parents and adults watching children in the water to go in with the mindset of a lifeguard.”

Ideally, Evans suggests adults get in the water and be in arms reach of their child. “Don’t let your child out of your sight and be there to grab children out of the water at any sign of trouble,” Evans said.

What You Need To Know:

Drowning prevention around the pool begins with adult supervision, but there are other steps parents can take at home to help protect their children from drowning.

Use these safety techniques and layers of protection whenever children are around the pool:

• Require adult Water Watchers to stay close and actively watch children in water. Water Watchers must stay off cell phones and not talk to other guests during their 15 minutes shift.
• If you are alone with your child, stay with your child. Get in the water with your child and be in arm's reach.
• Swim with U.S. Coast Guard-approved life vests. Don't use floaties filled with air.
• Learn to swim at any age.
• Learn CPR.
• Install a fence on all sides of a backyard pool or spa. Secure the fence with a self-latching gate.
• Use alarms that can be put on children's wrists.
• Also, install alarms in pools and on doors that lead to pools.
• Update pool/spa drain covers.
• Follow pool rules and signs.
• A fence with a locking gate should surround the pool.
• Install door alarms to alert adults when a child is entering the pool area.

In large pools, it’s ideal to split up in groups and take sections of the pool.

“If you are somewhere where children are in the pool, insist that an adult be on watch,” said Dana Walraven, community health outreach manager for Cook Children’s, said. “It should be done by a sober adult and that should be his or her only focus during their time watching the kids.”

2. Motor Vehicle Crashes

Last year, four kids were seen at Cook Children’s for injuries related to a car wreck. Since 2011, 23 kids have been treated during the Fourth of July holiday.

According to the National Highway Traffic Safety Administration, motor vehicle crashes are the leading cause of death in teens, ahead of all other types of injury, disease or violence. The Texas Department of Public Transportation states there are more than 100,000 traffic crashes in Texas each year involving distracted driving.

What You Need To Know

• Wear a seat belt on every trip.
• Make sure children are restrained in safety seats that are appropriate for their height, age and weight.
• Designate an alcohol and drug-free driver or arrange alternative transportation.
• Don't allow young drivers to drive with their friends. A single young passneger can increase a teen driver's fatal crash risk by 44 percent.

"If it can accelerate your body, it can injure you," said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's. "Vehicular accidents, including boats, ATVs, cars, scooters and bikes are all too common on holiday weekends during the summer."

3. ATV/4 Wheelers

The most injuries we had last year during Fourth of July weekend were ATV/4 Wheeler accidents. Five children were treated at Cook Children’s for an injury related to either ATV or four-wheeler accidents in 2016. Since 2011, 10 children came through the medical center, including one child who died.

What You Need To Know:

The state of Texas requires that ATV operators younger than 14 must be under the direct supervision of a parent. The minimum age to operate an ATV is 6, and older for ATV engine sizes under 70cc, 12 and older for engine sizes 70-90cc, and 16 and older for engine sizes 90cc and over. An offense of these laws in Texas is a Class C misdemeanor.

The American Academy of Pediatrics (AAP) discourages kids ages 16 or younger from driving or even riding on ATVS.

“It breaks my heart to see a child injured. I hope that people will see the reality of this situation. ATVs aren’t toys. They weigh more than 800 pounds and can reach speeds of 50 miles per hour or more. They are very dangerous for kids,” Sharon Evans, Cook Children’s Trauma Injury Prevention coordinator said.

Evans knows no matter how much she warns against it that parents will still let their children ride ATVs. If so, please follow these guidelines:

• Kids age 16 and younger should not ride an ATV. To reduce the risk of an accident or injury, anyone riding an ATV should follow these tips before and during riding:
• Take a safety certification program to learn how to operate an ATV safely.
• Ride an ATV that's right for your size and age. Visit 4-H ATV Safety for information on how to tell if an ATV is right for a rider.
• Always wear an approved helmet and eye protection. In many states, helmets and eye protection are required by law, particularly for kids.
• Wear long pants, long sleeves, gloves, and over-the-ankle boots to help prevent scrapes and cuts.
• Only ride during daylight hours.
• Always ride at a safe speed on a designated ATV trail.
• Know basic first aid to treat minor injuries, and be able to get help in an emergency.

It's important to never do the following while riding an ATV:

• Never ride on a three-wheel ATV.
• Never ride while drinking alcohol or using drugs.
• Never ride on paved surfaces or public roads (except to cross them).
• Never exceed the limit of passengers allowed by the manufacturer.
• Never allow kids and teens to drive another passenger.

4. Bike Accidents

Seven children have been seen since 2011 for an injury related to riding a bicycle.

From 2010 to 2013, less than 10 percent of patients seen at Cook Children’s for bike injuries wore a helmet.

Numbers have improved from 2015 to 2017 thanks to community education from groups like Peaks and Ladders, a collaboration between Cook Children’s, the Fort Worth Fire Department and Fort Worth Firefighter Charities.

During the past two years, 25 percent of children admitted for bike injuries wore helmets.

“Those numbers are still too low, but we’ve made some progress,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “It’s so important for kids to wear their helmets at all times. Even if they are taking a spin around their block, they need to wear a helmet. Injuries can occur anywhere, even when cars aren’t around. We’ve admitted children who have been injured in their driveways. Even little spills can result in concussions and broken bones.”

What You Need To Know:

Evans said a great way to encourage helmet use is to let your child pick out the helmet and decorate it with stickers and markers to his or her liking. Then, make sure you set the example by wearing your helmet too.

Among parents who say they always wear a helmet, 86 percent say their child also does. However, among parents who say they never wear a helmet, only 38 percent say their child always does.

“With warmer weather, your child will be spending more time on wheels – which means more opportunities for kids to get hurt,” Evans said. “The most important way you can teach your child to be safe is to always wear a helmet."

Safe Kids offers the following tips to help protect your child:

• Wear properly-fitted helmets, which are the best way to prevent head injuries and death, for every ride.
• Ride in safe locations like sidewalks, bike paths or bike lanes whenever possible.
• Follow the rules of the road.
• Check all equipment at the start or end of every season.
• Ride together until kids are comfortable enough to ride on their own.