If you’re a parent, you’ve said it to your child a thousand times. 

“Don’t run with that in your mouth!”

It could be a stick, a toy, a utensil or any other random object a child finds palatable.

While your little one may scoff at the command, it’s a fair warning. An ill-timed bump or fall could cause that object to crack a tooth or injure your child’s tongue, mouth or throat.

Data from Cook Children’s Medical Center suggests that palate injuries from an object in the mouth are on the rise. In 2021, there were two reported palate injuries, followed by eight in 2022. Already this year, there have been 14.

Six of the injuries since 2021 occurred while a child was using a straw, with some being a hard plastic or metal straw. Four of the injuries were the result of an accident while using a toothbrush. The others are from various objects, including a stick, curtain rod, spoon and plastic bat.

The activities leading to the injuries differ. They include everything from walking into a door while drinking from a straw, sneezing while using a straw, roughhousing with a sibling while brushing teeth and getting hit in the head with a ball while brushing teeth. These may sound random and far from the norm, but if you spend any time with children, you know the possibility of any one of these exists.

The key to preventing these types of injuries is to stay vigilant. Give kids a flexible, rubber straw rather than a hard plastic or metal one. Remind them not to play, roughhouse or throw or catch a ball while brushing their teeth or while holding anything in their mouths. And keep telling them not to run with objects in their mouths, even if it’s for the 1,000th time.

Jay Pearson, P.A., a physician assistant with Cook Children’s Trauma Services , says these injuries happen more than you would think.

“These soft palate injuries are considered penetrating injuries to the back of the throat and are at risk for significant complications,” Pearson said. “The risk is high enough that we activate the trauma team to do a thorough workup to make sure a significant injury is ruled out. We have seen an increase in these activations recently.”   

The most common injury from these incidents is a laceration of the palate that results in a hole in the mouth. These can be painful and interfere with a child’s eating and drinking, according to Michelle Marcincuk, M.D., Ear, Nose and Throat specialist at Cook Children’s. 

“They could potentially lead to an infection deep in the neck or even extending down into the chest around the heart area which can be very severe, and very dangerous. Sometimes they need surgery,” Dr. Marcincuk said. “But the most feared complication is for the object to go deeper and injure the big blood vessels in the neck. This can cause a stroke, a blood clot, an aneurysm, a catastrophic hemorrhage or even death.”

If your child sustains an injury from carrying something in their mouth, Pearson says they need to be evaluated by a medical professional. 

“The majority of the time these palate injuries are minor, but due to the potential risk of serious injury, an abundance of caution is taken,” Pearson said.

It’s a big milestone for parents of young children to turn their car seats to face forward. Some may wonder, when is the appropriate time to do so? Is it when the child wants to look out the window? Is it when the parent wants to see the child? This milestone should be delayed for as long as possible because safety is the top priority. Keep your child rear-facing to help prevent severe injuries during a crash.

“Keep them rear-facing until they reach the maximum weight and height of the car seat,” said Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “Rear-facing is the safest way they’ll ever travel.”

Car crashes are a leading cause of injury and death in children ages 1 to 13. Every year children are rushed to the emergency room to be treated for car-related injuries.  

Check your car seat’s manual -- the most important piece of information will be determining the maximum weight and height limit of their rear-facing car seat. Most car seats will go to 40 pounds rear-facing so your child could be 3 or 4 years old before you turn them around.

Keeping your child rear-facing also protects their spinal cord in the event of a car crash. When they’re rear-facing during a crash, the impact will cause the car seat to dip, protecting their spine and neck.

“You’re keeping their head, neck and spine all in alignment,” Evans said. “The majority of the crash forces are taken on the back of the car seat and less of the crash forces are not transferred to the child.”

Parents may worry that their child’s feet are touching the vehicle seat when the car seat is rear-facing.

“You would think that there is a chance that they would be more prone to having a broken leg, but what we found through research and the American Academy of Pediatrics says that there is no increased risk,” Evans said.

If a child is facing forward during a crash, that is a lot of force to put on a child’s spine and neck.

“If you have that sudden stop, the pressure and force put on their neck can cause severe spinal cord injuries,” Evans said. “During that stop, their head and their arms are all going to come forward and that force can cause broken arms and legs.”

Check the harness straps are at or just below their shoulders and the retainer clip always needs to be at the armpit level, Evans said. Make sure the straps are snug with the pinch test.

After outgrowing a rear-facing car seat, children will move to a forward-facing car seat until at least age 5 based on the weight and height limit for the car seat.

