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Ask Us Anything About… Children’s Outdoor Injuries

It’s spring…and soon summer. And as our kids head outside to ride their bikes, climb trees and hit the playground, some dangers await. In this interview, we’re focused on safety and how to help your children avoid common outdoor injuries, with Tracy Presite, a registered nurse and clinical case manager with Penn State Bone and Joint Institute.

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Scott Gilbert – Penn State Health. This is Ask Us Anything about Children’s Outdoor Injuries. I’m Scott Gilbert. Well, it’s spring and soon summer, and as our kids head outside to ride their bikes, climb trees, and hit the playground, some dangers do await. So that’s why today we’re focused on safety and how to help your children avoid common outdoor injuries. Here to help us do that is Tracy Presite. She’s a Registered Nurse and Clinical Case Manager at Penn State Bone and Joint Institute. She has specific expertise in pediatric orthopedics. So, Tracy, thank you so much for being here today. You know, I’d like to start by talking about some of the most common outdoor injuries you see in children, and especially those preventable ones. The ones that involve lawn mowers is, I think, where we’ll start, because I know that it’s not just about kids mowing the lawn. It’s about kids running outside while mom and dad are mowing the lawn, right?


Tracy Presite – Right. So you’re right. Unfortunately, we see a lot of lawnmower injuries every year and it is — it’s not just kids using the lawnmower. It’s actually the little kids, kids under six that are excited to see their parent or grandparent cutting the grass and they run up to them and, unfortunately, maybe slip on the wet grass, or another big problem is parents reversing a riding lawnmower and the child actually slips underneath. So this causes really life-altering, really traumatic injuries to kids, so that’s still one of the most common summertime injuries we see.


Scott Gilbert – And sometimes kids love to get a ride on the mower. Is that safe?


Tracy Presite – Yup, so I know everybody would feel confident, like I got ahold of my kid, I know what I can do, but kids are impulsive, you know, that they could want to jump off any minute. The other thing is it’s that next time when they come home from school or the grocery store or something and they see you out there, they’re going to want to run to come and greet you and that’s when there could be a tragedy.


Scott Gilbert – Right. Now, when it comes to kids mowing the lawn, actually using the lawn mower, what does the American Academy of Pediatrics have to say about that? Any advice for how to keep kids safe as they help us to keep our lawns in order?


Tracy Presite – Yeah, the American Academy of Pediatrics says they should be 12 before they try to use a push mower, and it’s actually 16 before, you know, a riding mower. But I always think to myself, you know, kids doing chores want to cut corners and things like that, so you have to make sure your kid is appropriate to do that chore and they don’t cut the corners. They have to clean up the yard to keep things like rocks and sticks out of there. They have to know they can’t reach under, into the blades to clear them, and also when they put the lawnmower away that the engine will be hot and they can avoid burn injuries, too.


Scott Gilbert – You’re watching Ask Us Anything about Children’s Outdoor Injuries from Penn State Health. I’m Scott Gilbert alongside Tracy Presite who welcomes your questions. It can be about anything. It could even be about that thing behind me. See, I’m outdoor for a reason here. We’re going to talk about a number of the most common injuries, but we want to make sure we touch on your question, so feel free to add those in the comment section here whether you’re watching this live or even after the fact and watching it on playback. So let’s talk about some of those other most common injuries. Perhaps, you know, mowing is a little more along the lines of work, but some of the injuries more common with outdoor play.


Tracy Presite – Well, you know, that’s a childhood thing. Accidents are going to happen and kids are going to get hurt, right? So a lot of the things we see, riding your bike, riding a scooter, hoverboards are really popular, monkey bars at playgrounds, kids will fall. Kids will get hurt. So we do see a lot of elbow fractures, ankle fractures, leg fractures, things like that. That’s kind of the more common things we see for kiddos that are just being active and can just happen at any time.


