Praise from Dr. John Monaco

Re: 365 Ways To Keep Kids Safe: How to Make Your Childs World Safer

Dear Don and staff of 365 Ways….,

Don Keenan has put together a remarkable book that will undoubtedly continue your mission to make safer the lives of children everywhere. It will be a welcome addition to the libraries of parents, teachers, counselors, health care providers and all who hold the welfare of our children in their hands. It is ground breaking, informative, practical and compelling and I commend you on this effort.

I have reviewed each chapter and section and then offered my comments on that particular section. At the conclusion I will offer my thoughts on the work as a whole. All in all, I thought it was great!

Table of contents

One of the strongest points of this book is its organization and reader friendly construction. The table is organized beautifully.

How to use this book

Two factors struck me here. The use of focus groups was brilliant, and makes the reader feel instantly that the book was written with them in mind. Correlating it to the way you plan case strategy was very interesting and offers the reader an “inside look” at what you do. Opening each chapter with an actual case gives the reader a sense of authenticity, authority and hits close to home. I love these parts! The “Taking Action” section was also ingenious. Later on the reader realizes the crucial lesson that one cannot rely on government and regulatory agencies to keep our children safe. It is up to our own decisions hopefully governed by common sense. Adding the CD at the end is a nice, and practical, touch.

Risks vs. Hazards

This is a crucial two pages. Matt Lauer asked the same question I would have asked, and I suspect many readers as well. Your explanation to him of the difference between risks and hazards is key to the purpose of the book.

The Home…Preface

I am so glad you included this discussion. Our daughter, I am ashamed to say, fell halfway down the basement stairs while she was in a walker at about 8 months of age. My wife and I were talking in the front hall not ten feet away from her when she managed to turn the knob on the basement door, push herself through it and tumble down the stairs. Had the walker not become wedged between the wall and the stairs, she would have fallen the rest of the way to the cement basement floor to certain death or severe brain injury. Quite possibly we would not have had the joy of seeing her descend the front stairs, 15 years later, in her ball gown, going to her first prom. And that’s with a pediatrician and PICU nurse supposedly watching her! So the word needs to get out. Thank you.

When you discuss the baby bath seats, I thought it might be worthwhile to include a medical description of just how quickly a child can drown, and how easy it really is. There are other sections ahead where I thought some infusion of plain spoken pathophysiology might help bring the message home to readers.

Giving alternatives to parents was good.

Cribs and Beds

The case description is fascinating. Aspects of your discussion reminded me of my own case, if you remember the facts. It is interesting that death scene investigations are now considered requirements before the diagnosis of SIDS can accurately and appropriately be made. You offer an interesting twist to the term “crib death”. I am not sure if the photo on page 10 is considered a crib or playpen. You might clarify this.

Carbon Monoxide

I am glad you include, in the checklist section, the fact that detectors are not a substitute for unsafe conditions, since the first part emphasizes well functioning and omnipresent detectors. One thing you might include in the “do not do” section is gas powered generators. We had a lot of experience with these in Florida last summer due to the many hurricanes and prolonged power outages. Several people died running generators inside their homes where they were not properly ventilated. They should always be run outside, and connected to indoor appliances via extension cords. Again, a brief description of what carbon monoxide is what it does and how it causes injury might be helpful to the reader’s understanding.

Lead Hazards

This is a topic that gets far too little attention probably due to the unfortunate fact that it seems to be more prevalent in lower income neighborhoods. Once again, a brief pathophysiology of how lead is thought to cause CNS injury might be helpful.

Hazards in Outside Play Areas

Great section. All too often safety is taken for granted in public play areas. A brief discussion of how pesticides biochemically work, both on bugs and humans, might be helpful to educate the reader. Also, they might be curious to have a brief pearl on how exactly electrocution causes death. The tree limb material is fascinating. I had no idea how prevalent this problem is. Thank you for the trampoline section. I have resisted one for years, much to our children’s’ chagrin!

Toys

The “Mooki” case is horrifying but incredibly illustrative. It is great for parents to see people in positions of authority, like the Quality Assurance guy who previous worked at the car wash, exposed. Not to make parents paranoid, but they need to be empowered with the knowledge that they are their child’s ultimate advocate. Might a little anatomy and physiology of choking and aspiration be helpful here?

Power Windows

It seems to me that there is never a reason to leave a child in the car with the keys or with the engine running, so I like number 2 of the checklist.

Escalators

Nothing to add. Again, supervision is essential.

Hidden Predators

This is perhaps the most terrifying section. Your suggestions are good and as complete as possible. You successfully illustrate the need for parents to be ever vigilant.

The Jury is Still Out. Autism and Vaccines

This is a fascinating section and very current with what is appearing in the popular press. You are right to state that the connection between autism and vaccines is controversial. As a physician I would feel more comfortable if a statement was made about the basic importance of immunizations to prevent the deadly diseases they are designed to protect against. For instance, there has been a considerable increase in the prevalence of pertussis and even diphtheria because of decreased use of infant vaccines. Even polio is beginning to show up, after it was deemed eradicated by WHO several years ago.

Coal Burning Power Plants

The causes behind the worldwide increase in the frequency and severity of asthma are discussed at great length in the medical literature. You are right to say that air pollution may well be one of the triggers. However, there is an even closer stastical correlation between the rising incidence of childhood obesity, which is also becoming worldwide, and asthma. In this context, advising children to spend less time outside might be counterproductive.

Food Litigation

Obviously there is a lot than can be said about the food industry and its effects on child health in this country, and much of it I have said in Slim and Fit Kids: Raising Healthy Children in a Fast Food World. (Please excuse the shameless plug!) Your mention of MSG is well done. There are two other ubiquitous additives that have probably done more to harm children in the long run than any others. These are refined sugars and hydrogenated fats. They are both present in nearly every snack food in every vending machine in every school in America. One is designed to make food more attractive to kids, and thus has become addictive. And the other, hydrogenated fats, has been linked to cancer and heart disease, not to mention obesity, and only recently has the public begun to learn about these substances. Again, parents and kids must become educated consumers of what they putting into their bodies.

Stevens Johnson Syndrome and Motrin

I found this amazing! You are right that since becoming an OTC drug, there is very little information about this association. I’ve taken care of many very sick children with erythema multiforme (Stevens-Johnson) and it has been linked to many medications. But I have been able to find very little about the association with Motrin. In fact, the pediatric literature constantly compares ibuprofen to acetaminophen in its efficacy in treating fever and in at least one article, they found ibuprofen to be at least slightly more effective. It is conventional wisdom, at least in our hospital, that high fevers respond more quickly to ibuprofen. The main side effects mentioned are GI related (gastritis, ulcer, etc.)

General Comments:

I think this book is amazing and needed and should be included in every parent’s collection of child rearing guides.

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