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What parents need to know about bouncy houses

Posted by Dr. Claire McCarthy November 28, 2012 08:30 AM

For around four years in a row, starting around 1996, my husband and I rented one of those inflatable bouncy houses for my son’s birthday party every August. We invited a whole bunch of his friends and cousins to bounce in it for a few hours (and let them play in the sprinkler and fed them cake). Nobody got hurt.

Which, in retrospect, was kind of amazing. 

In a report just out this week in the journal Pediatrics, researchers report that between 1990 and 2010 about 65,000 children were treated in US emergency rooms for injuries they got in bouncy houses. That’s about 31 kids a day. The number and rate of injuries increased fifteen-fold over that time period.

The vast majority of those injuries were fractures or sprains, usually of the arms and legs. Luckily, only three percent required hospitalization. And while the injuries spanned the age range, more than half were in six- to twelve-year olds, with most of the rest being in younger children. 

The injuries happened in all sorts of different ways. Most of them were caused by falls (often by falling out of the bouncy house), but kids are always creative in how they get hurt, and bouncy house injuries are no exception. Pushing and pulling caused a bunch of injuries, and kids crashed into each other and fell on top of one another too.

We did our best to have rules during the birthday parties. We limited the number of kids bouncing at any one time. We didn’t allow flips. We kept a grownup stationed nearby to monitor for roughhousing.  We kicked kids out if they were behaving badly. We weren’t perfect at enforcing the rules—there was a limit to the ability of two people to supervise twenty or so kids all over a yard, and the other grownups were not always invested in helping us out—but we did it well enough that there were no trips to the emergency room after any of our parties. 

I don’t regret having those parties. My kids have a lot of great memories from them. And bouncy houses are hardly the only or most dangerous activity out there for kids. According to the Centers for Disease Control, every year 500,000 people go to emergency rooms with bike injuries—and we’re not telling kids to stop biking. We can’t put kids in bubbles, and learning to manage risky situations is part of growing up. 

But with bikes, we have helmets, and rules of the road for bikers. It’s those safety rules that are missing when it comes to these “inflatable amusement devices.”  The authors of the study say that we really need to come up with those rules, given all the bouncy house injuries. They suggest that the safety rules be similar to those we have for trampolines, since the injuries are very similar.

The American Society for Testing and Materials has some guidelines, although they are pretty general and vague. The Consumer Products Safety Commission has recommendations that are more specific, although they are more aimed for people who run fairs, etc, than parents.

While we come up with the safety rules, the best thing you can do is use common sense:

  • Always follow the manufacturer's directions and safety guidelines
  • Be particularly careful with children under the age of six--might be better to avoid bouncy houses with them entirely
  • Keep numbers down (they vary in size, so it's hard to give a specific number). Everyone should be able to have their own personal space.
  • Make sure kids keep body parts to themselves (the point of the personal space)
  • No flips or other stunts. 
  • SUPERVISE. Make sure that you have enough grownups to do this (and make sure that they will enforce the rules)
  • Have a zero tolerance policy for rough-housing or other dangerous behavior. Consider using a whistle or something like it, the way lifeguards do.

As for me, I think I’m done with renting bouncy houses for birthday parties. I dodged the injury bullet for four years; I may have used up all my luck. Not that my youngest (the only one we'd do it for, at this point) will care; he doesn't like bouncy houses.

Smart boy. 

AAP says teen girls should get the morning-after-pill before they need it

Posted by Dr. Claire McCarthy November 26, 2012 09:00 AM

The morning-after pill (also known as Plan B): that’s the pill women can take when they’ve had unprotected sex—like when the condom breaks, or they didn’t use contraception for some reason, or, God forbid, they were forced into sex. Taken within 120 hours of intercourse, it can cut down the risk of pregnancy dramatically.

The American Academy of Pediatrics (AAP) would like doctors to give it to their teen patients before they need it. Like at checkups. Like, along with telling them to take vitamins, we should be giving them a prescription for Plan B. 

This sounds strange, but it makes abundant sense. 

I will never forget a conversation I had with my father when I was about fifteen years old. Out of pure curiosity--I wasn't even vaguely considering having sex at the time--I asked him what we would do if I got pregnant as a teenager. My father, who was one of the most laid-back, mild-mannered people I knew, said very sternly and brusquely, “I don’t ever want to find out what we would do.” End of conversation. 

