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Bear Essentials Online - June 2010

Tips to Prevent Choking

A recent study at Children’s National Medical Center looked at choking in children. Our tips help you prevent your child from choking.

Preventing Choking

Experts from Children's National Medical Center and Safe Kids Worldwide offer the following tips to parents and caregivers to prevent choking and other airway obstructions.

If you have an infant:

  • Supervise your baby when he or she is eating and playing.
  • Avoid giving your baby small, hard, or round foods.
  • Cut foods into small pieces and give infants soft foods that they do not need to chew.
  • Learn CPR for infants.
  • Remove strings and cords from baby's clothing.
  • Actively supervise your baby when he or she is playing.
  • Do not let babies play with small, rounded, and oval objects (like balls and marbles), which can easily fit into a child’s mouth and throat.
  • Remove crib toys with strings, cords, and ribbons, which can present a strangulation hazard.

If you have toddlers and older children:

  • Keep un-inflated balloons and broken balloon pieces away from children.
  • Supervise young children while they are eating.
  • Make sure all meals are consumed at the table or in a high chair.
  • Cut foods into small pieces.
  • Do not allow children younger than age 3 to eat small, round, or hard foods, including small pieces of hot dogs, hard candy, nuts, grapes, and popcorn. Other hazardous food items include raw vegetables, jellybeans, raw unpeeled fruit slices, dried fruits, grapes or chunks of meat.
  • Do not let your child eat or suck on anything while lying down or playing. Have children sit in a high chair or at a table while they eat.
  • Get on the floor on your hands and knees, so that you are at your child’s eye level. Look for and remove small items such as jewelry, coins, buttons, pins, nails, and stones.
  • Children should play with safe and age-appropriate toys, as indicated by choking hazard safety labels. Toys that are labeled for children 3 years and older should be kept away from children younger than age 3. These toys may have small parts and could cause choking if placed in the mouth.
  • Regularly check toys for damage that may have created loose small parts. Damaged or dangerous toys should be repaired or thrown away immediately.
  • Use an empty toilet paper roll as a guide for what is an appropriate size. Any toy that fits in the cylinder is not appropriate for young children.

Rahul Shah, MD, co-author of the choking study, is an active clinical researcher in the Division of Otolaryngology (Ear, Nose, and Throat) at Children’s National Medical Center.

Sukgi Choi, MD, co-author of the choking study, sees patients at Children’s National’s newest affiliated private practice, Children’s National Specialists of Virginia, LLC.

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Responsible Teen Driving

Be up front with your child about the responsibilities of driving before he or she gets behind the wheel.

Teens eagerly await the freedom they will have the day they receive their drivers’ license. Parents wait for the day they no longer need to shuttle kids from place to place. However, with driving comes responsibilities and dangers for which many teens are not prepared.

Teens often experiment with authority and may feel invincible. It is essential that parents be involved in their teen’s lives.

  • Establish driving rules with your teen from the beginning.
  • Enforcing those rules at all times.
  • Encourage your teen to be a cautious driver and follow all driving safety rules.

All families should have written rules for teen drivers, like:

  • No teen driver should carry more passengers than allowed by law. If a passenger limit law is not in place, there should be no passengers for the first 6 months (other than family), one passenger for the next year, and never more than 3 passengers.
  • No cell phone use while driving, including “bluetooth” phones, unless the car is stopped and pulled to the side of the road.
  • No excessively loud music.

Violations of rules should carry penalties up to and including license suspension.

Lawrence D’Angelo, MD, MPH is the chief of the Division of Adolescent Medicine.

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Healthy Snacking

Healthy SnackingHas excessive snacking, large portions, and lack of physical activity affected your family?

Today’s on-the-go family is more likely to choose unhealthy alternatives like potato chips to fill the hunger void in between activities. Develop a game plan to make healthy snacking part of your everyday routine.

Healthy Snacking Game Plan

Here are some tips to incorporate healthy snacking everyday:

Make your own snacks: Snacks like trail mixes are great on-the-go but store-bough varieties can be high in fat and calories. When you make your own snacks, you get to control the ingredients and put in what is good for your family. Try this easy to make trail mix: 1/4 cup dried apple slices, 1 tablespoon peanuts, 2 teaspoons chocolate chips. Teach children how to prepare healthy foods by explaining why certain ingredients are used more than others. Allow children to help measure and mix; the hands-on experience will add excitement to eating healthfully.

Prepare healthy snacks in advance: Cut up fruits and veggies and place them in baggies. Refrigerate and grab as you run out the door.

