Simple Prevention Steps Keep Athletes in Game, Off Bench

When it comes to sports, there’s big pressure on players—even ones who’ve barely just learned to tie their laces—to be bold, play hard, and make bleacher fans proud.

But at what cost? How hard is training too hard? How can you tell when you’re crossing the line, setting yourself up for short- and long-term—maybe even lifelong—pain? Whether you coach a little league team or are gearing up to tackle your first 5K, read on. We’ve talked with sports medicine expert Dr. Mike Maloney on the basics of avoiding athletic injuries, no matter what your sport.

Scripts: When it comes to injury prevention, are there fundamentals that every athlete should perform religiously before training/competing?

Maloney: Recommendations vary dramatically by sport, so I want to point you to really terrific resource—the “Stop Sports Injuries” website, sponsored by the American Orthopaedic Society for Sports Medicine. It’s a goldmine for coaches, trainers and athletes alike, serving up guidelines tailored to your team’s type of play, the unique pitfalls you might meet, and suggested steps you might take to avoid them.

More broadly, though, are basics we all can stick to. Like a proper warm-up and gentle stretching to loosen muscles and get blood flowing. You should also be intentional about taking time to rest—perhaps exercising alternate muscle groups each day, giving your body adequate chance to rebuild and recover.

Investing in the right, properly fitted protective gear—such as pads (neck, shoulder, elbow, etc.), helmets, mouthpieces, face guards, protective cups, eyewear—is important too. So is a supportive shoe, built for the stress inherent in your type of exercise. And of course, you can actively head off heat injury by drinking plenty of fluids before, during and after practice or play, wearing light, breathable clothing, and avoiding outdoor practice during periods of high heat or humidity.

Scripts: How do you know when you’re working too hard?

Maloney: Pain. It’s the body’s built-in alarm system, letting us know to stop and slow down.

Unfortunately, all too often young athletes fear that speaking up about troublesome symptoms might cost them their prized place on the team. There’s heavy social and psychological pressure to “be tough,” hide their injuries, and play through the pain. But that only ultimately makes things worse, and in extreme cases, can damage joints for a lifetime. I’d urge any athlete to keep the big picture—not just the next game—in mind, letting the right coach or trainer know if they’re uncomfortable, are hurting, or sense that their range of mobility is restricted. It takes courage, but it’s essential to voice these concerns.

Scripts: Are there some key injuries that spell death to a sports career?

Again, it depends on the sport. But some of the most devastating injuries we see are torn ACLs (anterior cruciate ligaments), a type of knee injury that can spell trouble (and the bench) for many young athletes—even leading to long-term disability from osteoarthritis (a painful joint condition). More than 50,000 debilitating ACL injuries occur annually in female athletes at the high school and college level. It can take between six to 12 months to return to a sport after ACL reconstruction; some sufferers may experience continuing knee symptoms that limit their participation.

Overuse injuries (in the form of stress fractures, shin splints, and tendonitis ) can develop when athletes boost the frequency, duration, intensity, or resistance of training too quickly—putting undue stress on a particular part of the body. Again, rest is really important. But sometime even that’s not enough; in more serious cases, treatment and medical intervention might be necessary.

Finally, concussions concern us. Research continues to evolve, most recently implicating repeated blows to the head with long-term brain trauma, and even dementia in later life.  We can’t exaggerate the importance of protective helmets and gear.

Scripts: So, what’s the bottom line?

Maloney: I think the overarching message is to train smart, sticking with a conditioning program that emphasizes fitness, strength, flexibility and endurance. Remember, we have one body to age with. It’s so important that we respect it, listen to it. The power of proper nutrition, rest, and prudent training cannot be overstated.

Want To Learn More about Injury Prevention—From a Local Olympian?

On Saturday, March 23, Olympic pole vaulter Jenn Suhr, who brought home the gold medal from the Summer 2012 games in London, will be the featured speaker at a free URMC Orthopaedics and Rehabilitation seminar. A graduate of Roberts Wesleyan College who makes her home in Churchville, Suhr will sign autographs and  share her Olympic experiences—and discuss the steps she takes personally to prevent injuries.