Scott Gilbert – All right, so let’s talk about this thing behind me here, this trampoline, right, because we hear a lot of different things. We hear that they’re just outright dangerous and evil. Whether or not this is in my backyard, I won’t confirm. And we also hear that there might be safe ways to allow kids to enjoy it. What’s your take on this, Tracy?


Tracy Presite – So it’s so hard, right? We don’t want to be like the Debbie Downers of saying, “You can’t have fun” and they can’t do the trampolines and they can’t do Sky Zones and things like that, but there are safe ways and safe rules for trampolines that can help kids avoid injury. Really, if you’re little, like two and under, it’s best if they don’t use them. Certainly for any age group, it’s really supposed to be one jumper at a time, which we know that doesn’t always happen. But even if they’re sitting down and someone’s jumping, that can throw off how they spring and rebound, which could lead to somebody falling. Of course, they try to maybe rocket one another higher each time and have fun in there and that can cause collision injuries. With your — you have the netting there. Sometimes that’s not enough to stop somebody from falling to the ground. Sometimes the safety padding around the springs, even for little kids, can pinch. We’ve had kids have toes pinched, you know, kind of almost amputated at the tip. So when it comes to trampoline safety, it’s really best that it’s one jumper inside by themselves jumping, so . . .


Scott Gilbert – Good advice. And so when it comes to playground equipment in general, the types of equipment you’ll see, like the monkey bars and the swings and that type of thing, I understand the most common cause of childhood injuries there is simply falling on the playground surface, right?


Tracy Presite – Yup, monkey bars. Monkey bars are usually the number one culprit. We see a ton of monkey bar injuries. That happens oftentimes at the beginning of school, maybe not a summertime injury, but kids getting back to school and still the weather’s nice enough for them to be on the playground. But the beginning of summer, too, we’ll see some monkey bar stuff, and that’s just the height of the monkey bars and then how they’re falling and catching themselves. A lot of elbow fractures with that, a lot of elbow fractures.


Scott Gilbert – Yeah, no doubt. You’re watching Ask Us Anything about Children’s Outdoor Injuries from Penn State Health. Tracy Presite is a Registered Nurse and Clinical Case Manager with Penn State Bone and Joint Institute. We welcome your questions for her and, you know, all those ways that we can help to keep your kids safe this summertime. To get into some terminology here, we hear about sprains versus strains versus fractures. Now, fractures, we know that involves a broken bone, but what’s the difference between a sprain and a strain? And maybe we can get into some of the more common causes of those two.


Tracy Presite – Yeah, sure, and, you know, a sprain and a strain and a fracture, kind of in a little kid, you have to come and probably see somebody. If there is an injury and you have a little kid that’s maybe, again, like under six and they won’t bear weight, won’t walk, and you know that something happened, you better bring them in. A lot of the times for younger kids, they will break before they tear. So that’s the opposite for adults. They’ll tear before they break. But for little kids like that, if you have somebody that you knew has had an injury, has fallen or something, and then they won’t bear weight or they won’t use their arm, it’s best to get them seen and get an x-ray to make sure that it’s not a fracture.


Scott Gilbert – The best way to get them seen is by calling that number that’s on your screen here. It’s also in the comments here below this Facebook post to reach the pediatric orthopedic specialists at Penn State Health. Another common injury, concussions, right? When you fall, if you fall and hit your head, kind of rattle the head a little bit you can — perhaps even falling off of a bike or something like that. What are some signs to look for there? I know that that’s perhaps outside the bone and joint specialties, but I know you can speak to that a little bit, right?


Tracy Presite – Yup, yup. So in ortho, we don’t really do — we don’t take care of concussions. However, when you have an injury, if you fall off your bike, the trampoline stuff, you’re falling off a trampoline, falling off a playground equipment and you — they do get a pretty decent bump on the head, certainly if you know that your child has lost consciousness, meaning they were asleep for some period of time, or have like amnesia to what happened, they might have to — it’s probably best they are seen at an urgent care or an emergency department for any loss of consciousness. If they have a bump and it’s just kind of a headache, you just want to follow up with your primary care provider or pediatrician to be seen for that. Certainly, if they are complaining of a headache or they start having vomiting, again, that’s another urgent care situation that they should be seeing right away.


