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DOERNBECHER PEDIATRIC EMERGENCY TEAM PROVIDES TIPS FOR CHILDREN'S WINTER SAFETY

PORTLAND, Ore. - During late fall and winter, Doernbecher Children's Hospital's pediatric emergency team sees an increase in some medical conditions and injuries that can be prevented by taking simple precautions. Pediatric emergency physicians say the following scenarios are among the most common:

Barking cough called croup
Fall not only brings cooler temperatures to the Northwest, but it also heralds the season for croup, an upper respiratory disease that affects toddlers. This viral disease, caused by the same organism that causes laryngitis in adults, is often accompanied by high fevers and a "barking" cough that is its trademark. The barking cough comes on suddenly and is frightening for both children and parents. The sound is created when air is inhaled through swollen vocal cords. It may appear as if the child is choking. However, simple treatment can alleviate the symptoms, usually at home. Jeffrey Disney, M.D., Doernbecher emergency physician and assistant professor of emergency medicine in the OHSU School of Medicine, suggests:

Sum Bundling up the child and taking her outdoors into the cold air, which decreases vocal cord swelling.

Children whose conditions don't improve or whose symptoms return quickly, or if they refuse to eat or drink, they should be seen by a pediatrician or pediatric emergency physician.

Bronchiolitis, the wheezing illness
Bronchiolitis is a another common cause of illness and hospitalization in infants and young children during the winter. This wheezing illness is caused by infection or re-infection with a virus or bacteria that results in inflammation of the small breathing tubes in the lungs called bronchioles. Respiratory syncytial virus, or RSV, is the most common cause. Antibiotics are not effective against this virus.

Robert Norton, M.D., professor of emergency medicine and vice chairman of the emergency medicine clinical program, OHSU School of Medicine, says that in healthy infants and young children, bronchiolitis usually is a self-limited disease.

"Therapy in most cases consists of supportive measures, such as salt water nose drops and bulb suction to relieve blockage of the nose," he says. Children can be managed as outpatients if they do not appear acutely ill, have signs of respiratory distress and are not dehydrated. Spread of RSV to other persons can be prevented by frequent hand washing and careful avoidance of secretions.

For some healthy infants and for babies with pre-existing heart or lung disease, bronchiolitis can cause more severe disease that results in difficulty breathing, Norton added. Children with rapid breathing rate or appearance of trouble breathing should be evaluated immediately. They may need supplemental oxygen and may require overnight hospitalization.

Very young infants less than 3 months old with RSV are prone to stopping breathing and need to be monitored in a hospital setting, but full recovery is expected.

Traveling over the river and through the woods - safely
Car accidents due to dangerous winter driving conditions send many patients to Doernbecher's emergency department each year. Some simple reminders may prevent a winter travel nightmare.

Doernbecher emergency physician and assistant professor of emergency medicine, Katie McClure, M.D., recommends having a few supplies in the back of the car just in case. "I always check the road conditions before I leave so I know what to expect. It is also important to have an emergency kit in the car. Having some warm blankets, a flashlight, gloves, a charged cell phone, food and water can make all the difference in the world during a winter storm."

McClure recommends the following to prevent winter driving nightmares:

• Always wear a seatbelt and insist all your passengers do the same.
• Check that you have washer fluid, an emergency kit and a full tank of gas before setting out.
• Pay extra attention to pedestrians and bicyclist on those dark, wet nights.
• Don't be in a rush to get to grandma's house. She would rather have you there late than not at all.

Safe fun in the snow
Many of us are excited when the snowfalls in the mountains so we can make plans for skiing, snowboarding and sledding. Although most injuries relating to these popular winter sports are relatively minor, some can result in significant injuries and even death.

Jenna Timm, M.D., Doernbecher pediatrician and emergency physician, says half of all snowboarding injuries are to the head, face, wrist or forearm, particularly among beginners, while more advanced riders sustain significant head and neck injuries.

Skiers are more likely to suffer from leg injuries, such as broken bones, or pulled muscles and tendons. Two-thirds of skiing-related deaths are caused by severe head injuries, particularly in children younger than 17. Head injuries also account for half of serious sledding injuries.

Timm's advice for prevention:

• Wearing a helmet will reduce your risk for head, neck or face injury by half.
• Avoiding crowded slopes.
• Ski and snowboard on slopes that meet your skill level.
• Wrist guards can be valuable in preventing write and forearm injury when snowboarding.
• Purchase sleds with a steering mechanism.