Dr. Michael D. Maloney, chief of URMC Sports Medicine and professor in the Department of Orthopaedics and Rehabilitation, will kick off the activities at 1 p.m. with a discussion about injury prevention and the proper steps that all athletes, whether middle and high school students or adults, should take to avoid injuries. Maloney’s medical practice is broad, including reconstructive surgery of the knee, shoulder, and elbow, and arthroscopy of the knee, shoulder, and elbow for patients of all ages in the Rochester region and beyond. He serves at team physician for the Rochester Red Wings, along with area college sports teams.

For more information on the free community event or to RSVP, please call (585) 275-8762 or e-mail ortho-info@urmc.rochester.edu.

More about URMC Sports Medicine

URMC Sports Medicine, the only medical practice in the nine-county region dedicated solely to sports medicine, offers the latest in medical and surgical care to prevent, evaluate, treat, and rehabilitate injuries for both recreational and competitive athletes of all ages. Its physicians are fellowship-trained sports medicine primary care physicians and orthopaedic surgeons who work together with physical therapists and athletic trainers to give complete medical care. For an appointment, call 585-275-5321.

Considering LASIK? Here’s What to Expect

Some people who used to wear coke-bottle glasses are thrilled to have 20/20 vision after undergoing LASIK surgery – and doctors at URMC’s Flaum Eye Institute are making that dream possible for even more people. They’ve developed new technology that helps doctors predict how refractive surgery, such as LASIK, will affect a person’s eyesight.

Dr. Scott MacRae is a pioneer in refractive surgery, a procedure used to adjust the eye’s focusing ability by reshaping the cornea. MacRae helped develop the Rochester Nomogram, a complex formula that improves the success rate for LASIK– meaning fewer people need additional procedures to get the best vision possible. Currently, a remarkable 99.3 percent of MacRae’s patients see 20/20 or better after LASIK (laser in situ keratomileusis) surgery, and are able to toss aside their glasses and contact lenses.

Scripts: How does this new Nomogram help make LASIK surgery better?

MacRae: The Nomogram adjusts the way a laser interacts with eye tissue. Using it helps refractive surgeons reduce the chance that the patient’s eyes will be near-sighted or far-sighted after the procedure and potentially need additional care. It’s another tool for doctors to use to help their patients achieve 20/20 vision — or better.

Scripts:  Does LASIK surgery hurt or require a lengthy recovery?

MacRae:  No, the actual treatment is painless. Patients receive anesthetic drops to completely numb the eye. You may feel a light pressure sensation around your eye, and after the procedure is finished you will feel a sensation our patients describe as gritty, or like a lash in your eye, for a few hours. But most people experience very little pain. Doctors give you a prescription for pain relief if needed,  but most people need nothing more than Tylenol or Advil and a little rest.

Recovery can vary from one day to one week. The majority of people are back to normal activities a day or two after surgery, but it may take one or two months for your vision to fully stabilize. Although everyone is a little different, the vast majority of our LASIK patients are back to normal driving vision or better, the very next day. That’s one of the most exciting advantages of the LASIK procedure; clear vision comes in quickly. Initially, your vision might not be crisp and may fluctuate slightly. This is perfectly normal and should improve gradually day by day.

Scripts:  How do you select the best LASIK surgeon?

MacRae: It’s important to do your homework and ask plenty of questions. Indicators of a quality surgeon can include experience, great credentials, word of mouth referrals and willingness to work with a patient to resolve possible problems following a procedure. It’s important to trust your surgeon; if you don’t feel comfortable with them, find another one.  Some basic questions to ask:

• How many procedures have you performed?
• What is your complication rate, and how does this compare with national averages?
• What are your outcome statistics, and how do these compare with national averages?
• If a complication does occur, what is your specific policy regarding follow-up?  Is the surgeon available if complications do occur?

There are lots of different report cards for doctors to review.  I recommend you do your research, talk with your primary care doctor or other doctors until you know in your gut that you’ve chosen the right surgeon for you.

Scott MacRae, M.D., is one of the most experienced and respected refractive surgeons in the world, performing more than 15,000 procedures. He has more than 25 years of experience as a cornea specialist and 15 years of experience as a refractive surgeon.  He serves as director of the Refractive Surgery Center at the Flaum Eye Institute. For more information, call 585-273-2020.

Protect Your Heart: Be Shovel-Smart

Winter has arrived, and we’ve all dusted off our shovels. As beautiful as the season is, clearing the snow can be risky for your heart health.

Interventional cardiologist Dr. Christopher Cove knows how often someone unaccustomed to the low temperatures and rigorous activity can suffer chest pain and seek immediate care in the Emergency Department.