Scott Gilbert – Right. So back on the prevention tip, let’s go back to the playground for a moment here. What are some common playground hazards to watch for? So when I take my child to maybe it’s a new playground, somewhere we haven’t been before, as I’m surveying the property, what are some things I should look for?


Tracy Presite – Well, you know, it’s hard, because kids will want to do whatever at the playground, right? So you want to make sure you’re taking your kid — maybe if your kiddo is really little, two or three, and it’s big-kid equipment, you might not want to go there because you aren’t going to be able to stop them from going on it. They’re going to want to climb the rock wall and do all that kind of thing that you’d have to be right there, you know, to keep them safe. But otherwise, you know, you want to see — I think most playgrounds are mulched or have that, like, playground rubberized that’ll help with any kind of falls. The equipment is in good repair, of course, like that, just using your best judgment. Does this equipment look like it’s being maintained? And is the ground being maintained in a manner that if they were to fall that they would probably be at least cushioned somewhat?


Scott Gilbert – We’re talking with Tracy Presite, getting her input here on a variety of children’s safety issues on Ask Us Anything about Children’s Outdoor Injuries from Penn State Health. We welcome your questions. Just add them to the comment field here whether as we’re talking live or even after the fact. We can get you a written response to your question, any way to keep your children safe outside. You know, supervising your kids when you’re outside, any advice for parents on how you can strike a balance between hovering over them, kind of watching their every move, and also just kind of letting kids be kids?


Tracy Presite – Yup, yup, that’s so hard, right? Because there’s so many things that you have to think about and be worried about, but you want them to be active and have a — like, really foster their sense of independence. So I think, again, like at a playground, is this, what we’re doing, age-appropriate for them, and you know your kids. You know, do you have a daredevil kid, do you have a more cautious kid, and what situation are you putting them in? Because I think if you get them to a situation where you know that they can do what’s there and be safe what’s there, you don’t have to hover over them. But it’s like when, you know, my two-year-old wants to climb the rock wall that I took him to because my four-year-old wants to be there, I have to be right there the whole time. So I think it’s finding that balance of what your kid can do and where you’re at, and then also the right equipment. You know, are they going to be riding bikes? Are they going to be doing things like going on the trampoline and is that going to be just one person on there or, you know, it’s going to be a crazy time on the trampoline? Are you going riding bikes or trying to skateboard and you’ve never tried to skateboard before and you’re going to just let them go out? Make sure they have the right safety equipment. Make sure they’re capable of doing that thing, and then I think you can relax a little bit more. So again, kids can fall and break their elbow just by walking, so you can’t stop them from walking. So it’s just setting them up for the best success that you can.


Scott Gilbert – Right, wearing those elbow pads, those knee pads, the helmet when you do things like skateboard. I’ve still got scars to prove that that’s a good idea, but that’s for another time. You know, I’d like to talk a little about sports-related injuries because when we think of summer, we think of a time when kids are off from organized sports in many cases, but then late in the summer, especially when fall sports kick in, they go back to practice and they might even be a little bit out of shape. What are some of the most common injuries you see, especially in the late summer, as kids get back into the swing of things with organized sports?


Tracy Presite – Sometimes, you know, it can be something — there’s something called “Sever’s apophysitis” that they can get from getting back into those cleats and going on — running on that with a harder surface that they can get like a repetitive use irritation to that. Sometimes it’s, well, he won’t bear weight, it’s really hurting, it’s really bothering him, but it’s the inflammation in there just from that kind of repetitive running back and forth with cleats on a harder surface where they might have been in flip flops and kind of doing more casual things over the summer. They can have something like that. And then there’s just the fact that if they are kind of — depending on what you did during the summer, are you a little bit more deconditioned and then you’re going back into camps that are, you know, trying to get you ready for football season or trying to get you ready for something. You’re doing more repetitive things that can cause just like the same aches and pains that we all get, but it’s just from the fact that maybe they weren’t doing those. They weren’t doing calisthenics. They weren’t doing kind of repetitive activities every day like they would in preparation for their fall sports.


