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“Forgotten Backseat Baby” Syndrome: an Unimaginable Danger

Child-in-a-Rear-facing-car-seat“Huh? Forgotten what???” is what I imagine you are asking after reading the title. The next question that probably comes to mind is, “what kind of idiot would forget his/ her own child in a car?” As the parent survivor of a child who was tragically lost to vehicular #heatstroke in 2011 when her daddy forgot to drop her off at daycare that fateful morning, I WISH I could tell you that only idiots make this kind of mistake; that only a selfish monster could do such a deed…..sadly, most of the more than 600 kids who have died from being left in a hot car since 1998 were victims of what I like to call forgotten backseat baby syndrome; a mistake committed not by idiots or monsters, but a mistake made by folks you would never in a million years imagine: caring, loving, responsible parents. Most of them took nearly every precaution to child-proof their homes and to assure that the car seat was installed correctly; many of them also took parenting classes in preparation for their bundle of joy’s arrival. Sadly, most of these parents also never imagined the remote possibility of forgetting their child in the backseat of a vehicle. In other words, folks just like YOU and ME, sadly, are capable of forgetting our most precious cargo in the backseat of our cars under the right conditions.

Your protective defense mechanisms are probably kicking in right now and you are probably saying “yeah right, not a chance lady”. …..but for those of you still in denial that you could make such a mistake, here is a little food for thought.

Have you ever, in a moment of multi-tasking, sleep deprivation, running late for work, or being severely fatigued after a bought of illness (you, your spouse, your kids), done any of the following?

  • Forgotten to turn off the headlights before exiting your car? (apparently so many of us in the past drained our batteries by doing this that most cars now have automatic function of headlights, or at least have an alert that “dings” when you open the door to let you know you forgot to turn off the lights)
  • Left your ATM card in the machine after a transaction? (again, so many of us were guilty of this behavior that now most ATM machines have quick swipe technology so that we no longer have to wait for our cards to be returned)
  • Forgotten to buckle your seatbelt? (are you thinking of that annoying alarm right now? So many front passengers have forgotten this safety routine in the past that the auto industry has decided we need this annoying reminder to protect our front seat cargo)
  • Forgotten to turn off the coffee maker? (note that most brands now have an auto-shut-off feature for us poor souls who just aren’t fully awake until chugging a cup o’ joe)
  • Walked into a room with a purpose to get/ do something, then arriving only to find that you couldn’t remember why you were there – no matter how hard to try?

If you have ever been guilty of any of those behaviors (or similar cases of stress-induced memory failure), then yes, unfortunately, you too are capable of forgetting a baby in the backseat.

I WISH I could tell you only a monster could do such a thing. Unfortunately, even the best of mortals can suffer the devastating consequences of “forgotten backseat baby” syndrome under the right conditions. That’s why I advocate implementation of safety nets/ plans for ALL child transport activities to verify arrival and/ or absence in a timely manner…..EVEN if you are still in denial that you are capable of forgetting your precious backseat cargo, consider a child transport safety plan an “insurance policy” to make sure you prove me wrong.

I lost my daughter, Sophia Rayne “Ray Ray” Cavaliero, to vehicular #heatstroke on Wednesday afternoon, May 25, 2011. That morning, our entire family overslept. Speaking in retrospect (after observing my 20 month old twins during the same phase of their lives), I think we overslept because it was the first time that Ray Ray finally slept through the night. We always called her our little alarm clock, because without fail she would awaken to nurse at 5:00 am, then sweetly drift back to sleep until about 7:30 am. Then we usually played with her for an hour or so before her daddy took her to daycare around 9:00 am. Ray Ray’s behavior was so predictable that I no longer set an alarm clock to awaken. That morning began with me awakening to my sweet child giving me precious kisses all over my face, followed by a glance at the clock. As I saw the time of 9:43 am, chaos ensued in my home. We had all overslept! Brett rushed to get dressed for work; I rushed to get Ray Ray fed and dressed for daycare. The entire family then hurried to daddy’s truck (I was still in PJs).

The defining event that led to Ray Ray’s death due to vehicular heatstroke was something very simple: ONEPicture of our daughter Ray-Ray WRONG TURN. My husband usually made a LEFT turn at the bottom of a major hill near our home to drop our child off at daycare (located less than 10 minutes from our home). After dropping her off, he would circle back onto the same major highway and head to his office, less than 15 minutes from our home. That morning for unknown reasons he made a RIGHT turn at that critical intersection. As Ray Ray sat rear-facing and quietly in the backseat, he had no clue along his work route that she was still in the truck….he couldn’t see her; he couldn’t hear her. WHY did he make this wrong turn? We have asked this question daily for almost three years and still have no answer. What we know (through the criminal investigation) did not contribute to the wrong turn was his phone—records show that he wasn’t talking, emailing, or texting…..Could you ever imagine that ONE WRONG TURN, as I am sure you have probably made a few times in your life as well, could have such devastating consequences???? We couldn’t either….We still can’t; but this is our reality, like a nightmare from which we cannot awaken….cannot awaken because sadly it is not a dream.

