Window falls and children: Lauren’s story

With a New Year’s Eve party a few hours away, Ruth Chi sent her 5-year-old daughter, Lauren, upstairs for a quick nap to ensure she’d have the energy needed later to ring in 2018.

Ruth had just turned her attention back to party prep in the kitchen when she heard yelling upstairs. Suddenly, her eldest son ran past her and into the adjacent backyard.

Lauren had fallen from her second-story window and landed on the concrete patio below. Her brother cradled her in his arms.

“I ran outside the screen door and saw my son hugging Lauren, who was on the ground,” Ruth says.

Crying only slightly, Lauren seemed miraculously unharmed. Ruth carried her daughter inside and examined her body from head to toe. She didn’t see any blood or notice any obviously broken bones. Lauren could understand her mother’s instructions, was responsive and could speak.

The only thing amiss that Ruth noticed were faint red marks on the side of Lauren’s body and a small bump on the right side of her head. Not wanting to take a chance, Ruth brought her daughter to closest emergency room despite Lauren’s protests that she might miss the party.

After a few tests and just 20 minutes or so, the team at the hospital prepared the family to be brought by ambulance to CHOC Hospital’s level II pediatric trauma center. Critically injured children from across the region are transported and transferred to CHOC for the pediatric expertise only a children’s hospital can provide. CHOC’s trained trauma team cares for children and their unique physiological, anatomical and emotional needs with protocols and equipment designed for pediatric patients.

At CHOC, Lauren and Ruth were met by a team of experts who performed more tests and scans. Lauren was the 22nd patient to be treated at CHOC that year for having fallen from a window. The following year, CHOC would go on to see 15 such patients, and in 2019, an additional 24 patients. And in the first 10 months of 2020, CHOC has treated 18 patients who tumbled from a window, says Amy Waunch, CHOC’s trauma program manager.

The no. 1 reason why children fall from windows is furniture placed below, Amy says – and that is exactly what happened with Lauren.

With warm weather a near constant in Southern California, Lauren opened her locked bedroom window. The curious 5-year-old climbed atop her bed and pushed her head against the window screen to survey a nearby park.

The window had a safety mechanism in place to prevent it from being opened too wide, but children can slip through gaps any wider than 4 inches, Amy says.

All those factors, combined with Lauren’s size and strength, allowed her to push through the screen and plummet out the window and onto the ground.

The most common injuries resulting from a window fall treated at CHOC are head injuries like skull fractures and intracranial bleeding, followed by extremity fractures, Amy says.

Lauren, however, seemed just fine. She and her mother passed the time waiting for test results by talking and playing games.

But the family received sobering news at about 9 p.m. that night, when Lauren was diagnosed with an epidural hematoma, a type of traumatic brain injury when blood builds up between the outer membrane of the brain and the skull. This can create pressure on the brain’s tissue and can be deadly.

Lauren would need surgery right away, CHOC experts told the family, who quickly agreed. Lauren was taken to the operating room.

After about an hour, Ruth and her husband were reunited with Lauren in the post-anesthesia care unit.

“She responded well when we talked to her,” Ruth recalls.

After a three-day stay at CHOC’s main hospital campus, Lauren and her family headed home.

After several neurosurgery follow-up appointments, Lauren began treatment with pediatric neurologist Dr. Sharief Taraman. Additionally, Lauren underwent neuropsychologic assessment to determine whether the injury affected her cognitive function.

Today, three years later, Lauren is a happy and healthy 8-year-old with no signs that she survived a near fatal accident. In fact, Ruth even needs to remind her fearless daughter to be careful sometimes.

And she’s not stopping with reminders. The furniture has been rearranged in Lauren’s room, and Ruth continues to caution her friends about the dangers of children and window falls.

“Never say never, I tell people,” Ruth says. “I never would have thought this would happen to me or my family or my daughter. It’s almost impossible. Well, it happens.”

5 ways to protect children from window falls at home

The combination of warming weather and children spending more time at home due to the COVID-19 pandemic prompts an important reminder for parents to protect kids from window falls.

In March and April 2020, the CHOC Trauma Center treated eight patients injured after falling from windows. By comparison, clinicians there treated three patients for window falls during the same time period in 2019.

“Forty-three percent of all trauma cases here at CHOC are related to unintentional falls, and of those, 35 percent were window falls,” says Amy Waunch, CHOC’s trauma program coordinator.

Window screens are no match for even a young child’s weight, and small kids can squeeze through openings as narrow as 4 inches. Any window higher than 6 feet from the ground poses a risk for serious, even fatal injury.

