Expert Interview: Flaura Winston, M.D., Ph.D., F.A.A.P.

Today we are continuing our interview with the experts from After the Injury. Flaura Winston, M.D., Ph.D, F.A.A.P is a board certified practicing pediatrician, biomechanical engineer and clinical researcher. She is also an Associate Professor of Pediatrics at the University of Pennsylvania. Dr. Winston is also the Founder and Scientific Director of the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia ( Dr. Winston’s main focus is traffic injury and she is the Principal Investigator for
research funded by the National Highway Traffic Safety Administration, the National Science Foundation, the Maternal and Child Health Bureau, and State Farm Insurance Companies®, among others. Hopefully Dr. Winston’s tips will help answer some of your questions about safety around the house and in the car.

Q: What are some basic safety tips for around the house for children of all ages?

A: First, think about making your house safe for everyone regardless of your age. For example, make sure smoke alarms are in all hallways and sleeping areas, and that they are working. Install carbon monoxide detectors. Make sure everyone in the family knows the fire escape plan. Get rid of any guns. If you have to keep a gun, make sure that it is kept locked and unloaded. Set hot water heater temperature limit to 120 degrees to prevent scalds.

Then, think about where your child is developmentally and where they will be in the near future. Use this information to predict the hazards that your child might face. For example, when a child is 4 months old, recognize that she might soon start to crawl. Get down on your hands and knees and look in every room and outdoor area at your child’s level, as your child would. Ask yourself what hazards look interesting and what can be reached. You’ll notice knives, glasses and scissors that are in their reach them and move them to safe places. Keep medications and cleaning products completely out of children’s reach, preferably locked up and clearly labeled. Safely store 5-gallon buckets.

As your child gets closer to 9 months old, she might start to pull to a stand and walk. BEFORE then, think about fall prevention. Falls down stairs and falling furniture cause many injuries to children at home. Install window guards on the windows and keep furniture away from the windows so smaller kids can’t climb on it to reach the window. Put baby gates at the bottom AND top of the stairs. Don’t use baby walkers.

Too many kids are severely injured from furniture that has fallen on them- a TV they wanted to reach or a bookshelf they were trying to climb to reach something.. Strap televisions and other large objects to the wall or a stand, and take down items that might entice their children to scale furniture, such as toys and remote controls.

As children become more mobile, there is so much trouble they can get themselves into! The street in front of the house and the backyard swimming pool can be deadly. Remember, drowning is silent. You won’t know that your child is under water until it is too late. Make sure there is four-sided fencing around pools and that children are never swim without supervision.

A little bit older and your child might be playing on your backyard playground equipment. Make sure that you installed it over a safe surface. There are safety standards for playground equipment that you should follow, even in your backyard, and don’t get a trampoline.

The school-age child might start riding a bicycle. Make sure you set a rule and enforce it that your child always wear helmets when riding their bikes or skating, and are buckled into the correct child seat for their age and height each time they are in the car.

Do not let children ride unsupervised unless you’re confident they have learned street safety and will use it without prompting –usually around age 10 or 12. has some great tip sheets for parents that give detailed information on how to keep kids safe at home and away.

Q: I’ve heard different things about when to turn a rear facing car seat around. Do you think car seats should be turned at 1 year and 20lbs or at 2 years?
A: Research is very clear that kids are safest in the car when they are in a rear-facing seat, as long as they are within the height and weight requirements for the seat, and the seat is properly installed.

I recommend keeping children rear-facing for as long as the seat’s height and weight limits will allow. For most children and their seats, this will occur around 2 years of age. Check your child safety seat instruction manual.
Q: What features should parents look for when choosing a car seat? Are the $300.00 carseats really that much better than the $75.00 car seats?
A: All the car seats sold in retail in the U.S. must meet the same rigorous minimum federal safety standards, regardless of price. Some of the more expensive seats have more features. The best seat for your child is the one that fits him best, and that fits your vehicle the best. I encourage parents to bring their child with them to the store, along with the vehicle the seat will be used in, and take the seat to the parking lot to make sure you can get a secure fit, and that the seat fits your child as well.
Children’s Hospital of Philadelphia has a great web site to help parents choose and install the right car seat for their child:

Q: What are some of your other safety tips for children while in the car?
A: We have four tips in priority order:
1. Everyone needs to be restrained on every trip every time.
2. Use the appropriate restraint for your child’s size and age.
3. Children under 13 should sit in the rear seat.
4. Use the restraints correctly.
No matter how short the trip is, make sure both you and your child are properly buckled in. Most crashes occur within 20 minutes of home, and you are your kids’ number one role model, so it’s important to model the behaviors you want them to keep as habits into adulthood.
Kids should ride in a booster seat until age 8 or 4’9”, and when they outgrow a booster seat, they should be buckled in the back until they’re 13 years old.