The next seat is a booster seat, which is used until the seat belt fits properly, usually around ages 9 to 12, according to the Centers for Disease Control & Prevention.

FREE CAR SEAT CHECKS

Parents and caregivers can bring their vehicle and car seat for a free car seat check with the Cook Children’s Center for Community Health at 682-885-2634 or go online to freecarseatcheck.org.

Certified technicians will inspect your car seat free of charge and show you how to correctly install and use it. Some locations now offer virtual inspections.Top of Form

The National Highway Traffic Safety Administration maintains a directory of many inspection stations.

Always refer to your specific car seat manufacturer’s instructions (check height and weight limits) and read the vehicle owner’s manual on how to install the car seat using the seat belt or lower anchors and a tether, if available.

More information & resources:

• Car Seat Safety (for Parents) - Cook Children's (kidshealth.org)
• Register your car seat and sign up for recall notices to receive safety updates
• Car Seat and Booster Seat overview from the NHTSA
• Car seat recommendations from the NHTSA
• Child Passenger Safety | Injury Center | Centers for Disease Control & Prevention
• Child Passenger Safety | Pediatrics | American Academy of Pediatrics (aap.org)

Ahh, summer. It’s full of adventure. Or, if your kids are anything like mine — misadventure.

Barely two weeks into our summer break this year I made a visit to urgent care with my 14-year-old to have a fish hook removed from his hand. Totally worth it, he says, since he caught a bass. (Insert my motherly eyeroll and exasperated sigh.)

The summer months can be busy ones in pediatric emergency departments, urgent care centers and pediatrician offices. With kids out of school and looking for fun, they sometimes find trouble that results in injury. Tragically, some of those injuries can be serious, life-altering or even fatal.

“In the summer, kids have all day and night to be able to get into trouble, which is what kids are supposed to do. They're just learning,” said Daniel Guzman, M.D., a pediatric emergency medicine physician at Cook Children’s Medical Center. “As parents, we're just trying to manage the chaos so they don’t make any tragic mistakes.”

Drownings top the list of summertime injuries and causes of death at Cook Children’s, according to Sharon Evans, trauma injury prevention coordinator. In fact, it tops the list nationally. Drowning is the leading cause of accidental death in children ages 1 to 4. For teens, it is the second leading cause of death.

The Center for Community Health, led by Cook Children’s, offers parents and kids water safety and drowning prevention education guides and resources like water-watcher tags and life jackets through its Lifeguard Your Child program. Through this program, anyone can learn how to choose and properly fit a life jacket, how to build a water safety plan, what type of physical barriers should be in place to secure backyard pools and tips for a safe and fun swim time. 

After drownings, the top sources of summertime injuries sending kids to Cook Children’s Emergency Department include:

• Motor vehicle collisions
• All-terrain vehicle (ATV) accidents
• Dog bites
• Falls on playground equipment and trampolines

Dr. Guzman says car and ATV accident injuries are often the most tragic.

An estimated four kids are seen in U.S. emergency departments every hour for injuries related to ATV accidents, according to the American Academy of Pediatrics. From 2017 to 2022, more than 700 North Texas children, most between the ages of 10 to 14, were treated at Cook Children’s Medical Center for serious injuries involving accidents with off-road motorized vehicles.

“The most critical injuries we see from these vehicles are head injuries from kids not wearing a helmet and being ejected,” Dr. Guzman said.

Golf carts can be particularly dangerous.

“With individual ATVs, people tend to put more of the safety equipment on their children, but with a golf cart people feel more secure and protected and less threatened,” he said. “They usually are not wearing a helmet or a seatbelt, so we see these ejections. When you are riding on pavement and it’s head versus pavement, the pavement always wins.”

While common summertime injuries seen at Cook Children’s Urgent Care Centers are more minor in nature than those in the Emergency Department, the sources of injury are often similar.

“We see lots of trampoline and bicycle injuries," said Kara Starnes, D.O, medical director of Cook Children’s Urgent Care Services. “Kids get outside, they're more active and they're more likely to break things. Bicycles, hoverboards, skateboards and trampolines are a big source of fractures or sprains. Fish hooks are more common in the summer, as are lacerations because kids are playing outside more. They get more cuts and things that need to be sewn up in the summertime.”

The primary care pediatrician’s summer risk list looks a little different given their focus on non-emergency care. When temperatures rise, pediatricians see more:

• Infected bug bites
• Sunburn
• Dehydration
• Poison ivy
• Swimmer’s ear infections
• Leg fractures

“Believe it or not, I see lots of leg fractures in little kids from sliding down a slide while sitting in their parent’s lap, because their leg gets caught between the parent and the side of the slide,” said Diane Arnaout, M.D., a pediatrician at Cook Children’s Pediatric Forest Park. “It’s a really dangerous thing to do.”