Have a snack stash: Keep healthy snacks with you by stashing fruit or whole grain crackers like Triscuits in a backpack, purse, or gym bag. Having healthy alternatives nearby will deter poor snacking choices.

Healthy SnacksSatisfy cravings with a substitute: Feel like ice cream on a nice day? Opt for nonfat frozen yogurt or sorbet. Having people over to watch a big game? Serve baked chicken skewers and veggies instead of greasy chicken wings and chips and offer salsa or bean dip instead of sour cream. Small substitutions go a long way to keep you on target with a healthy snacking game plan.

Add variety to your routine: Avoid healthy snacking boredom by switching up your snack choices throughout the week. Spice things up by trying spreads like peanut butter on a variety of foods like rice cakes, bananas, and whole grain crackers or put spicy mustard on whole wheat pretzels. Try all the flavors of light low fat fruit yogurts during the course of a week to keep things interesting.

Watch portions: Even when you are making healthy choices it's important to have smart servings. Eating to much of a good thing will still lead to unwanted excess weight.

Read what our experts have to say in the Washington Post.

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Bike Safety Video

Summer is right around the corner- know how to bike right.

Did you know that child bicycling deaths increase 45 percent above the monthly average in the summer? Many deaths can be prevented by simply wearing a helmet. Before you gear up for a bike ride, keep these tips in mind.

  • Always wear a bicycle helmet that meets the safety standards developed by the U.S. Consumer Product Safety Commission.
  • Encourage good helmet-wearing habits by putting on a helmet every time you and your child ride a bike.
  • If your child is reluctant to wear a helmet, try letting him or her choose his own.

(widget to the bike safety video on media center)

Helmet How To

Make sure the helmet fits and your child knows how to put it on correctly. A helmet should sit on top of the head in a level position, and should not rock forward, backward, or side-to-side. The helmet straps must always be buckled, but not too tightly.

Try the Eyes, Ears, and Mouth Test

  • EYES check: Position the helmet on your head. Look up and you should see the bottom rim of the helmet. The rim should be one to two finger-widths above the eyebrows.
  • EARS check: Make sure the straps of the helmet form a "V" under your ears when buckled. The strap should be snug, but comfortable.
  • MOUTH check: Open your mouth as wide as you can.  Do you feel the helmet hug your head?

Equipment fit and Maintenance:

  • Ensure proper bike fit by bringing the child along when shopping for a bike.
  • Buy a bicycle that is the right size for the child, not one he or she will grow into. When sitting on the seat, the child’s feet should be able to touch the ground.
  • Make sure the reflectors are secure, brakes work properly, gears shift smoothly, and tires are tightly secured and properly inflated.

Source: Safekids USA

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New Clinic for Children with Wetting Issues

Does your child wet or soil himself on a regular basis?

Children’s National has a specialty clinic for children with voiding (wetting or soiling) disorders.

The Division of Urology at Children’s National Medical Center offers a clinic called the Wetting and Soiling Help (WASH) Clinic to help parents and children address challenges with voiding (wetting and soiling). A multidisciplinary team of pediatric urologists, psychologists, and gastroenterologists see a variety of conditions including:

  • Urinary tract infections
  • Bedwetting
  • Painful urination

In addition to the Children’s National main campus location, patients can be seen at one of our Regional Outpatient Centers in the following locations:

  • Annapolis
  • Laurel
  • Montgomery County
  • Northern Virginia
  • Upper Marlboro

Naida Kalloo, MD, is the Director of the Wetting and Soiling Help Clinic at Children’s National.

Click here for more WASH Clinic information.

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Simple Snack Mix Recipe

Trail Mix RecipeEating healthy snacks is simple. Check out this easy trail mix recipe that your kids will love!

Simple Snack Mix

Preparation time: 5 minutes


  • 1 cup whole grain cereal (squares or Os work best)
  • 1/4 cup dried fruit of your choice
  • 1/4 cup nuts, such as walnut pieces, slivered almonds, or pistachios
  • 1/4 cup small, whole-grain snack crackers or pretzels


  • Measure out ingredients.
  • Combine in large bowl.
  • Mix ingredients with a large spoon.
  • Place into little baggies to ensure healthy portions.

Serves: 4; 1/2 cup servings


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The Parent's Letter Project

“I cried to myself, he was so darn brave and trusting. Of course I was scared to death.” –Paul’s Dad.

Paul’s dad wrote a letter to families at Children’s National who also have children with a rare neurological disorder. Imagine how valuable his experience could be to a parent just embarking on a similar journey.

Read Paul's letter.

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