Stephanie Chao, MD, is the trauma medical director for Lucile Packard Children’s Hospital Stanford and an assistant professor of surgery at the Stanford University School of Medicine. Among other things, her research focuses on preventing childhood injury, which is the leading cause of death among children. She is also working with anesthesiologists on use of virtual reality and other tools to minimize anxiety and discomfort among children undergoing surgery. In this Q&A, she advises parents on how to keep their children safe at home now that families are sheltering in place during the coronavirus pandemic.
Are there increased safety risks now that children are staying at home with their families?
I do think the risks are increased. Parents are juggling more than they ever have had to before. Normally children are out of the home 7 to 10 hours a day in a supervised environment. Now these children are home. Some parents may need to work from home, but at the same time they also need to watch their children. They are trying to balance both, but it is difficult to do both well.
Children now have many hours of the day without structure. They are exploring the house, exploring the backyard. With the nice weather, windows are open. The number one cause of unintentional injury among children is falls outside the window. Children may be sitting at the window or jumping on the couch next to the window, and in the blink of an eye they can fall outside. Accidents can occur if a parent leaves the room for even a short time. Parents should install window locks or window guards, but it is also just as important for parents to think about where their children are and be vigilant about what they are doing.
What kinds of injuries are you seeing in children now, compared with the days before the pandemic?
We are definitely seeing more bike accidents. So wearing helmets is important. The other thing we’ve seen is that during these challenging times, some kids may be under the care of someone who is not the usual caretaker, like an older sibling. Kids may be spending more time playing unsupervised and letting their imaginations run wild. Unfortunately, we have seen some accidents happen that way—like a child playing superhero alone in the backyard and being injured by falling. After all, kids can’t fly.
Another thing we have been concerned about is the potential for child abuse. Parents may be increasingly stressed, out of work, or under financial pressure. It’s important for parents to recognize that if they are stressed out more than usual, to find help. There are many mental health resources online and in person.
What guidance would you give to parents to safeguard their children?
I would suggest that all caretakers—whether it is a parent, sibling, or other family member—be reminded that kids are natural explorers. Sometimes these wonderful traits can get kids into accidents. For instance, my own 1½-year-old had no interest in climbing things before the pandemic. Now she is climbing onto the dining room table every day. So parents should survey their home: Things that can be used as a launching point have to be put away. Make sure a bed or a couch isn’t near a window. Make sure cleaning supplies and medications are locked away. If your child is going to run outside, make sure he or she is supervised. If you have a pool, see that the gate is locked and there is a child-safe pool cover. Empty all kiddie pools, buckets, and containers immediately after use, and store them upside down.
What about psychological trauma as a result of the pandemic—are you seeing signs of that in children?
When we follow up with some of our injured children at home, we screen them for PTSD. And we find it’s certainly harder for children to recover now. They don’t have time to reflect or to get the attention they might need. Some come from big families living in crowded spaces, and that can make recovery challenging. Emotional trauma in children is underrecognized. That’s true now more than ever. If you feel your child needs to be seen by a specialist, don’t wait. The Stanford Children’s Health website also has resources to help children cope.
What about teens, who tend to feel they are invincible? What risks do they face, and how can these be minimized?
It’s important for parents to take some quiet time to check in with their teens. Tensions may be running high. Teens need to be able to go out and release those tensions, and they are not able to do so now. Help your teen find a setting where they can social-distance—maybe an outdoor picnic where they can sit 6 feet apart. And find the time to have a discussion with your teen, rather than assume they’re OK because they’re at home on their phones.
What kinds of coping mechanisms do you recommend for parents?
Parents need to remember to carve out time for themselves. It’s so easy to let the day get away from us, and the result is that our ability to deal with stressors diminishes. So take some time, whether it’s half an hour to go out for a walk at lunch, a 15-minute mindfulness app, or a 30-minute meditation. It is important.
What other advice do you have for parents?
If parents have a concern about their child’s health, they should bring the child to the hospital and not put off getting care. We are seeing some delayed cases of appendicitis, for instance, because parents are afraid to bring their kids in to the hospital. But at Packard, we have made it very safe to bring children in during the outbreak. We have been testing all of our employees and staff for the coronavirus, and we are treating COVID patients in a separate area of the hospital. If parents are concerned about their children’s health, they should bring them in for care.
Learn more about our Childhood Injury Prevention Program, visit safety.stanfordchildrens.org.