Scripts: Why is there an increase in the number of heart attack cases this time of year?

Cove:  We often see people who don’t realize they’re at risk for heart trouble. They’re a bit out of shape, and the exertion of moving heavy snow is tiring.  Mix in cold temperatures or bitter winds – which constrict blood vessels, elevating the risk of a heart attack of blood clot – and some people find themselves in a bit of danger zone.

Scripts:  What do you tell people who ask about shoveling safety?  

Cove:  It’s important to use common sense:

• Know your risk factors. Heart disease can be hereditary, and the risk increases for people who are older, overweight, have high blood pressure, use tobacco, or don’t exercise regularly.
• If you’re planning to shovel or spend time outdoors and know you’re at risk, talk with your doctor before you start. To be safe, consider asking for help removing snow.
• If you are shoveling, take frequent breaks and don’t overdo it. Dress warmly and use a scarf or muffler to warm the air if it’s particularly cold.
• Don’t forget, post-menopausal women are just as susceptible to heart attacks as men.
• Know the symptoms of a heart attack, which include shortness of breath, sweating, nausea, and chest pain.

Scripts:  What is someone finds themselves in pain or suspects a heart attack?

Cove:  Call 911 and let an ambulance take you to the hospital immediately!  Don’t wait! Sometimes people come in the next day, but by then, the heart muscle has already been damaged.

If you choose not to wait for an ambulance, have someone else – a relative, neighbor or ambulance – drive you to the hospital. It’s safer for you and others on the road.

Christopher J. Cove, M.D., is assistant director of URMC’s Cardiac Catheterization Lab and provides life-saving interventions for people suffering heart attacks or other heart problems.

URMC’s Heart and Vascular Center is the region’s leader in comprehensive heart care, from disease prevention to heart failure and transplantation.  To make an appointment with one of the cardiologists, call 585-275-2877.

Children and CT Scans: What Parents Need to Know

Kids end up in emergency rooms more than 17 million times a year and chances are doctors will order a diagnostic CT scan. But is the imaging test safe?

A recent, headline-grabbing study suggests that more imaging tests in younger years (and therefore greater, cumulative exposure to radiation) results in a higher risk of cancer later in life.

CT (computed tomography) scans use ionizing radiation to allow doctors to quickly see details inside the body – internal injuries, tumors, appendicitis, for example. The British medical journal The Lancet reviewed the records of nearly 180,000 people younger than age 22 who received scans between 1985 and 2002.  Later, 74 developed leukemia and 135 developed brain cancer — numbers that were higher than what would be expected in the general population.

Dr. Hans Blickman, radiologist-in-chief at Golisano Children’s Hospital, often helps worried parents sort through the scientific data and balance the pros and cons of tests involving radiation.

We asked him to share his insights on this complex issue.

Scripts:  The Lancet study, published earlier this month, generated a buzz. What are the most important things to understand about that research?

Blickman: There are two major issues. First, the data comes from CT machines that did not use dose-reduction software, which only became available in 2001. Newer technology allows us to use the safest level of radiation possible. And second, we already knew that excess ionizing radiation might lead to an increased risk of cancer – and yet this hasn’t been proven conclusively.

Scripts: Aside from that particular study, are there other concerns you are aware of?

Yes, as the use of imaging scans has climbed in recent years, so have the questions of possible harm. It’s important to understand the factors leading to more scans, though. They include, but are not limited to, fear of malpractice lawsuits and the need to avoid delays in diagnoses.

Complicating the issue is other news from studies suggesting that a third of all scans are unnecessary or could be replaced by safer tests, like ultrasound or magnetic resonance imaging (MRI), which do not use radiation.

Scripts: It makes sense that newer technology and greater awareness of diagnostic tests have come into play. Tell us more about what evidence to consider when faced with a quick decision to have a CT.

Blickman: First and foremost, parents need to know that in the past 10 years we’ve made huge progress in reducing radiation exposure for both children and adults. As I mentioned earlier, the British study was based on estimates of what radiation levels used to be before industry changes took place. 

URMC and many academic medical centers across the country have invested in upgrades to imaging equipment during the past five years, to comply with goals established by an “Image Gently” initiative from the Society for Pediatric Radiology.

The acronym ALARA is another guiding principle for our industry. It stands for As Low As Reasonably Achievable. It’s not only a sound philosophy, but it’s a regulatory requirement for all radiation safety programs.

