Issue date: January 14, 2001

In this article: 8 Safety musts A doctor's role A child's role A great new book about safety Online extra: Safety links Also this week: Caleb the Cat teaches kids safety

Give your kids a good start

USA WEEKEND's medical expert lays out a game plan for parents, doctors and children themselves. And get ready to meet Caleb the Cautious Cat, the hero of an original children's story on preventing injuries, the No. 1 danger to kids.

Parents spend a ton of time thinking about all the things they want to give their children: games and toys when they are young, bicycles and balls when they are a little older, cars when they are teenagers, and college educations when they are grown. My wife and I spend time and energy on this topic, and most other parents do just the same.

Most of us succeed at providing everyday material things, but many of us fall short when it comes to planning for one of the most important long-term gifts we can give our children: the gift of good health.

Sound crazy? Think about it. Our children rely on us not only for financial needs, but also for developing them into healthy, vibrant adults capable of living a full, energetic life. It doesn't require money to give this to our children. It requires something far harder: time and commitment.

My prescription for childhood health combines

loving care, accident prevention and example-setting by parents, with regular help from doctors and an active role played by the children themselves.

The role of parents

As parents, we have the opportunity to give our children much more than a roof and three squares. We can provide values, self-esteem and love. The effect an emotionally stable family life has on a child's physical development cannot be overstated. Moreover, we should provide our children with a physically safe environment and a pattern of good habits to follow.

A physically safe environment basically means our children can live in a house that statistically reduces their risk for injury. Simple things make a big difference. By providing the eight conditions listed in the box at right, you help reduce the risk of physical harm to your children. For example, the list mentions CPR training for parents and caretakers. OK, my wife and I are both physicians, so we have a leg up in this area. But we have always made sure our baby sitters are CPR-trained.

It's also important that children have an emotionally safe environment. We must understand the impact that parental arguments, rudeness, shouting and so on have on impressionable minds. Children learn what they live! Grown-up discussions should be held behind closed doors, and children should not be subjected to this type of emotional intensity.

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Emphasizing good habits is critical, too. Start with regular physical activity. I am ashamed to say this, but 60% of Americans are completely sedentary! Regular physical activity is essential for increasing our life span and making our daily lives better, but most of us can't seem to get with the program.

More important, juvenile obesity now exceeds 20% and is especially prevalent among Hispanic children and African-American girls. The ramifications of this are twofold: First, children suffer psychologically from being overweight, and second, chubby children tend to become chubby adults, with serious long-term health consequences.

You can help offset this trend by developing healthy lifestyles. As a parent, you have tremendous influence over the habits your children develop. If you don't smoke, drink to excess or use illicit drugs, if you do watch your diet and routinely exercise, your children will see that those things are important to you. In turn, they will become important to the children.

Many of you may remember a commercial that showed a father and son sitting peacefully on a dock on a beautiful summer morning with their fishing poles in the water. As the father kicked off his shoes, so did the son. As the father reached for a soda, so did the son. As the commercial ended, the father reached for a pack of cigarettes and lit one up. The final image is of the son reaching over to grab that same pack of

cigarettes. Never underestimate the power of your non-verbal communication with your child.

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The role of doctors

Your pediatrician or family physician plays a crucial role in your child's health. Doctors are a great resource apart from the obvious need for them to do routine checkups on your child. Your doctor can provide information about how to make your home safe, how and where to get CPR training for yourself or caretakers, and how to get in contact with organizations that can help you understand particular needs of your child (such as learning disabilities).

Don't make the mistake of thinking your doctor is there only to treat sore throats and ear infections. Doctors have a wealth of data that can make your role as a parent less intimidating and more effective.

A key service by your physician is immunizations. I know, I know: A lot of people believe immunizations are overkill or even dangerous. In fact, a survey of 1,600 parents published in the November issue of the journal Pediatrics revealed that, while most parents deem immunizations very important, 25% have mistaken ideas that children get too many shots or that vaccines weaken a child's immune system.

Look: Any medicine used on any patient has an inherent risk, but vaccinations substantially protect children from certain illnesses.

Those of us raised in the "Brady Bunch generation" can't recall devastating childhood illnesses. Many of us believe measles is a "mild" childhood disease that, at worst, keeps a kid in bed for a few days. Wrong. "Before the vaccine became available, measles killed 3,000 children a year in the United States," says Steve Berman, M.D., president of the American Academy of Pediatrics. "It also caused 48,000 children to be hospitalized each year. A decade ago, when immunization rates dropped, there was a measles outbreak with over 55,000 cases reported, more than 11,000 hospitalizations and 125 deaths. So you see, we have to be sure to keep vaccinating our children against illnesses. The fact that you don't see those diseases anymore simply means the vaccines are working, and they will continue to work only if we continue to immunize our children." I couldn't agree more.

