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ASK THE EXPERTS

MICHAEL EGNOR, MD.

Patient Question

What are the best ways to help prevent brain injury in children?


MICHAEL EGNOR, MD.
MICHAEL EGNOR, MD.

Professor and Vice Chair of the Department of Neurosurgery
Director of Pediatric Neurosurgery

Expert Answer

The number one thing a parent can do to help protect children from injury is to make sure that their child wears a helmet every time he or she rides a bicycle, scooter, or skateboard. Prior to New York State's bicycle helmet law, we saw a number of children with severe, sometimes fatal head injuries from bike falls or from being hit by a car while riding. After the law, we saw a dramatic drop in both head injuries and the fatalities from them. The even better news is that these lowered numbers have been sustained. One note about bike helmets: It is important that they fit properly. If it doesn't stay on the head during a fall, it is of no use.

Another key way to prevent pediatric head injuries is to use car seats, booster seats, and appropriate child restraints when driving with children. Organizations like the National Highway Traffic Safety Administration (NHTSA) (www.nittsa.gov) offer specific guidelines, but the rule of thumb is to place children in the back seat. This is a safer position and helps keep children away from the front seat air bag, which may cause serious head and neck injury, possibly even death, when deployed. In general, babies should be in rear-facing car seats, small children should be secured in front-facing car seats, and larger children should use a booster seat or a shoulder strap device. This is recommended because the shoulder strap can ride up, hitting the child at neck level, which can cause serious cervical spine injuries if the vehicle gets into an accident. The booster seat or adaptive shoulder strap in effect realigns the shoulder strap in a safer position across the shoulder and torso. Stony Brook has a Safe Kids Program that coordinates NHTSA safety courses, including inspection of car safety seats and instruction on proper installation and use. Safe Kids also teaches helmet safety at seminars held in schools and local organizations, and hosts safety days and bike rodeos.

What are some tactics to use when a child refuses to wear a helmet or to buckle up?
One trick is to show them what the professionals do. Lance Armstrong, the mostfamous cyclist in the world, would never get on a bike without his helmet. Or look at skateboarding champion Tony Hawk, who always wears gis helmet. Reinforce safety measures from day one to help build good habits. Make sure that children know to never get on a bike without a helmet or into a car without fastening the seatbelt.

What other potential causes of brain injury should parents be aware of?
We have seen injuries related to trampolines, often a result of a child landing on his or her head or neck. In older children and teens, parents should be aware of the potential for diving accidents. In about 50 percent of cases of catastrophic injuries, alcohol is involved. It is important to ensure that responsible adults supervise pool parties and other events where swimming and diving are involved.

Are sports injuries a concern?
The few serious injuries we treat from organized sports are almost always unusual accidents that probably couldn't have been prevented. We see mild concussions-mild because most organized sports require helmets. We are seeing the most head injuries right now in skateboarding, especially in young teens, who might think it's just not cool to wear a helmet.

What distinguishes Stony Brook in treating brain injuries?
Having the only Level I Trauma Center in Suffolk County allows us to deal with serious injury immediately, which is key when minutes count. In general, the higher the level of trauma care available for head injuries, the better. The full extent of the injuries may not appear immediately, so it is important for a patient to be at a place like Stony Brook, where a neurosurgeon can be available quickly, and an operating room that is is fully equipped for Level I trauma is accessible.

Our team has six board-certified neurosurgeons, each of whom are at the top of their field. We have one of only 150 board-certified pediatric neurosurgeons in the country. Our nursing staff consists of nurse practitioners who have undergone a higher level of training, as well as many other specially trained medical professionals who consistently deliver quality, compassionate care.


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