When we open the new Golisano Children’s Hospital in 2015 the imaging suite will offer even more improvements, with the highest quality scans at the lowest dosing possible.

I’d like to add that most people don’t realize the radiation exposure from three to five chest x-rays is less than the exposure to naturally occurring radiation on a plane ride to Denver.

Scripts: That’s reassuring but some parents might still wonder: Can children safely avoid imaging tests altogether?

Blickman: Probably not. I recommend that parents have faith in their physicians while continuing to ask good questions about imaging tests and whether they are actually needed.  CT scans are very useful, but the circumstances will vary. If you have a child with a serious chronic illness, like lymphoma or another cancer, the number of imaging tests required will be greater than for a healthy child with an accidental injury.

Parents also should remind all doctors and radiologists involved in their child’s care about the frequency and history of imaging tests. Ask if the exposure is too much. With electronic medical records, calculating the cumulative exposure will be easier and more readily available. When doctors are ordering tests, this will help them decide if alternative tests might be a better idea.

Expertise in pediatric imaging is the key, and we are very fortunate to have a strong group at URMC.

For more information about pediatric radiology services, call (585) 273-1971 or visit: www.urmc.rochester.edu/radiology/procedures/procDetails.cfm?procid=8&id=8=

 

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To Grandmother’s (Dangerous?) House We Go

Later this week, holiday travels will draw families together for sumptuous feasts, giggles, gift exchanges and more.

And with so many loved ones milling about – crowding kitchens, sipping wine and getting caught up in the holiday cheer – it’s not uncommon the littlest guests to sneak off and find their way into trouble.

“We see too many toddlers suffer injuries while visiting grandparents, or while at holiday gatherings where their parents are otherwise distracted,” says Dr. Anne Brayer, an emergency department pediatrician at the University of Rochester Medical Center, who also co-directs the local Injury Free Coalition for Kids chapter.

So, how do you keep curious little fingers from finding danger – especially in a non-child-proofed home? Brayer offers the following tips:

• Before settling into the fun with friends and family, quickly scan the room that youngsters are in. Don’t let the munchkins toddle off without having made sure there are no open outlets, electric cords, or easy-to-swallow items in reach. Also pay special attention to pointy-edged coffee tables, wall corners that jut out, or any other sharp objects an infant could bump her head on – and watch out for kitchens, bathrooms, and other cabinets that might hold cleaning supplies.
• Don’t leave children without an adult. Well-meaning cousins or other grade-school-aged friends might not recognize potentially risky situations. What’s more, they often get so carried away in amusing one another, they forget to make babies’ and toddlers’ safety their first priority.
• Monitor a child’s interaction with pets. Little ones might be tempted to grab Fluffy’s tail, or even try to climb Fido, causing some pets to lash out. “Dog bites are especially problematic this time of year, since many dogs who aren’t used to toddlers horsing around the house,” Dr. Brayer warns. Even subdued pets can easily knock over little ones.

Remember, no one wants to spoil a holiday with a trip to the emergency room (or worse, carry the guilt of having a little guest injured at their house!) – so while it may seem cumbersome to pay extra attention to youngsters and prepare the house for their arrival, make the effort! It’s time well-spent.

Wishing you a most safe and happy holiday season!

Scripts will not publish next week, but returns Wednesday, Jan. 4. Happy New Year!

July 4: Beware Burns and Injuries from Fireworks, Campfires, Grills

It’s a daunting statistic: More than half of the 11,000 injuries annual injuries associated with fireworks and grill fires occur within the first week of July, according to the National Fire Data Center.

The encouraging news: Most of these accidents could have been avoided entirely just by following a few simple safety tips. So, to ensure that your holiday holds no unwelcome surprises, we’re breaking from our typical video interview format to offer some good advice below, courtesy of our friends here at URMC’s Kessler Burn & Trauma Center. (For even more safety tips from the Center, click here.)

From Shish Kabobs to Hot Dogs: A Recipe for Safe Grilling

• Check grills for leaks prior to cooking. Before using a gas grill – especially for the first time of the season – check all connections from the fuel source for leaks. A simple technique: After turning the valve on, spray soapy water on the connections and watch for any bubbles, which indicate a leak. If there is a leak, shut the valve off and tighten the connections (alternately, have a professional check the grill).
• Take care when starting charcoal grills. Make sure coals are cool – not warm or hot – when revving up the grill. Use charcoal starter fuel (never gasoline!) to soak coals, and then allow a minute or two for fluid vapors to dissipate before lighting.

