Driveway Disasters (Article)

The combination of driveways and your children can be a deadly one. Accidents can happen in the blink of an eye while a parent is performing a mundane task like backing their car out of the driveway; disaster can sadly be just feet away. We all know how much kids love playing outside in the driveway. This puts them squarely in a dangerous zone where they can be injured by a moving car. It’s an alarmingly easy mistake to make that happens frequently. So many families have been devastated when their children are injured or killed by the family car.

In the U.S., fifty children are backed over every week. Of these fifty, two are fatally injured, and most victims are between only twelve and twenty three months old; they are just little innocent toddlers who have no awareness of the danger a moving car poses. They just innocently toddle out into the driveway following their parents, right in the way of the moving vehicle. Most accidents occur when drivers cannot see children in their car’s blind spot, the space behind the car that is not visible from the driver’s seat. Since trucks, vans, and SUVS have the largest blind spots, the majority of accidents are attributed to these vehicles. Fortunately, with more awareness, most of these accidents are preventable.

Here are a few easy tips to ensure that your children are kept safe in your driveway.

  • Always walk all the way around your car before backing out of the driveway. These few seconds could save your child’s life.
  • When young children get in or out of the car, hold their hands and guide them to a safe area where the driver can easily see them.
  • When you’re behind the wheel, remember to back up slowly and always pay attention to your mirrors.
  • Consider purchasing a car that is equipped with a back-up camera and alarm, especially when your children are very young.

Hopefully, all these measures will reduce the number of children who are injured where they should be the safest…their own homes. The prevention of such accidents is possible and in our hands. This is a problem that we can fix!

Your comments are welcome at my blog, Until next time.

Smo Notes:


Written collaboratively by Keri Register and Paul Smolen M.D.

Children and Pools (Article)

​Summer is a season when parents need to be especially vigilant about their children’s safety. One of the biggest summer risks starts when the pools open for business. What summer vacation signifies for youth is cooling off from the summertime heat by jumping and playing in a pool. For children, the neighborhood pool means freedom, friends, and fun. For parents however, their immediate concern needs to be, “safety first!” As beautiful and harmless as backyard appears, parents must remember it can be dangerous and even lethal for their children. A 2013 report found that children younger than 15 represented 78% of deaths from pool-related injuries. These data certainly cast a dark shadow over the image of fun in the sun. ​Since when did swimming at the pool become dangerous? The report “Pool and Spa Submersions: Estimated Injuries and Reported Fatalities” discusses findings related to this class of injuries. This 2013 report found that the majority of these pool-related fatalities involved children “15 years or younger” at neighborhood pools. Interestingly enough, the report also found interesting demographic information related to these incidents. The Centers for Disease Control and Prevention found African American and Hispanic children at higher risk of drowning. Particularly, African American children, between ages 5 and 19, were “six times more likely to drown in pools [versus] white and Hispanic children.” They also found that 70% and 62% of African American and Hispanic children, respectively, could not swim adequately. The report did not identify the exact origins behind these figures but point out a serious health hazard threatening a large group of children. ​How do we solve the problem of childhood drownings? Should we outlaw community and backyard pools? No, we need to increase our efforts to make sure every child learns to swim and know how to safely be around water. Thanks to organizations like the American Red Cross, the YMCA, and most public swim facilities, families can teach their children how to swim and remain safe during this and all future summer seasons. Proper swimming is a vital life skill that all beachgoers, children and parents should know. It may seem obvious but the solution to childhood drownings is really simple, professionally taught swim lessons along with good adult supervision around water. Smo Notes: Written collaboratively by Norman Spencer an Paul Smolen M.D.