Pediatricians and Their Own Kids

Given these common injuries, we asked a few Cook Children’s physicians to weigh in on what they never allow their own children to do, or never let their kids leave the house without in the summer. It’s important to note these physicians are not afraid of fun, they just see the negative outcomes of these thrill-seeking activities on a daily basis. For them, the dangers associated with some of these risky behaviors outweigh the entertainment.

Here’s what they had to say:

Dr. Guzman:

“Trampolines are a big thing that I despise. We see so many injuries from those. You get multiple kids on a trampoline and that really becomes a problem. Another thing for me is golf carts. Until kids can drive, they probably shouldn't be in the golf cart unless mom or dad is in there with them. You wouldn't let your kid drive your car. Why would you let them drive a golf cart, ATV or other off-road motorized vehicle at a young age without any experience? They just don't understand the gravity of the responsibility or have the physical dexterity to maintain a vehicle.”

Dr. Starnes:

“I would never let my kids ride their bikes without a helmet because we see some pretty severe head injuries from bike accidents. ATVs are an absolute hard no for me. Also, kids go barefoot a lot in the summer, so we'll see things get stuck in their feet more often, like glass or gravel. To avoid this, I would recommend they at least wear flip flops or some sort of shoe while playing outside.”

Dr. Arnaout:

“I never let my kids leave the house without a water bottle in the summer. We don’t do trampolines without safety nets or bikes without helmets. And ATVs are a no-go for me.”

Bianka Soria-Olmos, D.O., pediatrician at Cook Children’s Pediatrics Haslet

“Insect repellant, sunscreen and big hats for scalp protection are a must for my kiddos. Water safety is my No. 1 topic in the summer and must be the No. 1 focus of parents when their kids are in or near bodies of water.”

RELATED:

• Should My Child Ride ATVs? Cook Children's Experts Weigh In (checkupnewsroom.com)
• Sunburn Relief at Home, When to See a Pediatrician (checkupnewsroom.com)
• Pediatrician Shares Top Beach Vacation Health Tips (checkupnewsroom.com)
• Heads Up: Helmet Tips for Safer Bicycling (checkupnewsroom.com)
• Teen Driver? What to Know Before They Go This Summer (checkupnewsroom.com)

From Aug. 22 to Aug. 28, Cook Children’s treated five patients who were struck by vehicles in separate incidents.

As the new school year gets underway for many districts across North Texas, it’s crucial that drivers look out for children, especially in school zones.

Injuries treated:

• 3 patients (pedestrians) struck by vehicles
• 1 patient (pedestrian) struck by an ATV
• 1 patient (bicyclist) struck by a vehicle

Drivers should eliminate distractions and pay attention to their speed, especially in school zones. Always look out for pedestrians and don’t text and drive.

Dan Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center, says that it’s important that parents also teach their children safety precautions for walking near a road, including paying attention, using sidewalks and crosswalks, and always looking both ways before crossing a street.

“It’s really important to teach your kids and make sure they understand that we need to pay attention because this is your life, there’s only one you and there’s no way to get this back if something bad were to happen,” Dr. Guzman said.

Dr. Guzman says the emergency department sees more children this time of year as kids walk or ride bikes to school and are, unfortunately, struck by vehicles.

“We want our children to be safe and no one wants to hurt a child,” Dr. Guzman said. “We all need to slow down close to school zones and neighborhoods. Make sure we take care of our kids.”

Elementary school children are very active and impulsive. Although they’re learning and growing, school-age children 10 and younger still need guidance and supervision when playing and walking near traffic, according to the National Highway Traffic Safety Administration.

Pedestrian tips:

1. Children less than 10 years old should not be crossing the street without an adult.  All kids are different, but developmentally until they are about 10 years old they don’t have the cognitive ability to judge the speed of an oncoming car.
2. Don’t be distracted while walking.  Stay off your phone and if you HAVE to use headphones, only use one. You have to be aware of your surroundings!
3. Look left, right and back left again before crossing the street. 
4. Only cross at the light, corner or crosswalk. Never cross the street between parked cars.
5. Walk on the sidewalk. If there isn’t a sidewalk walk FACING traffic.
6. Be alert for cars pulling into parking lots and driveways as well as cars backing up.
7. When there is a car approaching or even stopping, make eye contact with the driver and wait for them to motion for you to cross the street. Often times you may think the driver is looking at you but they may be in a “daze” and not truly see you.
8. More than 80% of pedestrians die when hit by a car going 40 mph or faster, and less than 20% die when hit at 20 mph or less. As a driver, SLOW DOWN.