The story I have just told to you replicates the story of more than one hundred families since 1998, as forgotten childcare drop-off is the leading source of child hot car death (aka child vehicular heatstroke or hyperthermia). Another resounding theme in nearly every “forgotten backseat baby” syndrome tale resulting in child hot car death is a change in routine on the day of the tragedy. For us, that change in routine was oversleeping, with a resultant chaotic start to our day. For other families, that change in routine was commonly an alternate person dropping the child off at daycare (one not accustomed to doing so). Other common changes in routine that we have seen in these tragedies include changes in school routine–either at the start of summer when grade school has just ended or in August at back to school time, ESPECIALLY where there are multiple siblings in the family and one starts kindergarten and the younger still needs to be dropped off at daycare.

I have shared my story with you today to commemorate the upcoming National Heat Awareness Day (designated by the National Weather Service/ NOAA) this Friday, May 23, 2014. The rate of child vehicular heatstroke tragedies begins to rise exponentially around this date, peaking in August (aka “back to school” time—remember that change in routine risk factor I alluded to earlier???). This year for the first time, numerous national child safety advocates, including the staff at Pediatric Safety, will join forces to commemorate and co-promote this day. We will be posting hourly child vehicular heatstroke facts and prevention tips on social media outlets to raise public awareness of this often unrecognized danger to child passenger safety, focusing on “forgotten backseat baby” syndrome, which is every parent’s unimaginable risk and the leading cause of child hot car deaths. Please join us and help spread vital information to PREVENT child vehicular heatstroke by sharing our social media posts and encouraging your friends and family to do the same. We will be using the tag “#heatstroke” on all of our posts and encourage you to do the same.


Editor’s Note: We are just at the beginning of summer and 5 children have already died this year. Please reach out to everyone you know, to everyone who follows you on Twitter or Facebook or any other social media you have access to – and help us raise awareness of this terrible tragedy.

All it will take is a minute to post any one of these:

  • Call 911 if you see a child alone in a car. ACT to prevent child vehicular #heatstroke
  • Most kids who die of vehicular #heatstroke are accidentally forgotten in the backseat by a loving, responsible parent.#LOOKbeforeyouLOCK
  • Forgotten childcare drop-off is the #1 source of child vehicular #heatstroke. #RayRaysPledge
  • A child overheats 3-5 times faster than an adult. Never leave your child alone in a car. Prevent vehicular #heatstroke
  • 30% of kids who died in a hot car gained access to an unlocked vehicle. Prevent vehicular #heatstroke
  • The inside temperature of a car increases more than 40 degrees in less than an hour. Prevent vehicular #heatstroke
  • Most kids who die in a hot car are less than 2 years of age. Prevent vehicular #heatstroke
  • Most common factor associated with parents who forgot their kids in the backseat: change in routine. Prevent vehicular #heatstroke
  • Is your child in daycare? Make an absence verification plan w ur provider aka #RayRaysPledge. Prevent vehicular #heatstroke
  • Create reminders for all child transport activities eg: purse/ briefcase/ cellphone in backseat. Prevent vehicular #heatstroke

If we can save just one child’s life, all our efforts will have been worth it.

How to Choose the Best Daycare for Your Child

Day CareOver 2.3 million American kids under five are cared for at day care centers. If you’re like most parents, I’m sure you’ve pondered the age-old question: “What impact does child care have on my child?” Well, now there’s an answer.

A federally funded study by the Early Child Care Research Network released results that will have parents and educators alike on alert. Since 1991 researchers have been tracking over 1364 families. Children in the study were randomly selected at birth (all born within 24 hours of each other) from 10 different American locations and have been followed since one month of age. Upper, middle, and lower income families were represented. Investigators examined how differences among families, children and child care arrangements might be correlated to their health as well as intellectual, social and emotional development.

The children were evaluated periodically, most recently at age 15, with a host of measures. The study is significant because it is first to track children representing all demographics and incomes a full decade after they left child care.

 Key Findings About Day Care That Parents Must Know

  • “Parents have far more influence on children’s growth and development than any type child care they receive.” (YES!)
  • Academic and behavior gains from child care that endured until age 15 were slightly higher when children were involved with “high quality child caregivers.” High quality is defined as “caregivers who are warm, supportive and provide high quality cognitive stimulation.”
  • Teens who were in high-quality child care settings before age 5 scored higher on measures of academic and cognitive achievement.
  • Specific academic areas (in order) that showed the highest gains at age 15: Reading, Vocabulary, Verbal Analogies, and Math.
  • Teen also reported fewer acting-out behaviors than peers who were in lower-quality child care arrangements during their early years. [Watch the discipline policies of the providers. Are they firm, child-centered, consistent and help children learn healthier ways of behaving?]
  • Teens who spent more hours in child care in their first 4½ years of life reported a greater tendency toward impulsiveness and risk-taking behaviors (taking drugs, smoking, and alcohol) at age 15 than did peers who spent less time in child care.
  • More than a decade after parents stopped those day care payments those behavior differences were still evident.
  • Though differences in these measures among the youth were deemed small, researchers still considered them significant since the gains latest until age 15. Translation: high quality care giving in the early years affects children’s social, academic, and behavioral development in the teen years.