White Noise Machines Can Be Noisy! (Article)



I am an old enough pediatrician to have seen a number of sleep fads come and go in my career. I recall a device that gently shook the crib and made the noise similar to a car ride that was very popular back in the 80’s.  I also recall, a set of springs that were fitted to the bottom of the crib so as to create a rocking motion each time the baby moved.  Who could forget the stuffed animal that had placenta noises or heart beat sounds emanating to help the infant replicate the womb-like environment in their crib. The current trends in infant sleep aides seem to be  swaddle devices and white noise machines, to a large degree popularized by Dr. Harvey Karp, a pediatrician in California.


It was with great interest to me when I recently read a study that has questioned the safety of the white noise machines that are currently sold in the US. The authors recorded the decibel level of a variety of these machines and found that, at close distances, the amount of noise they produce could potentially cause hearing loss in an infant, especially if they were run all night. Currently, experts recommend that noise in hospital nurseries not exceed 50 decibels but many of these machines tested reached 85 decibels sound levels, far above what is considered safe. Exposure to noise of that level over an extended period of time can potentially cause permanent hearing loss.


Parents need to use caution when they introduce any external device into an infant’s sleep ritual as we have recently been reminded with revelations about swaddle devices and now sound machines.  Yes, there might be some short-term advantages from these devices but those unintended consequences often come back to haunt us.  In the case of white noise machines, exposure to a lot of noise is clearly a limiting factor. Although difficult for many infants, maybe learning to settle oneself down and control one’s own environment by creating their own “Comfortable sleep environment” is an important learning step for infants.


Smo Notes:

Swaddling Harmful? (Article)

What is old is new and what is new is old as they saying goes. Nothing could be more true when it comes to swaddling infants, that ancient practice that has enjoyed a resurgence of popularity among todays parents.  Just go into a baby store and you will know what I am talking about; baby blankets for swaddling, swaddle wraps (a blanket with pockets for the infant’s arms and legs along with Velcro), wearable blankets (a blanket with holes for the arms and head zippered up the front), and sleep sacks (a sack with an opening for the infant’s head), along with other variations.  Most parents will agree that these swaddling devices sooth babies and create a warm environment for the infant but are they safe?


The dangers of swaddling have been known about for decades; over bundling and heat illness, suffocation if the wrap gets loose and gets near an infants face, an infant who rolls over while wrapped and smothers, being wrapped too tightly restricting breathing, pieces of the swaddle coming loose or damaging an infant’s mouth. In a recent retrospective study published in the Journal of Pediatrics, the authors reviewed deaths and injuries from swaddles between 2004 to 2011 in the US.   In all, they found 22 infant deaths in part or totally attributable to swaddling.  Here was the breakdown:

 5 cases involving wearable blankets (1 death, 2 injuries, 2 potential injuries);

 18 cases involving swaddle wraps (8 deaths and 10 potential injuries);

 1 death involving an unspecified product (either swaddle wrap or wearable blanket); and

 12 deaths involving swaddling in ordinary blankets.


Swaddling remains a useful tool for parents to soothe a fussy baby but this new study reminds us of its limitations and dangers.  Parents need to be vigilant not to overwrap their infants and get them too hot, wrap them too tightly and restrict their breathing or leg movements, ever leave a child swaddled who can flip onto their stomachs and smother face down, or have a wrap that can get anywhere near a child’s face.  22 deaths out of approximately 21 million babies born during the study period isn’t exactly an epidemic but maybe if the limits of swaddling are better understood, we can make the next number collected be ZERO!  Let’s hope.  Until next time.


Your comments are welcome at my blog,

Smo Notes:


2. J Pediatr. 2014 Jan 30. pii: S0022-   3476(13)01591-6. doi: 10.1016/j.jpeds.2013.12.045.

Infant Deaths and Injuries Associated with Wearable Blankets, Swaddle Wraps, and Swaddling, McDonnell E1Moon RY2. 

