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Why Kids Shouldn’t Wear Bulky Coats in Car Seats

carseatby Shannon England-Rice
Child Advocacy Specialist

When it’s cold outside, most of us want to bundle up to stay warm. During the winter months, I am continually telling my children to put on their coats. At times I feel like a broken record. When it is cold, there are times a coat is necessary, but generally not in your vehicle.

Why is it unsafe to wear a coat in your vehicle? In a crash, you want the seat belt or harness of a car seat to be as close to the individual as possible. Here are a few tips to remember when fitting a child in a 5 point harness:

  • The harness should be snug, comfortable, and positioned closely to the child.
  • Big, fluffy coats prevent a good fit. They create a gap between the child and the harness.
  • Winter coats can make it difficult for a parent to get the harness straps tight so they tend to leave the harness looser which is dangerous.
  • In a crash, even when the harness is tightened, if a child has a coat on, the fluff compresses and the straps are too loose for the child’s body. When harness straps are loose, injury can result and at worst, ejection from the vehicle can occur.
  • Keep in mind; this applies to children in booster seats and adults in seat belts as well.

There are many options for keeping your child warm in the vehicle without a coat on. Dress your child in layers before strapping them into his/her car seat. Undershirts, leggings and long johns work well for layering. Once the child is dressed, car seat manufactures and safety advocates recommend a sweatshirt, or a well fitted fleece coat be worn by the child in place of a bulky coat. If the car is extra cold, a blanket can be placed on top of the harness itself. Never place a blanket under the harness, because this causes the same problem – an improper fit with a gap between the child and the harness. Placing a coat on backwards after a child is buckled in is also an option. Gloves and a hat will also keep children warm and won’t interfere with the harness.

The installation of the car seat and the fitting of the child are equally important. Always follow the manufacturer’s instructions for both rear-facing and forward-facing positions. Please feel free to call one of Primary Children’s child passenger safety technicians with any fitting or installation questions. You can also call to schedule a free car seat check appointment Monday through Friday from 9:30 am – 3:00 pm by calling 801 662-6583.

Here’s to the rest of a fun, warm, and safe winter!

Shannon Rice Shannon England-Rice has a degree in Public Heath, and has been working in Primary Children’s child advocacy department for 10 years. She’s dedicated to keeping kids safe through car seats, helmets, and parental supervision. She works with the Hold On To Dear Life campaign and other outreach programs. Shannon has 6 children and loves to exercise, read, shop, and travel.
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The Air We Breathe: Protecting Our Kids During An Inversion


by Elizabeth Joy, MD, MPH, Michelle Hofmann, MD, MPH, & Steven Bergstrom

It comes as no surprise to anyone living along Utah’s Wasatch Front that our air quality is compromised for days to weeks come wintertime. Our murky air is referred to as an “inversion” as it is the reverse of a normal air pattern (i.e., cooler air above, warmer air below). During inversions, the Wasatch Front valleys and their surrounding mountains act like bowls, trapping a dense layer of cold air under a layer of warm air. The warm layer acts much like a lid, and any pollution produced during an inversion becomes trapped in the cold air near the valley floor (Figure 1). This warm inversion air layer is usually displaced when a strong storm system blows in, releasing lower polluted air, and restoring air quality to healthier levels.

Children and Those with Acute Respiratory Problems Face a Higher Risk

Figure 1

Figure 1

Poor air quality is unhealthy for everyone, but some groups are more susceptible than others. Children, especially those with asthma, are considered at high risk because they spend more time playing outdoors, their bodies are still developing, and they breathe more rapidly than adults, inhaling more air per pound of body weight. The elderly and those with acute or chronic respiratory problems, or vascular diseases such as heart disease or stroke, are also at high risk. Given that nearly one third of Utah’s population is younger than 18 or older than 65, in addition to the more than 200,000 Utahns with asthma, and 500,000 with heart disease, addressing air quality is indeed a public health imperative.


Figure 2

The primary contributor to our poor air quality and its impact on health during an inversion is fine particulate matter (PM) pollution. Often referred to as PM2.5, the 2.5 refers to the size of the particle (2.5 micrometers per cubic meter). Figure 2 provides some perspective on the size of these particles-which is 30 times smaller than a human hair!