“Boys younger than 5 are at the biggest risk, and the peak age is 24 months,” says Amy Frias, a CHOC community educator and the Orange County coordinator for Safe Kids Worldwide.

With Trauma Injury Awareness Month underway, here are five tips from CHOC experts to help keep kids safe from window falls:

  1. Lock them down— Install removable window locks or guards to limit a window’s opening to no more than 4 inches. Be sure the device can be removed quickly by adults in case of an emergency. Keep windows locked when not in use.
  2. Open windows strategically – If your home has double-hung windows, which open from both the top and bottom, open just the top to prevent falls.
  3. Practice vigilance – If you open windows to let in fresh air, be mindful of closing and locking windows before you leave the room.
  4. Position furniture carefully – Keep beds, bookcases, chairs, play chests and other furniture away from windows so your child isn’t tempted to climb.
  5. Supervise, supervise, supervise – As with all injury prevention efforts, keeping an eye on kids is critical. As children grow, their abilities, strength, dexterity and curiosity grow too – and they may be able to outsmart your best-laid safety plans.

If your child does fall out of a window, call 911 and avoid moving your child. A traumatic injury to the head, neck or spine may not be immediately obvious.

Home Safety Tips for the Whole Family

Most injuries for kids up to five years old occur in or around the home because that is where they spend the most time learning and growing. Keep in mind these home safety tips to protect kids of all ages in your home. Download this home safety checklist to help make your child’s home safer.

Kids have more freedom as they get older, which teaches them independence and nurtures their curiosity, but they can often overestimate what they’re capable of doing.

“Older children tend to take more risks, so we as parents must walk a fine line between bubble-wrapping our kids and protecting them,” says Amy Frias, community educator at CHOC Children’s and Safe Kids Orange County coordinator.

Batteries

Keep batteries and battery-operated devices out of sight and out of reach. If your child ingests a battery, seek emergency medical attention or call the National Battery Ingestion Hotline, 202-625-3333.

Burns

Getting kids involved in cooking your family’s meals can be a great way to encourage healthy eating habits later in life, but should be done under careful supervision. Don’t hold a small child when using the stove, and always keep sharp and hot objects out of reach.

Carbon monoxide

In addition to a working smoke alarm, ensure your home has a carbon monoxide detector and check its batteries regularly.

Choking

Even when kids are old enough to start learning how to use utensils themselves, make sure food is cut into bite-size pieces. When purchasing a toy or game, take into account the size of its pieces. Keep small items such as magnets, makeup or batteries out of reach, as they could be confused for a toy or candy. Cords and strings from window blinds should also be kept out of reach to prevent choking.

Falls

Install window locks that prevent openings greater than four inches, yet could still be easily removed by an adult in the event of an emergency. Children under 10 years old should not be on a top bunk of a bunk bed. Use liners underneath rugs and in the bathtub to prevent falls. Secure-top heavy furniture to the wall. Move furniture away from windows to prevent falls.

Fire

Make a fire escape plan. Establish a place to meet in the event of a fire in your home, and remind children that getting out safely should be their first priority.

Helmets

As younger children spend most of their time at home, that may include riding bikes or scooters in the driveway or neighborhood. Always make sure children wear a properly-fitting helmet. Here’s a helmet safety tip sheet.

Medicine

Remind children that medicine is not candy. Medication should be stored out of reach and out of sight, and in a locked location. Keep in mind that medicine is usually stored in more places than just a medicine cabinet, and can usually also be found in a purse, nightstand, etc.

This article was updated on March 30, 2020.

Are Laundry Packets Really That Dangerous?

A recent study published in the medical journal JAMA Ophthalmology stated that an increasing number of toddlers are suffering eye burns as a result of coming into contact with laundry packets. We spoke to Dr. Kenneth Kwon, director of pediatric emergency services at CHOC Children’s at Mission Hospital, about what parents should know about this hidden household danger.

Q: Are laundry packets a serious danger to children? Should parents be concerned?

A:  Yes, they are a serious danger. The colorful and candy-like appearance of these packets makes them particularly attractive and dangerous to children.

Q: There are many products in a typical home that could be harmful if accidentally ingested. Where do laundry packets fall on the scale?