As a teenager, I was taken aback by his reaction; as a mom, I totally get it.

I’m not saying that babies aren’t wonderful. They are incredible and worthy and life-changing. But it’s the life-changing part that is problematic with teen moms, of which I have seen many over the years as a pediatrician. It’s not just that they have to stop cheerleading or going out with friends. Having a baby as a teen throws school, college, graduate school and getting a good job into jeopardy. I’ve watched many girls give up their dreams and quit school and take minimum-wage jobs—or struggle to hold down a job and go to school while parenting a toddler. And then there’s everything it means to the child and the child’s future to have a mom who, frankly, isn’t really ready to handle the stresses of parenthood. 

All of us parents want to think that this happens to other people’s kids, not ours. Other people’s kids have sex, other people’s kids don’t use contraception. Ours are smarter and more, um, moral than that. But the statistics don’t back us up.  Just under half of 15- to 19-year-old girls report ever having had sex, ranging from 13 percent of 15-year-olds to 70 percent of 19-year-olds. And here’s a frightening fact: ten percent report being forced to have sex. As for birth control, condoms are the most common method, and they break. The second most common method is withdrawal, which leads to pregnancy really often. Oral contraceptives are third—but I’ve had patients forget to take them. These are teenagers, after all. 

Enter Plan B. 

Plan B is not an abortion. It works the way birth control pills work, by getting in the way of ovulation and messing up the hormones needed for early pregnancy. It stops things from getting started. And if you are already pregnant when you take it, or if it doesn’t work and you get pregnant, it’s not dangerous to the baby (if you use levonorgestrel, the most common kind of Plan B pill). 

But the key is getting it early. While it will work within 120 hours of the unprotected sex, it's better to get it within 72 hours--or, even better, 24. That’s why the AAP wants doctors to give it to girls ahead of time. Studies show that having a plan B prescription ahead of time makes teens more likely to use it when they need it (many teens delay getting in touch with the doctor, especially if they might have to tell a parent)—and it doesn’t make them more likely to have sex or less likely to use regular contraception. 

I know this will make a lot of parents uncomfortable. In an ideal world, we don’t want to have these conversations with our daughters—in an ideal world we don’t even want to think about them having sex.

But we don’t live in an ideal world. We live in the real world. And what we most want for our daughters is for them to have the best future possible. 

So if you are the parent of a teen girl, think about it. Talk to your daughter and your doctor about whether a prescription for Plan B makes sense.

This Thanksgiving, I am thankful...for being tethered.

Posted by Dr. Claire McCarthy November 21, 2012 04:27 PM
As I write this, I am sitting in Logan Airport, waiting for my flight to Amsterdam--I will go from there to Paris, where my eldest daughter is spending a semester. I'm going there to spend Thanksgiving with her.

I'm going alone--the rest of the family is staying behind. It's going to be just me and my adult daughter together in Paris for five days. We haven't had five days alone together since her brother was born in 1992. She is a great person, fun and silly and easy to be with. I'm getting five days away from cooking and laundry and sibling rivalry and my beeper. Heaven.

And yet I'm feeling a little sad.

Like most other mothers (parents--don't want to be sexist)--I often feel like Gulliver in Gulliver's Travels, tethered down by a million little ropes tied by Lilliputians, the tiny little people he meets. Well, not Lilliputians. You know what I mean. There are so many things that are tied to me--so many things I spend every day of my life doing, keeping track of, planning for. There are so many people whose lives are inextricably tied to mine, in small ways and big ways. There are days when I wish that I could sit up like the big giant Gulliver and break free.

But today, as I packed and picked up Liam (7) and Natasha (11) from school and did errands for Elsa (15) and switched the laundry, I felt pangs of uncertainty. Was it a good idea for me to leave everyone? My husband and mother-in-law are very capable, but we were having technical problems with a website Elsa needs for an online course, and the scanner wasn't working, and I'm the tech parent. And then Liam started to come completely undone at my going. He curled up in a ball and started crying inconsolably.