Marshmallow time! Gathering Round the Fire

• Select a smart spot for a fire. Build the campfire downwind and far away from your tent (or any other structure). When possible, use a designated fire pit. Once a spot has been selected, clear ground within a 3-foot radius of the fire free of leaves, dry grass and pine needles.
• Alcohol and campfires don’t mix. Most campfire burns are associated with alcohol use, so it is best to avoid drinking beside a burning fire.
• Keep a lookout. Never, under any circumstance, leave a campfire unattended. Never leave children alone to watch the fire.
• Leave a safe site for the next folks. Before leaving the campsite, ensure that the fire is put out. Douse the place of the fire with water, then stir to make sure it says out.

Beware of So-called “Harmless” Fireworks

According to the National Center for Injury Prevention and Control, almost 45 percent of persons injured from fireworks every year are kids 14 years and younger.

What’s more, seemingly safe fireworks – such as sparklers (when lit, they can reach dangerously hot temperature levels around 1800 °F!), firecrackers and bottle rockets – are responsible for more than two-thirds of all fireworks-related injuries. Need another reason to steer clear of them? Fireworks are illegal in a number of states, including New York.

Know Basic Burn Care

Even with the best safety measures in place, accidents sometimes still happen. If you or a loved one suffers a burn, be sure to follow these four “C’s”:

• Cool the wound. Pour cool water directly over the wound as often as you can. Do not use ice or ice water, since this might make the burn deeper.
• Clean the wound. Wash the area gently with mild soap and water to remove any dirt or debris.
• Cover the wound. Use any clean covering, such as a towel or gauze, to protect the wound from future contamination.
• Call for help. If you’re unsure if the burn requires medical attention, you probably do need to see a doctor.  Remember, burns can look deceptively minor immediately after the injury, and waiting will only prolong the pain and treatment time. Another rule of thumb: If the burn area is larger than the palm of your hand, or if hasn’t improved within 24 hours (i.e., if it still looks red, blistering, peeling skin), call your physician.

On that note, have a safe and happy Independence Day!

(Please note: Our Scripts blog will not publish next week, but will resume the week of July 13. )

Hollywood’s Holiday Hazards: Classic Films Offer Valuable Safety Tips

Snuggling up with hot chocolate and the holiday movie you must watch dutifully every year may have some health benefits: parading as comedy, many of the films offer warnings about real holiday hazards.

You can be sure to keep the humor on screen by heeding the unfortunate examples of your favorite characters; just follow the tips below, courtesy of the Injury Free Coalition for Kids at Golisano Children’s Hospital at URMC.

Merry Mishaps: Falls and Flames

A holiday favorite with accidents to avoid: “The Santa Clause” (1994). Character Scott Calvin startles an intruder atop his roof Christmas Eve: the real Santa Claus. The big guy slips, falls off the roof and disappears, forcing crotchety, cynical Calvin to rally his holiday cheer, assume Santa’s job and make sure the tradition of Christmas continues seamlessly.

With this being a season for ladders, rooftops, and unfortunately, as the poem goes, clatters, experts warn that kids shouldn’t climb up ladders until they’re 16 years old. Even adults should be careful, especially when snow and ice are involved.

Other roof and ladder tips:

• Don’t reach, don’t push the limits. Extend ladder at least three feet beyond the edge of the roof top, keep your feet centered (never on the top two rungs), and don’t overreach – it’s better to move the ladder than take a risk.
• Four-to-one rule. Place ladder one foot out for ever four feet of height (the distance between the ground and where the ladder comes in contact with the building).
• Don smart shoes. If you have to use a ladder or climb on the roof, choose good weather: opt for a dry, non-windy day. Wear shoes with good traction (e.g., rubber soles).

As if Calvin doesn’t suffer enough, he also roasts (well, chars) the holiday turkey. Luckily, he has a fire extinguisher (and a Denny’s restaurant) nearby.