School Zone tips:

1. Slow down and follow all speed limits.
2. Pay attention and look out for pedestrians.
3. Cell phone use is prohibited.
4. Obey crossing guards.
5. Stop for school buses.

Tips for Drivers:

1.  Always stop for pedestrians.
2.  Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
3. Yield to pedestrians in crosswalks and stop well back from the crosswalk to give other vehicles an opportunity to see the crossing pedestrians so they can stop too.
4. Never pass vehicles stopped at a crosswalk. There may be people crossing where you can’t see.

Media partners: If you are interested in telling this story, please contact Public Relations Manager Kim Brown at Kim.Brown3@cookchildrens.org or at 682-885-1080, 817-266-3728

It is likely the only thing that will be on my TV for the entire 16 days!

Even though we don’t get a lot of snow and cold weather here in Fort Worth, many kids in Texas are able to partake in winter sports. Sometimes this is at a local indoor skating rink, and sometimes we travel to the ski slopes. However, the wintery fun can bring injuries along with it. In fact, research shows that 3.8 million people in the U.S. experienced an injury while participating in a winter sport in 2013. The most common injuries include concussions, ACL tears, ankle and wrist sprains, strains, shoulder and elbow dislocations and broken bones.

There are several things that you can do to prevent winter sports injuries, should the Winter Olympics leave your child feeling inspired. Here are some tips:

Use the proper equipment:

• Wear a helmet! Look for a helmet with a hard outer shell, a shock absorbing layer, and fits appropriately without impacting your vision.
• Inspect your skis or snowboard. Make sure that the edges have been properly sharpened and there is an appropriate wax on the underside.
• Make sure you have well fitted ski or snowboard boots. They should be snug. If you aren’t sure, be sure to ask a pro at the rental shop or ski store.
• Get fitted for the proper ice skates if you are playing hockey or going ice skating.
• Don’t forget about other safety gear such as goggles and pads!

Dress for the weather:

• Choose base layers, such as long sleeve shirts and long underwear, that are loose fitting, breathable, and made of synthetic material. This will allow them to wick sweat away from your skin, helping you to stay warm and dry.
• Long wool socks are the best for skiing and snowboarding, but don’t double up your socks. This actually makes the socks rub together and tends to give you uncomfortable blisters on your feet.
• Don’t forget your sunscreen! You can get a sunburn even on the slopes.

Warm up your body:

• It’s cold outside! Get moving before you skate or ski!
• Get your heart rate up by doing jumping jacks or jogging in place.
• Stretch your arms and legs by doing arm circles, upper body twists, squats, and lunges.
• Start with several slow laps around the skating rink or an easier ski slope to get your legs under you before you get going.

Learn from a pro:

• Take a lesson, or several, from a qualified instructor. They can teach you the rules of the rink or slopes, as well as how to fall correctly.
• Be sure to learn the basics. It is important that you can skate safely before you can play hockey. You also have to know how to safely turn and get on and off a chair lift before you can head up the hill on your skis or snowboard.

Know your limits:

• If you are cold or exhausted, take a break! Let your body rest and then get back to the fun.
• Remember that you don’t have to follow the crowd. If everyone else is hitting a double black diamond, you can always take a hot cocoa break if you don’t feel up to it!

So let the Winter Olympics inspire you to have some fun this year, but stay safe while you are out there!

About the author

Jacky Arrow, PT, DPT, SCS, is a physical therapist for the SPORTS program at Cook Children's. The Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS) program offers care to children and adolescents with orthopedic or sports-related injuries. If your child gets injured and needs medical care, it's very important to choose a program that has experience working with the growing dynamics of your child's body to prevent further injury. Click here to learn more about the program or call 866-205-7270 to make an appointment.

Last month alone, eight children were taken to Cook Children’s Emergency Department after being hit by cars while walking or riding bicycles. The same number of children were injured in February.

“Over the past couple years, we’ve seen the numbers increase,” said Sharon Evans, Trauma/Injury Prevention Coordinator at Cook Children’s. “We can’t say why this is happening, but we do know children do not have the cognitive skills to cross a street safely by themselves until they are at least 10.”

According to a new study released by the University of Iowa, 10 may still be too young. Researchers suggest children may not have the perceptual judgment or motor skills needed to safely cross a street until they are 14 years old. The study used virtual reality to simulate a busy street. Then, children, ages 6 to 14, were asked to cross multiple times.