I comforted him and came up with a plan B for the scanner and made Natasha promise to get the tangles out of her hair (which I always end up doing). I stuffed the last few things in my suitcase and off we went in my mother-in-law's car to the airport. All of a sudden I wanted to cry along with Liam. As we were leaving, Natasha said, "I put a card in your bag. Don't read it until you get to the airport."

Once I got to the gate, I took out the card. She'd pasted a picture of the Eiffel tower on one side, and on the other had written: "Dear Mom, Have a wonderful and joyful time in Paris! Tell Michaela I said hi! I am going to miss you a lot! I love you! Love, Tash. P.S.: I will take good care of my hair! :)"

It made me grin. And it made me think that being tethered, as hard as it is, is a really good thing. Because being tethered is really being anchored. It is being held and wanted. It is being connected and loved and part. It is what life is all about. It feels hard and exhausting sometimes, but it's what life is all about.

So off I go to Paris, following another tether, to another adventure. And then I will come happily home to the Lilliputians.


Study: teens want more muscles (and are willing to risk their health to get them)

Posted by Dr. Claire McCarthy November 19, 2012 10:27 AM
When it comes to body image and teens, it's not just about lean. It's about mean.

Mean as in muscular, that is. And while pumping iron (or other exercise) is the way they most often go about trying to get those muscles, they are willing to do risky things too.

According to a study just released in the journal Pediatrics, about 34 percent of teen boys and 20 percent of teen girls have used protein powders in the past year. Ten percent of boys and five percent of girls have used creatine or other "muscle-enhancing substances". And more than five percent of both boys and girls have used steroids.

Five percent doesn't sound like much, but that's one in twenty--so out of each middle or high school classroom, one kid would be using steroids. Maybe that kid is yours.

This worries me as a pediatrician and parent. Overuse of protein powders can lead to malnutrition, weight gain and other possible health problems--and some have heavy metals such as arsenic, cadmium, lead and mercury (check out the 2010 Consumer Reports article about this). There are concerns that creatine can cause kidney, liver or heart problems. And steroids can cause a whole host of physical and mental health problems.

The authors were surprised by their findings, which were much higher than previous studies had shown. While they didn't ask the teens why they wanted more muscles, the authors point to how  the media is showing more and more pictures of muscular bodies. It's not just men (there do seem to be a lot of six-pack abs in ads these days) but women, too--being beautiful isn't just about being thin. It's about having muscle definition.

One of the interesting things in the study is that the muscle-enhancing behaviors were more common in overweight teens. We can only guess at why this was true, but it feels to me like the overweight teens wanted to change their bodies--but instead of doing healthy things to decrease calories and overall weight, they worked to get more muscle instead. If they did it by exercising, that would be fine--but if they did it by drinking protein shakes, it could seriously backfire on them.

These are teens, after all--going through that time of life when they make all sorts of, um, interesting decisions. They aren't kids anymore--but that doesn't mean they don't need guidance, because they do. They need responsible, empathetic, supportive grownups more than ever.

So talk to the teens in your life. Talk to them about how they feel about their bodies--especially, talk to them about how the media images make them feel. Make sure they know that there is way more to life and success than how they look; help them find the ways they can shine. And please, talk to them about making healthy choices. 

After all, ultimately it's not about lean or mean. It's about healthy

How smart are you about antibiotics? Take this quiz.

Posted by Dr. Claire McCarthy November 12, 2012 07:44 AM

Let's get right to the bottom line: antibiotic resistance has become on of the world's most pressing public health problems. And the cause of the resistance is overuse of antibiotics.

Antibiotic resistance means just that: antibiotics aren't working as well as they used to. Bacteria, in their quest for survival, are figuring out ways around them. And when we use antibiotics a lot, the weaker bacteria get killed, leaving the superbugs behind.

Those superbugs are causing infections that are increasingly hard to treat. And while these infections are bad for everyone--last longer, are more likely to lead to hospitalizations, require stronger drugs with more side effects--they can be very dangerous, even deadly, for people with weak immune systems. That's why the Centers for Disease Control (CDC) is working with partners to sponsor "Get Smart About Antibiotics Week" November 12th to November 18th. 

So how smart are you about antibiotics? Are these statements true or false?