Scott Gilbert – Learning how to get flexible once again, and also perhaps watching for things like heat exhaustion. That can apply not only to organized sports, but any child who goes outside. And again, I know beyond the orthopedic realm here, but heat exhaustion a major issue for those hot sweltering summer months, right?


Tracy Presite – Yeah, especially until — you know, it’s staying hotter for longer, so into August and September. You know, September used to cool down and it doesn’t cool down as much. So kids, you know, still have to be more cognizant of what they’re doing, the time of day that they’re having activities, and how much fluid they’re drinking.


Scott Gilbert – And at the pool, parents watching their children because drowning happens and it doesn’t happen the way a lot of people think it does, right?


Tracy Presite – No. It’s quiet. When little kids drown, it’s not like on TV. You know, it’s quiet. They kind of just go under. So again, swimming safety is the same as anything else. You want to make sure they’re in an environment where if they don’t know how to swim, then you’re going to have to be right there. You know, floatation devices sometimes aren’t enough, so you have to make sure. We really encourage swim classes for kids and that, if you don’t have it, that pools have to have fences and they have to have, you know, alarms and things like that for small children. But you should always have an adult right there, really a designated person for a small kid that can’t swim.


Scott Gilbert – And, Tracy, I know we’re talking a lot about outdoor activity today, but we also know that a lot of children, perhaps most children, will also be spending some time on screens and gaming devices when they’re indoors, let’s say at least on those rainy days, if not more. Any tips you can offer to prevent some of those repetitive use injuries that may surface and maybe even, on the flip side, on ways to help kids stay active.


Tracy Presite – Yeah, yeah, you know, we haven’t seen a ton — it’s interesting, you know. With gaming, there hasn’t been like repetitive use that we see, like hand trouble or wrist trouble or anything yet. But what we see with kids like that do a lot of screen time, do a lot of sedentary activities like gaming is back problems and maybe some neck problems because they’re kind of hunched over, you know. You don’t have the best posture when you’re doing that kind of thing. So we really encourage limited screen time all year round. And really getting out there as a family, that’s the best way to show your kids how to be active, is to do things together. If there’s the expectation that everyone goes together and does something fun, whether it’s even just a walk, you know, not even every day, maybe just most of the week, that’ll show kids. That’ll be the model. So we always say the families have to be the model. You can’t expect your kid to do something and then you don’t demonstrate it. So we love to encourage families to get outside and be active together and cut that screen time down as much as you can.


Scott Gilbert – That’s really what it comes down to, right? And we’re talking about keeping kids safe outside, but we’re not saying in order to keep them safe keep them inside.


Tracy Presite – Right, no, right, right, right.


Scott Gilbert – You’ve got to get on the playground because, I mean, childhood obesity is a major issue and we’ve got to strike a balance here.


Tracy Presite – Correct, yeah, yeah.


Scott Gilbert – All right. Tracy, thanks so much for your time today. Some great advice for parents everywhere, and I appreciate you taking the time.


Tracy Presite – Oh, yup, that was great. Thanks so much, Scott.


Scott Gilbert – Tracy Presite is a Registered Nurse and Clinical Case Manager with Penn State Bone and Joint Institute with a specialty in pediatric orthopedics. Tracy, thanks so much for your time. To reach her and her colleagues if your child has any kind of medical issues that you feel warrant their attention, you can get their phone number from the chat here below this Facebook post. Thanks so much for watching Ask Us Anything about Children’s Outdoor Injuries from Penn State Health.


Tracy Presite – Thank you.

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