Our children don't have the best chance for long-term good health if we slip up on their immunizations. To stay up to date, check the recommended schedule from the American Academy of Pediatrics. You can review it any time at the medical Web site www.aap.org/family/parents/immunize.htm.

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The role of children

Like it or not, at some point we must see to it that our kids take care of themselves. Once children grow to be somewhat independent, past age 5, their risk of injury skyrockets. Between ages 6 and 12, more than half of all deaths are caused by unintentional injuries. Burns, car crashes, head injuries from falling off skateboards -- the list goes on and on. Anyone with children knows they all become young explorers at this age. Whether it's flying down the street on a bicycle or flying down a ski slope, these kids know no fear.

Children must be given safety guidelines, and parents must make sure they follow those guidelines. My wife, Janet, and I wrote a safety story with

elementary-school children in mind. Having children this age follow clear, simple rules like the ones in our story Caleb the Cautious Cat can prevent a world of heartache. It's printed on the next page; we hope you enjoy reading it -- and teaching its lessons -- to the children you love. Clip it and save it.

As children grow into teens, they should know what the safety rules are and why they are important. But parents still aren't out of the woods!

Your best efforts to instill good health and safety habits in your children can be offset by peer pressure and puberty. As children spend more time with friends and undergo the physiological changes that make them adults, they tend to engage in risk-taking behavior in spite of knowing better. Accidents still are the highest risk for teens, mostly from motor vehicles.

Teens often think they know more than their parents. It was Mark Twain who said: "When I was 14, my father was so ignorant I could hardly stand to have him around. When I got to be 21, I was astonished at how much he had learned in seven years." That's what parents are working against. Still, it does not absolve us of the need to protect our kids, often from themselves! The same safety rules we taught them as preteens apply now. Don't assume they no longer need reminding. The constant encouragement and insistence of a loving parent is extremely important.

The teen years also are when habits are being formed that will help or hurt in the long term. If you have not reinforced, through your own behaviors, those habits you want your children to develop, it is difficult to expect it of them.

We're back to time and commitment. It is easier to provide a car when they turn 16 than it is to teach them how to use that car responsibly. It is easier to tell them to watch their weight when they get into high school than it is to show them what a lifetime of exercise and appropriate diet has done for you.

The bottom line

Few things are more important than giving health to your children. This gift requires a daily commitment. It requires parents to know the health risks for their child -- and what parents, doctors and kids can do to reduce those risks. A child's health concerns change with age, but at every age you should keep your kids focused on healthful habits. Although the investment in time and emotion is significant, the rewards speak for themselves. Keep it up. Persevere. You can do it. (It's not as easy as going to Toys "R" Us, is it?)

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A great new book to have handy

Parents, wouldn't it be nice to have one resource that covers all questions about children's health? Well, physicians at Harvard Medical School are about to release an information gold mine: The Children's Hospital Guide to Your Child's Health and Development ($40, Perseus Books). Other books are too technical to be useful; this one offers detail without dreariness. Its simple illustrations and easy language are user-friendly and enjoyable. Each step of the way, practical advice is given on things as simple as clipping nails and as complex as handling a baby with colic (incredibly hard to do!). Its explanation of normal development, both physical and psychological, could go a long way toward alleviating the stresses of raising children. Plus, its novel approach of explaining what a doctor is likely to do in certain situations can help parents be partners with doctors. Add a detailed section on common ailments and a highlight section on emergencies and this book is a must for anyone who cares for small children or wants to start a family.

Illustration by GARY BASEMAN for USA WEEKEND

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Online extra

edsnet.org This pediatrician-run effort gets good word-of-mouth on parenting message boards, thanks to its focus on child wellness: news and health alerts, food safety info and immunization trackers. An original library of 600 "ask the expert" Q&As plus well-researched articles address issues such as: Will giving my 5-year-old the chicken pox vaccine harm my newborn?

familydoctor.org Check out the site's self-care flowcharts that can suggest possible diagnoses and recommend treatments or actions for all kinds of medical conditions. Plus, a long list of handouts on non-illness health issues such as Air Travel Health Tips.

A VALUABLE RESOURCE TO CHECK OUT ORIGINAL MEDICAL RESEARCH

medscape.com Click on "Medline." This is an exclusive Medscape feature that narrows the search to articles in 270 of the most popular (and consumer-friendly) journals.