Monitor Air Quality and Protect Your Family’s Health

A growing body of evidence suggests that even on some of Utah’s best air quality days, there are pollution sources that may be impacting health. In particular, living, working, and attending school within close proximity to major roadways results in exposure to automotive emissions that are a major source of PM2.5 and other harmful air pollutants. Considering how you can prevent or reduce exposures to vehicle exhaust is a good step everyone can take to protect themselves and their children from some of the harmful effects of air pollution. Avoid idling your vehicle, exercise outdoors away from major roadways, and for schools located near highways, schedule outdoor activities outside of peak rush hour times.

Other ways to protect ourselves and our loved ones include “reading the air.” Much like checking the temperature to know how to dress for the day, look at the current air quality conditions to know if you and your family need to use extra caution with outdoor activities that increase pollution exposures. Useful tools for monitoring air quality can be found on www.airnow.gov or www.airquality.utah.gov, or UtahAir, an app that can be downloaded onto your smart phone for real time, local air quality information. These tools also provide exposure recommendations for people with and without sensitive conditions that may be exacerbated by poor air quality. First and foremost, always listen to your body, and consider if air quality may be influencing you or your child’s health, by monitoring for symptoms like increased cough, chest tightness, wheezing, or difficulty breathing after exposures to air pollution.

Personal Responsibility in Air Quality Improvement

In addition to protecting our health, we all have a responsibility to improve air quality in Utah. Utah’s Clean Air Action Team (CAAT) published a number of recommendations aimed at improving our air quality. Some of these recommendations are aimed at policy makers such as access to lower sulfur gasoline, and investing resources to expand public transportation.

However, there are several recommendations that are actionable at an individual or household level. These include reducing both wood burning and total miles driven per person during inversion periods, and installation of ultra-low nitrogen oxide water heaters. According to the CAAT report, the emissions from heating 1 home with wood burning as the sole heating source is equivalent to emissions from 200 homes heated with natural gas in terms of fine particulate matter (PM2.5). Be a part of the solution, by doing all that you can do to reduce your own contribution to Utah’s poor air quality.

The following authors contributed to this article:

Elizabeth Joy, MD, MPH
Michelle Hofmann, MD, MPH
Steve Bergstrom
Medical Director
Clinical Outcomes Research
Intermountain Healthcare
Medical Director
Riverton Hospital Children’s Unit
Director of Sustainability
Intermountain Healthcare
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Play it Safe Outside this Winter

skiby Whitney Henrie & Tim Cosgrove
Child Advocacy Specialists

Winter sports can be a great way to make the colder months fly by and keep kids active. But when your kids are sledding, skiing or skating, you need to know how to be safe so they don’t get injured and miss all the fun.

No matter what activity you are enjoying, staying warm is important. Make sure to dress your children in layers that will keep them dry and apply sunscreen so the sunlight reflecting off the snow doesn’t cause sunburn.


Flying down the hill is a great feeling, but sledding can be dangerous if you’re not careful. Make sure the sled is sturdy and easy to steer. Don’t use homemade sleds like garbage can lids, plastic bags, or pool floats—you can lose control too easily. Wear gloves and boots to protect your hands and feet and consider having your child wear a bike helmet to protect their head while sledding.

Be careful when choosing the hill and make sure it isn’t too steep, near a busy road, or covered with rocks and trees. Adult supervision is very important. Make sure kids take turns sledding down the hill and that the person sledding is out of the way before the next one takes off.


Whether playing hockey or ice skating, the most important thing is to skate only on safe and sturdy ice. Indoor ice rinks are safer than outdoor ponds or lakes. Be careful when skating outdoors because even if the ice looks strong it may not be able to hold a child’s weight.

If your child plays ice hockey don’t let them step out onto the ice without proper gear. This includes padding, and most importantly, the right helmet. Use only a helmet approved for ice hockey, not a football or bike helmet.

When skating for fun, be sure your kids skate in the same direction as the rest of the crowd. If they are going to try out a new figure skating move, be sure they watch where they are going and leave themselves plenty of room.

Skiing and Snowboarding

Before getting to the slopes, make sure you have the right equipment and that it fits correctly. Don’t use equipment that is too big, as it will make it difficult for your child to stay in control. Be sure kids wear ski boots, goggles and a helmet. Snowboarders will also need knee and elbow pads.

It’s a good idea to have your child take at least one skiing or snowboarding lesson. That way you can be sure they know the basic skills needed to stay safe. It’s also important to supervise kids and make sure they stay on trails appropriate for their skill level.

No matter what activity you choose, staying active and remembering these safety tips can make your winter great! Oh, and don’t forget to have a delicious cup of hot chocolate to warm up after your fun activities!

