Things My Mother Told Me

Point Taken

My mother wasn’t one to dish out advice, so on those relatively rare occasions when she did, I listened. There are three things in particular that stuck with me: 1. a heartfelt piece of guidance that it’s easier to lose weight when you are young than when you are grown up; 2. don’t smoke, and if you do, quit!; and 3. never be without health insurance…it could ruin your life (and your family!). The first stemmed from her own battles with weight, which lasted a lifetime. I listened, and while I may have been a tad obsessive about dieting as a “tween,” I did lose a lot of weight at age 10 and was never again as “chubby” as I was as a child. The second stemmed from all the warnings that cigarettes can kill you that came out in the 1970s. This guidance may seem self-evident now, but my mother grew up during a time when it wasn’t. I smoked a lot in college and finally quit after a much older woman in a bar came up to me and said “you don’t want to end up like me, young lady.” She had a hoarse voice and a hole in her throat. I was shocked into taking action but it still took a 9-week smoking cessation course with the college nurse in charge. The penultimate step in the program was to switch to Carlton, a brand so humiliating that the final step was rendered almost unnecessary (those of a certain age may remember the campaign “If you smoke, please try Carlton!”). The third — don’t risk going uninsured — haunted me as a prospect of financial ruin. After all, it’s one thing to quit smoking, but an accident or infection or inherited disease could happen to anyone anytime. I sometimes wonder if that particular exhortation, in a funny way, led me to work in health insurance at a much different time of life. The idea that a lack of insurance might hurt not only myself, but also others connected with me, bothered me the most. It placed invisible fetters on my appetite for risk-taking in this particular arena.

Safety First!

There are other, perhaps smaller ways that my mother’s perspective is engrained in habits that are now second-nature to me, and it’s these that lead in to the true subject of this entry (yet to come!): Riding a bike without a helmet is like playing Russian Roulette, and the life you might ruin isn’t only your own. Imagine the bicyclist-turned-vegetable demonstrably at fault but the driver involved forever burdened by legal entanglements, remorse and guilt. Imagine….If you aren’t wearing a life jacket, to step into a canoe, a rowboat, or anything else that floats on water is to court bad luck or worse (certain death!). Seat belts are non-negotiable and anyway it’s illegal not to use them, at least in any of the places we were ever likely to drive.

This mindset however extended beyond everyday rules to things like refrigerators, plastic bags, 6-pack rings, toys, balloons and cleansers, all of which carry hidden dangers for the foolish or simply unaware. Let’s start with the latter: mixing bleach and ammonia creates a toxic gas and can trigger swelling, headache, even a full-on seizure. Using two different types of drain busters can cause an explosion. Birthday balloons can pop and, if chewed or inhaled, lead to rapid suffocation. Just the act of blowing up a balloon can result in the same, and balloons are in fact the leading cause of suffocation among children. Christmas gifts often come with lots of little parts. Said little parts can be attractive to toddlers, who may put them in their mouths and choke…with fatal consequences. Those innocuous-looking plastic bags used for fruit and vegetables are tainted by environmental concerns first and foremost. But they are also tempting playthings for the young. If placed over the head, peekaboo style, they can cause suffocation. Dry cleaners’ bags are the worst because they are so thin and filmy and can cling. And refrigerators? They too can result in suffocation and death, especially the kind made in the early decades of the 20th century, which have vintage appeal but also open only from the outside, making it possible to be trapped on the inside with no means of getting out. Not a good hiding place! That leaves six-packs, and here we must consider not children so much as seagulls and other marine life. Those clear rings that so conveniently hold our cans of soda and beer together reek havoc when they end up as “marine litter.” Not only do sea creatures swallow bits and pieces of them, but before the plastic breaks down it can cut, tangle and strangle them.

And So

There are so many things, both big and small, that can cut short the thread of life and are especially treacherous for children. Some require only common sense, practiced with vigilance and responsibility, to prevent. But some merit legislation, elevated levels of consumer warning and perhaps media awareness investments as a form of public service. Think of the role advertising played in hemming the tide of lung cancer caused by cigarettes. (See Guns and Sugar for research and commentary on two of the biggest threats to public health we face today; this blog is on lesser known, highly preventable risks). I’ll touch on magnets, home elevators and crib bumpers as three products that merit elevated levels of regulatory oversight.

Magnets. There’s a type of magnet called a “rare-earth” toy magnet that is very tiny and extremely powerful — up to 30x more than a regular kitchen magnet. They are commercially available under various brand names and while they are ostensibly intended for adults, they are very attractive to children, many of whom have swallowed them. In 2014, after hundreds of cases were reported, they were pulled from the market and the number of incidents declined by 80% until two years later, when they were put back on due to a ruling by the 10th Circuit Court of Appeals. Since 2016, ingestions have proliferated to 6x the volume they were three years ago, according to the Washington Post. These magnets are so strong that they can literally pull two different areas of the intestines together, requiring invasive surgery. Two doctors at OHSU Doernbecher Children’s Hospital, Amy Garcia and Sanjay Krishnaswami, have advocated for the Consumer Product Safety Commission (CPSC) to reissue its recall. They describe their experience working with victims in painful detail in STAT.

Home Elevators. According to an expose in the Washington Post, the home elevator industry has known of the significant risk that home elevators pose to children for a long time…seventy years, in fact. Lawsuits have been filed and won, but the problem persists. The descriptions of accidents and deaths caused by a standard design flaw are so wrenching that I have not been able to stop thinking of this piece published seventh months ago. As with magnets, the ask is that the CPSC step up to exert its influence and help put an end to these avoidable tragedies.

Crib Bumpers. Crib bumpers can be found in multiple mainstream retailers and are often marketed in idealized images of babies’ bedrooms or nurseries. Yet many pediatricians and other experts judge that the risk of suffocation they pose is significant, and not worth the trade-off with purported benefits. This is a third area where disagreement is rife, even within the CPSC. With multiple data sources in play, estimates range from 27 deaths attributable to crib bumpers during a 20-year period to 62 deaths in just 11 years. Regardless of the exact toll, at issue is the fact that these deaths are preventable. The American Academy of Pediatrics advises parents not to use crib bumpers. This piece from the Washington Post details the conflict between industry leaders, doctors/ medical experts and regulators.

If my mother were alive today, I’m sure she’d say why risk it? Keep children well away from all of the above and let the experts duke it out.