Sometimes as kids get older, they start to fight using the car seat or booster seat. Parents can get a little creative to find ways to make the booster seat cool instead of a baby seat. Let them have their own spot in the car, where their seat goes every time, and when they’re in “their” seat, they get to pick the radio station. Or let them “decorate” their seat and their area of the car with things they pick out. Attach a piece of fabric to the seat back in front of them, and let them choose stickers or drawings they like for their seat.

Q What is the most common mistake parents make when putting their children in the car?
A: Probably the most common mistake is that the car seat doesn’t fit the vehicle tightly enough, or that the harness straps that secure the child are too loose.

Another big one is moving kids into an adult seat belt too early. Kids shorter than 4’9” and younger than 8 years old should be in a booster seat to reduce their risk of injury by 60% compared with an adult seat belt.
Another mistake is that drivers make the mistake of allowing child passengers under the age of 13 to sit in the front seat.

Q: What are the most common injuries that send young children to the emergency room? How can they be avoided?
A: The number one cause of injury and fatalities is car crashes. Falls, drowning, and bike crashes are also extremely common.

Car crash injuries can be avoided by making sure your child is securely restrained the the proper seat for his or her age and height. This reduced a child’s risk of injury in a crash to less than 1% (1 injury per 100 crashes).

Injuries from falls can be avoided by supervising small children at all times; making sure windows have safety locks and that no furniture is kept near windows; keep gates at stairways for small children and toddlers; and by discouraging children from playing on fire escapes, roofs, and balconies, especially those that are not adequately fenced.

Kids playing in or near water need adult supervision at all times- even if they know how to swim. For the youngest children, use touch supervision (touch them the whole time they are in the water). As they get older, keep children within an arm’s length away. Drowning prevention requires concentrated supervision. You might want to share the task with another parent – taking turns with focusing on supervision. If you have a home pool, make sure your pool has fencing on all 4 sides.

Kids and adults should always wear a helmet when riding bikes, on every single ride. Modeling important safety behaviors for kids is extremely important. Set limits on where children can ride based on safety, and make sure they know the rules of the road and proper safe riding skills before they ride alone. Come to a complete stop before entering driveways, paths or sidewalks, and then look left, right and left again for bikes, cars or pedestrians.

A big thank you to Dr. Winston for all the great tips on vehicle and home safety! What was your favorite tip that Dr. Winston gave us? Let us know by leaving a comment!


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  1. "Injuries from falls can be avoided by supervising small children at all times . . . "

    Ah, sounds so logical. So factual. So simple really. Just supervise your small children AT ALL TIMES and they won't get hurt.

    I know what she's saying, and this post has great advice. I just want to give a word of encouragement to the SAHM of twins who just started crying after reading the AT ALL TIMES part. Let go of the guilt, sister friend.

    You can't be there every second of every day of every year. Your kids will get hurt, and that doesn't mean you aren't doing your job. That means you have normal, healthy, active, curious kids who are going to climb, fall, smack their faces on the floor, even break a bone. And you are still a good mom. DO YOU HEAR ME? It's not normal to go through childhood without any kind of pain, emotional or physical. Kids can (and will) get hurt, even under direct supervision.

    Be careful, but don't be a martyr. And for all that's holy, don't be a helicopter mom! Life happens, and kids are kids.

    (Just want to emphasize that this is not meant as disrespectful to Dr. Winston in any way, and I very much appreciate her words of wisdom!)

  2. Dr. Flaura Winston

    Hi, Kim.

    Point well-taken! There is no perfect advice. It's hard to cover every situation in such a short column, so I kept my advice general. You, as the parent will have to decide what is right for the situation.

    To clarify… I am most concerned with preventing serious injuries. We
    need to be most diligent when there is a risk of brain, spinal cord, and organ injuries and fractures, knowing full well that we can never reduce the chance to zero! Of course, bumps and bruises will occur – that IS part of childhood.

    I want families to know that there are practical things they can do to
    reduce the chance for serious injuries. For the most part, serious injuries are not accidents. They are predictable and preventable. Prevention is the best

    I like to think of safety in much the same way I think about all of parenting –
    1. Think about setting your child up for success – for injury, set up the environment so that it reduces the chance for injury. Set clear limits appropriate to your child's development, behavior, etc. while making the environment as low risk as possible (e.g., good surfacing under playground equipment)

    2. Think about ways to protect your child should something untoward happen – one way is setting rules about safety – (e.g, helmets with bike riding) and set a good example!

    3. Keep track of what your child is doing to a degree that is consistent with their development and the danger level.

    4. Do all of this in a supportive, instructive, and kind manner. This is about safety, not about control!

    This will allow your children to explore in ways that are consistent with their development and reduce the chance of serious danger. As an added benefit, this sets you up for promoting growth and development to independence – logical progression of freedoms as your children grow and develop. Little by little – not all at once.

    But, I live in the real world. I know that even children of the most diligent parents can suffer injuries, even serious ones. To help
    families help their children recover from injury, we developed

    It is not easy being a mom or dad! It's the most important job in the world and there isn't an instruction manual.

    Lots of hugs to all of you and your kids.

    Dr. Flaura Winston

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