Seatbelt Marks Indicate Trouble (Article)

Recognizing which children involved in an automobile accident have serious internal injuries can be a very difficult task for both physicians and parents. Some recent information, gathered by the Pediatric Academic Societies, seems to have made that recognition a little easier, however. These investigators have found that children with external marks from seatbelt injuries, also called the “seatbelt sign,” had a much higher probability of internal injures after a car accident. When young auto accident patients enter Emergency Departments (EDs), doctors are increasingly recognizing that bruising on the chest or abdomen from seatbelt trauma often means trouble, even if the child has little or no pain.

What is this “seatbelt sign?” Well, this physical sign is an elongated area of redness with possible bruising and tenderness on the skin caused by pressure from the seat belt during a collision. Although seen in adult accident patients as well, this bruising can be far more painful for small children and adolescents. Investigators surveyed 3,740 pediatric patients from multiple EDs after auto accidents. 16% had the seat-belt sign present while 84% did not. One in ten of the children with external seatbelt marks had serious internal injuries, especially intra-abdominal, regardless of whether they had pain.  Researchers concluded that external marks from a seat-belt are an important sign for parents and doctors to recognize after an auto accident.

This new data indicates that it is important for both physicians and parents to pay close attention to any bruises or areas of swelling on children involved in an auto accident, since these marks may indicate underlying serious injuries. This study also indicated that the seatbelt sign is not the only indication of abdominal injury; changes in a child’s breathing, low blood pressure, and abdominal tenderness were some of the other significant associated factors for detecting intra-abdominal injury. Dr. Angela Ellison, an emergency physician with the Children’s Hospital of Philadelphia, reported that children with this seatbelt sign remain at high risk of injury, most notably gastrointestinal injury. Parents and doctors alike need to recognize and act on this important physical sign.

If you found this article interesting, take a moment to leave a comment at my blog, While you are there, feel free to explore the hundreds of pedcasts and articles in the Doc Smo’s vault. Until next time.

Smo Notes:


Written collaboratively by norman Spencer and Paul Smolen M.D.

Spinal Cord Injuries in Young People (Article)

Spinal cord injuries often involve young people but  few teens and college students understand the potentially life threatening risks that come with playing many popular sports. Unfortunately, with their youth often comes a feeling of invulnerability, and the belief that they are impervious to injury. It’s all part of being young, but all it only takes is one fall, or one bad tackle to turn a cheerleading stunt or football game into a literal nightmare. Spinal cord injury awareness is often overlooked during training, possibly because concussions and other more common injuries take the forefront. Recently, the Center for Disease Control has provided some specifics with regards  to spinal injuries. According to their statistics, as many as 20,000 spinal cord injuries occur every year, with 12% resulting from sports, and most new cases involve 15-35 year olds. In 2008, 14 injuries resulting in some degree of paralysis were reported, and over the past ten years, the double-digit trend has continued to escalate. Though the numbers may seem small in comparison to other sports injuries, these life-changing and life-threatening injuries could happen at any time to anyone.

The cervical spine is a crucial, highly vulnerable area that safeguards the spinal cord connecting the body to the brain. Spinal cord injuries often occur when athletes tuck or bend their heads towards their chests during a fall. When the head makes contact with the ground or other obstacle, the sensitive cervical vertebrae are jarred, resulting in most commonly in sprains, or stingers (a temporary injury where the head or neck is jerked to one side with the shoulder going in the opposite direction), from which most young people recover. Other spinal cord injuries are much more serious and permanent.  A ruptured disk is a long-term and very painful injury, while a fractured vertebra, more commonly known as a broken neck, is life threatening. If the spinal cord is severed, paralysis or even death may result.