The Child Advocacy Department at Primary Children’s Hospital embraces the concept that injuries are preventable. The HOLD ON TO DEAR LIFE© campaign is housed in the Child Advocacy Department and provides awareness and resources to parents and caregivers about unintentional injuries and how to prevent them. Tim Cosgrove and Whitney Henrie are Child Advocacy Specialists from the department that contributed to this Blog Post.
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The Risks of Avoiding or Postponing Vaccination

vaccineTwo siblings in Utah County have tested positive for measles—the first cases in Utah in several years. This incidence is part of a larger outbreak that is being investigated in California, where health officials have confirmed at least seven cases.

According to the CDC, 2014 saw a record number of measles cases, with 610 confirmed cases reported. This was the highest number of cases since measles elimination was documented in the U.S. in 2000. Although measles has been scarce in the U.S. in recent years, it is still common in other parts of the world and can spread when it reaches a community where groups of people are unvaccinated. 

Vaccines and Misinformation

When it comes to immunizing their kids, increasing numbers of parents aren’t just consulting their pediatricians for advice — they’re also paying heed to rumors and advice spread online through websites, message boards, and blogs. And conversations with other parents at dinner parties or playdates can be enough to instill doubts about vaccine safety or the necessity of giving multiple vaccines in one shot.

Even when the science or sources behind anti-immunization stances are proved unreliable or even completely discredited, it can be difficult for some parents to accept that vaccines are safe. And sometimes other personal or religious beliefs persuade parents to skip immunizations.

As a result, health officials are seeing alarming rises in preventable diseases. The Centers for Disease Control and Prevention (CDC) reported hundreds of U.S. measles cases in 2014, the largest number in many years. Most of these occurred in people who were not immunized against measles.


A Myth Debunked

Much of the controversy about vaccines stems from the now-debunked 1998 study that tried to link autism to the MMR vaccine that protects against measles, mumps, and rubella (German measles). Study after study has found no scientific evidence that autism is caused by any single vaccine, combination vaccines (like the MMR vaccine), or the mercury-containing preservative thimerosal, which was once widely used in many childhood vaccines but has since been eliminated.

Indeed, the journal that originally published the 1998 study retracted it and called the findings “a deliberate fraud.” And the doctor behind the study lost his license. But the study and the attention it received influenced parents worldwide and contributed to a decrease in immunization rates. Indeed, recent polls indicate that 1 in 4 parents still think vaccines are linked to autism.

Community Immunity

Some parents wonder why their kids need immunizations if many of the diseases they protect against are no longer commonly seen in the United States. But the fact is that infectious diseases that are rare or nonexistent here (because of immunization programs) are still huge problems in other parts of the world.

If immunization rates drop among U.S. kids, an outbreak could be an airplane flight away if a disease is introduced by just one unimmunized person (as in 2007 when a 12-year-old boy from Japan came to the United States for the Little League World Series and passed measles on to others).

It’s also important to understand the concept of “community immunity” (or “herd immunity”) which is when the majority of a population is immunized against a contagious disease, thus providing little opportunity for an outbreak. A single person’s chance of catching a disease is low if everyone else is immunized. But each person who isn’t immunized gives a highly contagious disease one more chance to spread.

People who can’t receive certain vaccines (such as infants, pregnant women, and those with compromised immune systems) are also protected when most of the population is immunized. So when parents decide not to vaccinate their kids, they not only put them at risk, but also others who cannot be vaccinated.

Stay On Schedule

Many parents worry about their children (especially infants) getting too many shots in one visit. They feel it might be “overwhelming” to the child’s “immature” immune system. This prompts them to request delaying or postponing some immunizations so that the shots could be more spaced out or given one at a time. A recent online survey shows that more than 1 in 10 parents use alternative immunization schedules that don’t adhere to the recommendations of health experts.

Yet, the truth is that there is no evidence to suggest that childhood vaccines can overload a baby’s immune system. On the contrary, babies are exposed to numerous bacteria and viruses on a daily basis — so much so that the added exposure from the vaccines is simply a drop in the bucket.

Similarly, giving “simultaneous” vaccines (more than one shot at the same time) or “combination” vaccines (more than one vaccine in a single shot) has not been shown to produce any different effects than giving them separately. But it does allow for immunizing kids as quickly as possible so that they are protected during the vulnerable early months of their lives. And fewer office visits can be less traumatic for a child and can save the parents both time and money.