A:  On a scale of 1 to 10, with ingesting cyanide or a poison causing death in minutes considered a ten, the chemicals in these laundry packets would be an 8. Standard liquid household detergents, such as bleach, would be considered a 3 or 4. However, due to the concentrated nature of the chemicals in these laundry packets, they are much more likely to cause serious injury in a very short period of time if ingested. These liquids are alkali in nature and are considered caustic substances, similar to acidic chemicals. The public may be under the misconception that alkali chemicals are less dangerous than acidic chemicals, but when ingested, alkali chemicals tend to cause much deeper and serious injuries to the esophagus and gastrointestinal tract than acidic substances.

Q: Another common injury stemming from laundry packets is eye burns. Why are eyes so susceptible to damage? What treatment can parents do at home?

A:  Eyes are particularly susceptible because children tend to bite into or try to open these packets, and contents can very easily splash into the eyes causing burns to the cornea and surrounding parts of the eye. The cornea, which is the top layer of the eye, has little to no blood supply, which can impair or limit healing, leading to permanent vision problems. The most common symptoms of an eye burn are pain, redness, tearing and vision problems. If you suspect that your child may have an eye burn, irrigate the area under cold running water for at least ten minutes and then take the child immediately to the ED for further irrigation and treatment.

Q: Children often get into laundry packets, or other household chemicals, when left unattended only for a moment. What are the warning signs parents should be aware of that their child has ingested something dangerous?

A:  Commons signs include difficult or painful swallowing, drooling, oral pain, chest or abdominal pain, vomiting, excessive crying, or breathing or speech problems.

Q: How can parents know what to treat at home versus when to seek emergency medical care?

A:  If known or suspected exposure to laundry packets with any symptoms, bring your child immediately to the ED. If the eye is involved, irrigate with running water for at least 10 minutes before transport. Administration of a neutralizing or diluting agent is not recommended for a suspected ingestion. If possible exposure to an opened packet with no symptoms, call Poison Control at 800-222-1222 for further direction.

Q: What can parents do to prevent their children from getting their hands on laundry packets or other chemicals or medication in the home?

A:  The best prevention is elimination of laundry packets from the home. Since there are so many cleaning detergent alternatives available, why even introduce laundry packets into the home at all if you have small children?  If these packets are in the home, make sure to keep them high up in overhead cabinets in the laundry room out of reach of children. Certainly avoid storing these packets in the kitchen or pantry area, as they can easily be mistaken for food or candy. Lastly, periodically check your house to make sure that dangerous medications and chemicals are safely out of reach of toddlers and children. Childproofing the home should occur as regularly as cleaning your home.

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Carbon Monoxide in the Home: What Parents Should Know

Parents understand the importance of having working smoke detectors in the home to protect their family in case of fire, but sometime carbon monoxide detectors fly under the radar, says Amy Frias, a community educator at CHOC Children’s and coordinator of Safe Kids Orange County.

Carbon monoxide is a gas you cannot see, taste or smell, and it can be extremely dangerous to children when they’re exposed to unhealthy levels.

Fuel-powered devices that aren’t properly functioning can emit dangerous levels of carbon monoxide into the home with no warning unless you have a working carbon monoxide detector, says Frias. Faulty furnaces or heaters, portable generators, water heaters, clothes dryers, or cars left running in the garage, can all result in carbon monoxide poisoning.

It’s important for parents to know what can create high levels of carbon dioxide in the home and avoid these activities, says Frias.

  • Don’t use a grill indoors
  • Don’t leave a car running in the garage even if the doors are open
  • Never use the stove or oven to heat your home
  • Ensure vents (stove, furnace, fireplace, stove) are free or debris
  • Store gasoline properly: keep it in a locked location away from children and living spaces, in a well-ventilated area away from any heat sources.

Children process carbon monoxide differently than adults and can experience harsher side effects. Early symptoms include headache, nausea and vomiting. Each year, carbon monoxide exposure results in 15,000 emergency department visits, according to the Centers for Disease Control.

Frias offers tips on how to prevent carbon monoxide poisoning in your home:

  • Make sure you have a carbon monoxide detector. Install one on every level of your home, particularly in bedrooms, and keep them 15 feet away from fuel-burning appliances.
  • Remember that carbon monoxide detectors are not a substitute for smoke detectors.
  • Detectors only detect high levels of carbon monoxide when they are properly functioning. Check the batteries often and replace the unit every five to seven years depending on manufacturer’s recommendations.
  • Ensure alarms are linked throughout the home so when one sounds, they all sound.

If you experience symptoms of carbon monoxide poisoning, or your alarm detects a hazardous level, leave the area immediately and get fresh air, and call 911.

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