Some fire-proofing — and fire-fighting — tips:

• Don’t light and leave. If you light a candle, stick around to supervise it. Keep votives and tapers in stable holders, and keep them out of a child’s (or the tree branches’) reach.
• Guard your tree. If you prefer a real tree, you’ll have to keep it fresh. Pick one with a trunk that’s sticky to the touch (due to resin) and needles that bend but don’t break. Keep it well-watered.  If you opt for artificial, be sure to buy one that’s flame-resistant.
• Tend a safe fire. Have your fireplace and chimney inspected each season before using it. If you experiment with fire salts (which create colorful flames), keep them away from kids (the heavy metals in their composition will cause irritation and vomiting if consumed). Also, stick to wood for fuel and kindling – wrapping papers burn hot and rapidly. Be sure to deter children from touching fireplace glass and doors by use a sturdy screen and exercising plenty of supervision.
• Know the drill. Have a family escape plan and practice it. Make sure extinguishers are placed conveniently (for small emergencies, only) and that smoke detectors have fresh batteries.

Merry Mishaps: Thin Ice and Playing with Power

Retreating to two traditional, time-tested holiday tales about the value of family: Frank Capra’s “It’s a Wonderful Life” (1946) and “Little Women” (1994 film adaptation). Both show what maladies await kids who sled and skate atop thin ice.  It’s a Wonderful Life’s George Bailey and Little Women’s Jo March both must rush to save younger siblings that crack through frozen streams and ponds, almost drowning in the frigid water.

Experts warn that kids should only skate if supervised by an adult, who should first check to make sure the ice is clear of debris and at least four inches thick. When in doubt, opt for an indoor rink.

Other skating (and sledding) tips:

• It’s not a fashion show. Bundle up – the multiple layers both cushion falls and prevent hypothermia.
• Guard kids’ courses against crashes. Consider having children 12 and younger wear a fitted helmet when sledding. Help them choose a sled they can steer (not a tube or disk) and a well-lit, tree-free path. And always, feet first, not head first.

And of course, there’s always the quirky classic: “National Lampoon’s Christmas Vacation” (1989). Clark Griswold strings his house with 25,000 bulbs, blinding the neighbors, overloading his outlets and ultimately electrocuting his uncle’s cat (he chews on a strand of lights).

To keep your Christmas light-stringing safe, heed these safety tips:

• Replace lights, if necessary. Toss old strands with broken, cracked or open sockets and frayed wires.
• Avoid shocks and charges. Never string electric lights on metallic trees; don’t overload plugs, and be sure to use surge protectors.
• Indoors don’t belong outdoors. Be sure house-trimming lights are certified for outdoor use (they’re built to withstand the weather). Hang them from insulated plastic hooks, not nails (which can conduct heat and electricity).

Merry Mishaps: Tree Trimmings and Tempting Toys

Another telling moment occurs in “Home Alone” (1990), where one of character Kevin McCallister’s booby traps to fend off “Wet Bandits” Marv and Harry sends a sharp message to parents – literally. Marv screams, slicing his foot on a pile of sharp glass ornaments Kevin has strategically spread beneath an open window.

Choosing plastic bulbs may be safer, experts suggest — especially with youngsters and pets that could knock them off, causing them to explode into hundreds of sharp pieces.

Another ornament safety tip:

• Skip the sugar plums. If possible, pick ornaments without metal hooks of detachable parts, and don’t choose ones that resemble food or candy.  In fact, avoid placing edible trimmings, like candy canes and popcorn, on the tree if youngsters are in the house – these only add to the confusion.

And even that oh-so-pined-for toy at the top of a kid’s list can be dangerous.  Parents are reminded of “A Christmas Story” (1983), in which character Ralphie, after much obsession, receives “an official Red Ryder, carbine action, two-hundred shot range model air rifle, with a compass in the stock and ‘this thing’, which tells time.” He also winds up fulfilling the adult warnings, nearly shooting his eye out.

The message to parents is clear: some toys can become dangerous, especially if misused or not age-appropriate, experts say.

Other toy safety tips:

• Read, read, read. Scour the packaging and the instructions for warnings and safety recommendations before purchasing and opening toys. Opt for toys that are age- and skill-level appropriate for the child (and, if applicable, for the child’s siblings). Especially beware of choking hazards, like small parts, strangulation hazards, like pull-toy strings, and the obvious hazards related to misuse of pellet and BB guns.
• Batteries are better. Choose toys that use batteries over those that require being plugged into outlets, especially for younger children – just keep an eye to make sure the compartment that holds them is secure (look for screws, not snap-in covers), so they don’t pop them in their mouths.

Our Scripts blog entries will resume on Jan. 5. Wishing you a safe and happy holiday season!