Opinions differ on how strongly doctors should adhere to the standard vaccination schedule. Some pediatricians will try to accommodate a parent’s fears and thus go against their own best medical advice in order to keep the peace.

The Bottom Line

Immunization is the best way to protect kids from preventable diseases. A series of simple shots given from infancy to the teen years can fend off many major illnesses in millions of kids. The only time it’s safe to stop vaccinations is when a disease has been totally wiped out worldwide, as in the case of smallpox.

If you search online for health information, make sure it comes from reputable websites and legitimate sources. Keep in mind that many studies are poorly conducted and inconclusive, and often cannot be replicated by other scientists. Yet, once the information is posted online, it takes on a life of its own and is shared and quoted widely — often without a knowledgeable expert to refute false claims.

And take random opinions with a grain of salt. Some people talk about “toxins” (like mercury or aluminum) or overwhelming an infant’s immune system, and many even believe that the diseases are safer than the vaccines meant to prevent them. In truth, the risks of serious reactions to vaccinations are extremely small compared with the health risks associated with the often-serious diseases they can prevent.

So if you see, hear, or read about side effects or downsides of immunization, speak with your doctor.It’s important to get all of the facts before making a decision to delay or skip an immunization — a choice that could affect not only your kids’ health but that of others.

Have You or Your Children Been Exposed?

Individuals who came into contact with them may also have been exposed to the virus and public health officials are working to track down and notify these people.

The infected individuals in Utah County would have been contagious from December 27, 2014 through January 5, 2015 and attended several events during the infectious period. The Utah Department of Health lists their whereabouts during that time and is urging anyone who may have come in contact with them to contact the Utah Poison Control Center, which is screening individuals for potential exposure, at 1-800-456-7707, or visit the web site www.health.utah.gov/measles:

Additional Reading

This information is part of Primary Children’s KidsHealth website. This resource features information on a variety of health topics for you and your children.

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10 Ideas to Help Your Kids Set & Keep New Year’s Resolutions

newyearsresolutionsBy Sara Bybee, LCSW
Center for Safe & Healthy Families

Although making New Year’s resolutions seems to have become an annual joke for many adults, setting and keeping goals is a very valuable lesson for children. By setting goals and working towards them over time, children learn how to persevere, handle setbacks and delay gratification.

Here are some ideas about how you can set your children up for success in setting and keeping goals:

  1. Make goals, not resolutions. By encouraging your children to set goals instead of resolutions, it will stress the importance of the goal and the fact that goals can be set at any time of year.
  2. The goals should be something your child wants to achieve since it requires his or her effort.
  3. Start setting goals by having a conversation with your child:
    What does he/she like doing?
    What is he/she good at?
  4. Break down the goal into smaller, more manageable steps.
  5. Make the goal SMART:
    Specific: the goal should be written simply and specify what he/she will do
    Measurable:  the goal should be able to be measured so there is evidence of having accomplished it
    Achievable: the goal should be reasonable enough to be accomplished by your child
    Results-focused: the goal should measure outcomes, not activities
    Time-bound: the goal should include a time-limit to establish urgency
  6. Once goals are set, write them down and post them somewhere visible to monitor progress.
  7. Consider placing other family member’s goals next to your child’s goals to show support and model how to work towards accomplishing a goal.
  8. Offer encouragement/positive feedback when you notice your kids taking steps to meet their goals.
  9. Acknowledge the feelings your children may have as they try to meet their goals and be sure to listen and empathize.
  10. Consider a reward system or sticker chart to help younger kids accomplish their goals.

Remember, goals aren’t something that can be attained with the push of a button. By helping your kids set and keep goals, you are setting them up for success by teaching them the rewards of perseverance. Encourage your children and model your own accomplishments so they will feel good about the progress they are making too.

Sara graduated with her Master’s in Social Work from Portland State University and moved to Salt Lake City in 2012. Since then, she has been working with Safe & Healthy Families and has been enjoying all that the Southwest has to offer. In her free time, she loves hiking, biking, running, taking her dogs to the park, speaking Spanish, learning about other cultures, cooking, and baking.
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Managing Stress During the Holidays

todolistby Sara Jackson Bybee, LCSW
Department of Safe & Healthy Families

The holidays are a special time for creating memories and traditions with family and friends. However, for many, the holidays are also a stressful time with extra demands and activities. While it may seem that everyone is basking in holiday cheer and excited for the holidays, know that you are not alone if you are not looking forward to the upcoming holidays because of the additional stress and chaos they create. Here are some tips and suggestions for how to take care of yourself and have a less stressful holiday season.