The results show the children, up to their early teenage years, had a difficult time deciding when to cross the street. The study also evaluated how often the children were involved in an accident during the simulation.

Accident rates from the study:

· 6 year olds – 8%

· 8 year olds – 6%

· 12 year olds – 2%

So what do parents need to know?

Do not allow children under the age of 10 to cross the street by themselves. Even better, wait until they are a teenager and able to confidently know when to safely cross.

Cook Children’s recommends teaching these behaviors before allowing a child of any age to cross the street alone:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

Researchers in Pediatrics found that only track and field and swimming were safer as far as the number of injuries to athletes, but because of the high risks of cheerleading stunts the injuries were often times dangerous.

The study found:

• The most common injuries are concussions at 31 percent, but lower than all other girl sports.
• About one third of those injured, were participating again in a week.
• Forty-one percent of cheerleaders were out for one to two weeks.
• Eleven percent were out more than three weeks.
• Five percent were out for either the season or were career ending injuries.
• Most of the injuries were to girls, but boys also were injured because they were usually at the base of the formation.

The Cook Children’s Emergency Department admitted six cheerleading injuries from Oct. 9, 2014 to July 28, 2015, a low number compared to a sport like football. But four of those six required surgery at Cook Children’s.

Amanda Vick, PT, DPT, a Cook Children’s SPORTS physical therapist, was a cheerleader in high school. She points to the focus of cheerleading become a year-round sport, including athletic competitions, summer camps and competitions, leading to the increase in the number of injuries.

Plus, cheerleading has changed over the years to include high level gymnastic tumbling runs and stunts. Most common injuries seen at Cook Children’s are fractures, strains, sprains and concussions. She says more regulations could help lower the amount of injuries in cheerleading.

“Cheerleading has not historically been recognized as a sport, at many levels,” Vick said. “This means cheer may not be under the control of an athletic department. Cheerleading does not have to follow certain rules and regulations that other sports monitor and improve for safety. Therefore, increasing safety awareness is key for protecting cheerleaders.”

Due to this change in the demands of cheerleading, it is important for coaches and cheerleaders to understand proper techniques during stunts and tumbling, strengthening, leg and arm alignment, core activation and different risks related to floor surface and practice time.

Read more on Vick’s advice to protect cheerleaders here.

About the source

Amanda Vick, PT, DPT, is a Cook Children's SPORTS physical therapist.The SPORTS Program at Cook Children’s offers educational material for parents, coaches, trainers and nurses for sports-specific injuries. Our team of experts have specialized training in pediatrics and collaborate together to share their knowledge in growing bodies and dynamic training principles. 

That’s great. I appreciate all the efforts to protect the well-being of those players.

But today, I want to focus on our youth and how to make sure injuries can be prevented at the 14 and under level. In 2012, the City of Fort Worth estimated 10,000 volunteer coaches managing youth sports teams throughout the Fort Worth and Tarrant County, under the age of 14. The report said “most of these coaches are parents or other family members who have not been specifically trained on how to coach youth sports or youth sports safety.”

Sports activities help children and adolescents stay fit, learn about teamwork and develop self-confidence. However, with the number of youths participating in sport activities increasing, the rate of injuries is also steadily rising for this group. Each year, approximately 775,000 children under the age of 15 are treated in emergency rooms for sports injuries across the nation.

How can injuries be prevented?

According to the American Academy of Pediatrics, it is recommended that children wait until 6 years of age before participating in team sports. Young children could sustain injuries because they do not understand the concept of team play. In addition to age, sports injuries can result from not following recommended procedures for the young athlete before, during and after their sporting activities.

Here are nine recommendations for lowering the risk of injury to the young athlete.

1. Get a sport physical from a physician for your child.
2. Coaches/instructors/athletic trainers should have annual education on specific sporting activity and guidelines.
3. Make sure your child has well-fitted safety/protective equipment and shoes.
4. Have an Emergency Action Plan in place and practiced as a drill.
5. Follow a pre- and post-practice/game dynamic warm-up program.
6. Take the time teach the correct technique of skills.
7. Take rest breaks and drink water frequently during activities.
8. Know the signs of overtraining.
9. Maintain good mental health.

If you are coaching youth sports or you are the parent of a youth participating in sports, please read all of the “young athlete’s injury prevention guides” from our experts at Cook Children’s Sports Performance Orthopedic Rehab Team Specialists.

Additional training for coaches both recreational and professional:  City of Fort Worth Training Video complete with a pre/post-test.