1. Antibiotics treat all infections. 
FALSE. Big time. Antibiotics only treat bacterial infections. They do nothing for viruses, which are the cause of most of the infections we get.

2. Antibiotics are commonly prescribed for colds.
Sadly, this is true. According to a study, antibiotics were prescribed at 68 percent of doctor visits for symptoms related to the upper respiratory tract--things like coughs, congestion, sore throat. Eighty percent of those prescriptions were unnecessary.

3. The common cold is caused by a virus, but sore throats, ear infections and sinusitis are caused by bacteria.
False. Most sore throats, ear infections and sinus infections are caused by viruses too and will get better by themselves.

4. Children have the highest rate of antibiotic use.
True, perhaps because they tend to visit the doctor a lot with upper respiratory tract complaints. And there's the parent factor...

5. Parent pressure makes a difference.
True. This one embarrasses me a little as a doctor. A study showed that doctors prescribe antibiotics 62 percent of the time if they think parents expect them, but only seven percent of the time if they think parents don't expect them.

6. A million dollars are spent every year on unnecessary antibiotic prescriptions for adult respiratory tract infections.
False. Make that a billion. There are so many better uses for that money.

7. We can all help fight antibiotic resistance.
True. Here are some ways the CDC says we can do this:
  • Don't ask for antibiotics for viral infections. Talk to your doctor about ways to relieve symptoms. Definitely be in touch with your doctor if an illness gets worse or isn't getting better within a few days
  • Don't save antibiotics for the next time someone is sick
  • Don't take antibiotics prescribed for someone else
  • This is key: DO take antibiotics if your doctor says you really need them, and take them EXACTLY as prescribed. Taking too much or too little can lead to resistance.
To learn more, and for ideas on how to make you and your loved ones feel better when you are sick this cold and flu season, visit the CDC's Get Smart About Antibiotics web page. Take their quiz (you should ace it after this), and check out their video:

How smart phones help me be a better doctor

Posted by Dr. Claire McCarthy November 8, 2012 05:04 AM
Your child has a rash and is acting a little sick. You reach for your phone--not to call the doctor, but to look up rashes on Google or your symptom checker app.

This, according to the latest report from the Pew Internet and American Life Project, is the direction we are moving. As a doctor, I think it's great.

In May of 2011, a third of cell phone users had a smart phone; in a mere year and a half, that's jumped to half. Given that 85 percent of US adults have a cell phone, that's a lot of smart phones out there. And along with the many other things people do with their smart phones, half of them are looking up health information and one in five has a health-related app.

Among parents, the numbers are even bigger. Ninety percent have cell phones, higher than the general population, and of them two-thirds have smart phones. And not surprisingly, they are more likely to look up health information or have a health app.

I suppose I should be bummed or worried that people might be turning to the Internet rather than to me, but I'm not. You hear talk about the dangers of getting bad information from the Internet, and that's always possible, but I don't see that happening all that often. I do see people getting information that scares them (and usually doesn't apply to them), but the good news is that when they get scared they call, and we have a chance to talk about it.

I see this as an incredible opportunity. My smart phone helps me be a better doctor. It lets me look up drug dosages and find out which immunizations people need to travel to Chile--it helps me deal with the information overload that has become intrinsically part of the practice of medicine. I use my smart phone to communicate with patients by email and sometimes text, answering questions quickly in between doing other things (and I can copy and paste the conversation into the medical record). Patients send me photos of rashes (taken with their phones), which is really helpful as it can be very hard to describe a rash over the phone. I can decide if the patient needs to come in--and if I'm stumped, I can forward the picture to a dermatologist.

Because communicating is so easy, I get real-time information from my patients that helps me take care of problems before they get big--and if I'm not the best person to help them, I can quickly connect them to the person who is. This kind of communication has to be done carefully and safely, but with common sense and some safeguards that's very manageable.

And I'm just skimming the surface of the possible. While most of the health apps that people use now are related to diet or exercise, there are all sorts of apps that help patients keep track of their symptoms and medications and communicate the information to their doctors. This can make all the difference for people with chronic diseases like diabetes. Here at Boston Childrens, my colleagues have developed apps that help you find a flu shot--and apps that track outbreaks of illnesses like the flu so that doctors can be ready. Every day there is a new app that is full of possibility and promise.