In light of the increased numbers of spinal cord injuries, many schools are trying to institute more safety regulations and are training more highly certified athletic trainers in proper safety techniques to prevent cervical spinal injuries. Coaches are teaching their football players to tackle with the head up, instead of tucked,. A program to prevent “spearing”-headfirst contact in football- has been around since 1976, but it hasn’t been enforced consistently. Most colleges and two-thirds of secondary schools have hired highly trained, qualified athletic trainers who are specially trained to quickly recognize and detect spinal cord injuries.  Some schools even run emergency-response drills on the field with players, first-responders, and athletic trainers in case of a spinal cord injury to learn proper techniques in removing helmets, face gear, and shoulder pads, and immobilizing techniques to prevent further injuries. A few high schools are also allowing parents to sit in on coach and athletic trainer training sessions to increase awareness on spinal cord injuries. If your teen’s school offers these programs, try to attend a session so you can have a one-on-one talk with your teen about the dangers and all of the available safety techniques. If your teen’s school has yet to implement these programs, let administrators know that spinal cord injuries are real and that prevention programs are important. Increasing awareness is the key to beginning the important task of prevention of spinal injuries

Your comments are welcome at my blog,  Feel free to share your thoughts and stories there.  Until next time.

Smo Notes:


1. Wall Street Journal, written by Laura Landro, September 16, 2013 edition.


Written collaboratively by Keri Register and Paul Smolen M.D.

The Electronic Cigarette Teen Craze (Article)

Every parent needs to be aware of a new trend among teens and young adults: using what are called “e-cigarettes,”  a high-tech alternative to traditional cigarettes. Makers of e-cigarettes claim that they are safer, have lower cancer risks, and provide higher doses of nicotine per breath. What is this new and improved cigarette, the e-cigarette? It is a battery powered tube that uses the heat from the batteries to vaporize nicotine, allowing the “smoker” to inhale without the smoke. Nothing is actually burning in these devices. Unfortunately, just because the user isn’t inhaling smoke does not mean that e-cigarettes are harmless.  Nicotine itself is addictive and poisonous. The World Heath Organization and the Food and Drug Administration  have concluded that there is no evidence that e-cigarettes are safer, and that the makers of e-cigarettes are misleading the public. Many states are working on banning the sale of e-cigarettes to minors.

Nonetheless, the teen move toward  e-cigarettes has begun.  A recent study at Eastern Carolina University  surveyed 3200 urban high school students between 2011 and 2012 on their attitudes and use of e-cigarettes. The average age of the students was 16.4 years with the following ethnic breakdown: 44% black, 38% white and 8.2 % Mexican American. The investigators asked the teens if they had ever used e-cigarettes or smokeless tobacco. The survey revealed the following results:

  • 25% of teens had used or were using traditional cigarettes
  • 15% of teens had used or where using e-cigarettes
  • 13% had used or were using smokeless tobacco.

Teens seem to be unusually susceptible to the smoking/tobacco messages. Many believe that smoking is cool, provides a pleasurable taste, reduces stress levels, moves them into the “adult world” more quickly, and impresses their peers. Additionally, they seem to believe that e-cigarettes are a safer alternative to traditional tobacco. Unfortunately, the health problems that traditional cigarettes cause aren’t seen until many years after their use; the same may be true for e-cigarettes. It will be a long time before we have any idea if e-cigarettes are safer than traditional tobacco products.

Here is our advice for parents when talking to children about cigarettes and tobacco:

  • Send a clear message all through childhood that tobacco products cause serious health problems
  • Get ahead of the peer pressure by reminding children that tobacco use does not enhance  looks or attractiveness in any way
  • Teach children that smokeless tobacco is probably as dangerous or more dangerous than traditional tobacco products
  • Offer help to children who are using tobacco products (In this regard, a child’s doctor can be a wonderful resource.  In North Carolina, the following resource are available to anyone, free of charge.
  • If a child is using e-cigarettes as a “safer alternative” to cigarettes, point out to him or her that the long-term health consequences of e-cigarettes are unknown.

For more portable, practical pediatrics, log onto  Subscribe, comment, or simply tell your story.  Until next time.

Smo Notes:

1. Naseem Miller, E-cigarettes gaining popularity in high schools, Pediatric News, November 13 2013.

Written collaboratively by Catherine Wu and Paul Smolen M.D.