  • Accept that your body will experience stress. Acknowledge how you feel and allow yourself to feel that way. Everyone has their own way of dealing with stress so know that however you feel, it’s okay.
  • Surround yourself with people who love and support you. Talk with loved ones about your emotions and allow others to support/help you.
  • Plan ahead. Plan meals, gifts, etc. ahead of time so you aren’t caught scrambling last minute for forgotten ingredients or gifts. Allow yourself plenty of time to do shopping to avoid the stress of overcrowded stores and parking lots.
  • Set realistic expectations for yourself. Limit the number of activities and commitments you make; think about ways to reduce your stress (maybe consider buying a dish to bring to a party instead of making it)
  • Cultivate gratitude. Even amidst particularly stressful times, finding something to be grateful for can change your perspective in a positive way. Finding the silver lining in situations can help you step back and realize what’s truly important to you.
  • Take care of yourself. Schedule down time for yourself amidst holiday plans, write your feelings in a journal or take a break and go for a brisk walk when feeling stressed. Awareness of what stresses you out and what you can realistically accomplish will help you make better choices for yourself. Don’t forget that sleep, eating healthy and exercise are still very important for curbing stress.

The holidays can be a stressful time as they are often filled with extra activities, family time and can bring up painful memories. Be sure to take care of yourself and allow yourself to say no when feeling overwhelmed. Use these tips and anything else that works for you to create a more relaxed and meaningful holiday season.

Sara graduated with her Master’s in Social Work from Portland State University and moved to Salt Lake City in 2012. Since then, she has been working with Safe & Healthy Families and has been enjoying all that the Southwest has to offer. In her free time, she loves hiking, biking, running, taking her dogs to the park, speaking Spanish, learning about other cultures, cooking, and baking.
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Choosing Safe Toys for Christmas

kiddoby Whitney Henrie
Child Advocacy Specialist

My 5-year-old nephew was writing a letter to Santa recently. It went something like this:

“Dear Santa,

I have been good. How’s Mrs. Santa? How are the elves? Now, can we get to the list?”

He then proceeded to write a very long list of toys that he would like to see under the tree on Christmas morning.

Like my nephew, I’m sure that your kids have a pretty good idea of what they’d like to get this holiday season, but it’s important to keep safety in mind when shopping for toys. Each year, many children are treated in hospital emergency departments for toy-related injuries. Here are some general guidelines to keep in mind when shopping for toys:

  • Toys made of fabric should be labeled as flame resistant or flame retardant.
  • Stuffed toys should be washable.
  • Painted toys should be covered with lead-free paint.
  • Art materials should say non-toxic.
  • Crayons and paints should say ASTM D-4236 on the package. This means they’ve been evaluated by the American Society for Testing and Materials and found safe.

It is also important to make sure the toy you buy is appropriate for your child’s age. Many toys have labels on them with a suggested age range but use your best judgment and consider your child’s temperament, habits, and behavior when you buy a toy.

Here are some guidelines to keep in mind:

  • Think large. Make sure all toy parts are larger than your child’s mouth to prevent choking or other injuries. Be sure if you are buying a small toy for an older child that it stays out of the reach of younger children.
  • Avoid toys that are too loud and could cause damage to your child’s hearing.
  • Stay away from toys with sharp edges or points and toys with cords and strings. The cord can become wrapped around a child’s neck, creating a strangulation hazard.
  • Electric toys should be UL approved. Check the label to be sure.
  • If you buy your child a bike, scooter, skateboard or other toy they can ride, make sure you also get them a helmet and the proper protective gear.
  • Do not buy toys that contain powerful neodymium magnets. These can cause serious injury and death if ingested. It’s also important make sure that if a toy contains small “button” batteries, that they cannot be easily removed from the toy and swallowed.

You can check the Consumer Product Safety Commission’s website for the latest information about toy recalls or call their hotline at (800) 638-CPSC to report a toy you think is unsafe.

When it’s time to “get to the presents,” I hope that the children in your life will find fun and safe toys under the tree this year.

Whitney-HenrieWhitney has a degree in Health Promotion from Weber State University. She has been working in the Child Advocacy Department at Primary Children’s for almost 2 years. She is a certified Child Passenger Safety Technician, and loves the opportunity she has to help educate others about injury prevention. Whitney loves to read, travel, and spend time with her family.

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