The Internet, too, is a treasure trove of information that can help people learn about and take charge of their health and well-being. As someone who spends a lot of time reading what's out there and writing myself, I'm particularly aware of it. I have such a limited time with patients in the exam room; if I can refer people to websites to read about general health topics, I can spend more time talking about their particular situation and concerns. I do this already (I've been referring various patients to the post I wrote about arsenic and rice, for example, or sending them to the Facebook page I created to curate everything I write) but smart phones allow me to do it more efficiently. I can email links--or, instead of giving a written handout to a parent (which, if it even makes it out of the exam room, usually ends up in the trash), I could print them up a QR code. My friend Dr. Natasha Burgert has QR codes up in exam rooms--while patients wait, they can read the latest health information.

Good health care is about good communication. It's about getting people the information they need. It's about partnerships, and empowering people to take charge of their lives and their health. Smart phone technology gives us the tools to do all of these things better than we ever have before. 

Of course, patients are catching on to this before doctors. But we'll catch up. Count me in.

Parents, use the election as a teachable moment

Posted by Dr. Claire McCarthy November 6, 2012 09:09 AM
When I was a child, my father used to take me to vote with him. I remember it as something really exciting, being in the booth and watching him make his choices. I felt--I knew--that I was part of something important.

It's a tradition my husband and I have carried on with our children. Every year, we take our children to vote with us.

I think that here in the US, we often take our right to vote for granted. But voting is not something we should take for granted--all you need to do is read or watch some international news to understand this. By voting, we have power. Voting gives us a voice.

And yet, only about half of registered voters in the US vote in presidential elections. If it's not a presidential election, that number drops to about a third. That's a lot of voices missing--and a lot of power wasted.

So get started with your children. Take them to vote with you. Make sure they know that it's something important, like I did. (If there's a bake sale, buy something--makes it more fun.)

And like my father did, talk about the issues at home. Explain why you make your choices. Talk about ballot questions--have a real debate. Discuss and respect both sides--that's really important. Increasingly, we seem to be becoming polarized, with people voting along party lines without thinking everything through. Teach your children that nobody can do their thinking for them.

Most of all, vote. I know the lines can be long--I was in them this morning--and lives are busy. But that's all the more reason to make it a priority: that's the way you will set the best example for your children. That's how you can help be sure that once they turn 18, they will use their voice and their power.

My oldest two children are both studying abroad--and they both voted by absentee ballot. My dad would have been proud; I am. And hopeful for our future.

Study shows doctors aren't good at changing TV behaviors in kids--got any advice for me?

Posted by Dr. Claire McCarthy November 5, 2012 03:33 PM
When it comes to getting parents to cut back on their kids' screen time, we doctors aren't doing such a great job.

Like most of my colleagues, I talk about screen time at almost all checkups. I talk about how too much screen time makes a kid more likely to be overweight and have behavioral problems. With the parents of babies and small children, I talk about how experts think they shouldn't watch TV at all, and about how it can get in the way of learning. I encourage parents to limit screen time, not have TV's in bedrooms and turn off the TV at meals. We talk about other things they might do instead.

Their eyes glaze over, and they keep doing what they were doing.

That's pretty much what happened in a study just released in the journal Pediatrics. Researchers in Toronto divided families coming in for the three-year checkup into two groups. One group got some general information about safe media and Internet use. The other got specific counseling about risks of screen time in kids, with suggestions to do all the things I talk about, like budgeting time, getting the TV out of the bedroom, not eating in front of it, etc. A year later they checked in with the families again. There was essentially no change and no difference between the two groups--except that the group that got the counseling now ate 1.6 meals a day in front of the TV instead of 1.9. Which is still, in my opinion, not great--they were still essentially eating half of their meals in front of the TV.

It's hard to change behavior. For reasons that I don't entirely understand, it's particularly hard to change TV behavior--perhaps because TV is convenient, kids like it, and their parents do too. And given that TV is only one of the many things I need to talk about at a checkup, I can't talk about it for very long.

According to the authors of the study, the only interventions that seem to make a difference when it comes to families and screen time are ones in which parents get talked to a lot--and they usually come from schools or other groups, not doctors. This makes sense. But it's disappointing.

See, I don't want to give up. And yet I don't want to take up valuable time (when kids are well, I might only get to spend 15 or 20 minutes with them a year!) doing something that doesn't have any effect whatsoever. 

So help me out here, you parents reading this post. What's going on? Do you tune us doctors out? Do you think we're out of touch, that we don't get what it's like to be a parent? Or do you agree with us, but find our advice too hard to follow? What would be more helpful? Is it that there's too much advice all at once at a checkup? Would it be better if we used mailings or social media (should we Tweet you?) to give you more information and reminders?

Screen time is something that can end up affecting the health and well-being of kids for a lifetime, if kids get into unhealthy media habits. I really want to know: how can I help parents make the best decisions for their kids?
For more information on media and its effect on kids, visit the Center on Media and Child Health of Boston Children's Hospital.

What I'm telling my patients about arsenic and rice

Posted by Dr. Claire McCarthy November 1, 2012 10:00 AM
Okay. I've now read a whole lot about this whole arsenic and rice thing and I've decided I'm going to tell parents in my practice to cut back on the rice they give their children--and not give rice cereal to their babies at all.

I know, I'm late to this. I should have paid more attention. I kept putting it aside until I had some time to really read and think--and that time was elusive. But since I was thinking about my position on organic foods after the AAP came out with their report, I realized that I should have a position on rice, too.

And after doing some research, I think that we all need to eat less rice, especially babies and children. Which is too bad, because rice can be healthy. But as with mercury in fish, sometimes the risk of toxins start to offset the nutritional benefits.

So in case you missed it entirely: Consumer Reports came out with a report detailing the amount of arsenic in various brands of rice and rice-based products (like cereals or rice milk). It was scary, actually. There's an awful lot of arsenic in some of this stuff. Rice apparently absorbs arsenic more effectively than most plants, in part because it's grown in lots of water--and  a lot of the rice produced in the US is grown in places where a lot of arsenic-laden pesticide was used on cotton.

Arsenic is bad for you. It's actually a poison that can kill you. In smaller amounts, it can do things like damage the brain, nerves, blood, blood vessels, heart and skin. It can cause birth defects and cancer. While the rice producers are correct that there's no proof that arsenic in rice has lead or will lead to health problems, that doesn't mean we shouldn't be worried. According to the report, if a baby eats rice cereal twice a day, which is very common, her risk of cancer doubles. 

That's why I'm going to tell parents to avoid rice cereal. There are other kinds of cereals. That one is easy--it's definitely not a risk worth taking. And besides, rice cereal a highly refined carbohydrate that can increase the risk of obesity--that's why Dr. Greene started his White Out campaign long before this news came out, encouraging parents not to give rice cereal to their babies.

According to Consumer Reports, kids should be having no more than about one serving of rice or rice pasta a week--and the serving size is pretty small. I have a lot of Latino patients who are eating much more than that, with much larger serving sizes. 

I've been telling people to eat brown rice rather than white rice because it's healthier, because whole grains are better than refined ones--but brown rice, it turns out, has on average more arsenic than white rice. Bummer. One thing you can do, though, is cook brown rice like you might cook pasta, in lots of water--and then drain the water off. That can lower arsenic levels. 

Now, it's not like rice is the only risky food out there. It's not the only source of arsenic, either; other foods, like leafy green vegetables, juices and some seafood can contain it as well. If we were going to cut out every even slightly risky food, we wouldn't be left with much to eat. There are toxins everywhere. But when we get information like this from a reputable source, we can't ignore it.

Here's what Consumer Reports recommends for upper limits for children (serving sizes are uncooked):
  • Infant cereal (1/4 cup): one serving a day 
  • Hot cereal (1/4 cup): 1 3/4 servings a week
  • Rice-based ready-to-eat cereal (1 cup): 1 1/2 servings a week
  • Rice drink (like rice milk): none
  • Rice (1/4 cup): 1 1/4 servings a week
  • Rice pasta (2 oz): 1 1/2 servings a week
  • Rice crackers: 8-9 crackers a day
  • Rice cakes (1-3): 1 serving a week

To learn more about arsenic and how you can decrease your child's exposure, check out the website of the Environmental Working Group.

About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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