10 Questions to Help You Choose a Quality Day Care

Preschool children

OK, you’ve read the results. You recognize know that the study says the key to reap academic and behavior gains for your child’s success is to find a quality care giver. Of course you want a great day care for your child, but how to you know which facility is the best one for your child? How do you know which is a quality care facility? My strongest recommendation: observe a few centers and always observe when children are present. It will help you decide if it’s a place you want your child to spend part of his or her day. Here are ten questions to ask yourself-and the staff-to help you make your final decision.

1. Does this seem like a place my child would like to be?

Use your instinct on this one. Can you see your child fitting in and being comfortable in this environment? Are the children enjoying themselves? Do they appear to be happy and active? Is there a variety of activities that are age-appropriate for the children? You know your child better than anyone, so rely on your instincts!

2. Are there rich, interactive language experiences?

Watch the staff interaction with the children closely. Are they talking with the children? Are the children communicating with the staff? Are there rich language experiences and if so are they “hands-on” (not just paper and pencil)? For instance, is the staff reading, speaking, listening to the children? Are there outings, art, dress up, and play type of activities in which children can communicate with peers? Is there a television and if so, is it being used as a “baby sitter”?

3. Is the staff knowledgeable about child development?

Ask the staff what their philosophy about early childhood education is (don’t worry if you don’t know their answer – make sure they have one). Ask how the staff is trained in child development and how frequently? How many of the staff are credentialed in early childhood education? How do they stay current on the latest child development research (such as this study)? What is the educational background and credentials of the supervisor?

4. What is the daily schedule?

There should be a consistent daily structure where children know what is expected. Is there a balance between physical activities and quieter ones? Watch the children. Are they doing the kinds of activities your child would enjoy doing? There must be rich language experiences and activities that stimulate cognitive growth to reap those gains. Make sure children are actively engaged in creative play, interacting with adults, and are not just sitting and doing paper and pencil tasks. Make sure the television is not used as a baby sitter! Then visualize your child in this setting: Is this a good match for your child’s needs, temperament and abilities?

5. What is the ratio between staff and children?

It’s always best to have a smaller number of staff to children. You want to make sure your child is being closely watched. You also want to make sure there is positive interaction (face-to-face!!) between that caregiver and your child.

6. Is the staff “kid friendly?”

Watch the interaction between the staff and children. Do they enjoy kids? Are they patient and kid-oriented? Are they respectful towards them? And (most importantly) do the children appear to enjoy the staff? The “kid friendly” rule has always been the one I was the pickiest about when choosing a school for my own children. A key to the study was that a “High Quality Caregiver” was warm, supportive and provided quality cognitive stimulation. Watch for those traits!

7. What is the discipline policy?

Ask what their discipline approach is for inappropriate children’s behavior – especially for hitting or biting. Ask, “How do you deal with aggressive children?” Make sure they have a thought-out plan and you agree with their plan. Watch how the children interact with one another: are they caring or aggressive? If you witness an aggressive child, how does the staff respond? The NIH report found that the longer a child was in day care the more likely he would be impulsive at age 15. Habits are formed early. Make sure the facility has a proactive approach to behavior and knows how to replace acting out, aggressive behaviors with more appropriate ones.

8. Is the program within my budget?

Are there any additional costs for the program such as materials or transportation? Find out the entire budget. Is it worth the cost?

9. Will my child fit in and be safe here?

Is it well gated? Are electrical sockets covered? Are fire extinguishers available? How well are they equipped to deal with accidents? Is the staff trained in CPR? Hopefully, there will never be a safety issue, but a good day care makes sure that children’s safety is a primary focus. What do you when my child or other children are ill? Find out what the policy is when children are ill at the center. Is there a supervised location where they can be removed from the other children? Could I see my child in this facility or with this care giver? Is this a place where he would fit in, feel comfortable and thrive? (Use your instinct! Get into the shoes of your child and see the caregiver or facility from your child’s eyes!)

10. Does the staff share the same values as I do?

These people will be sharing their lives with your child, so you want them to hopefully share a few similar values. Think through what are your core beliefs about raising your child and watch to see if the staff models them. For instance: Is the staff respectful? Do they require children to be courteous and are they courteous to children? Are they dressed neatly and appropriately?

Use your instinct! Look around. Ask the parents of the other kids. Visit at a few different times and days. In the end the critical questions to ask yourself are these: “Do I want these people to be responsible for my child’s safety and well-being?” “Would my child feel safe and secure in this setting?” No one knows your child better than you. Right? Right!


Borba - book cover -parentingsolutions140x180

Dr Borba’s book The Big Book of Parenting Solutions: 101 Answers to Your Everyday Challenges and Wildest Worries, is one of the most comprehensive parenting book for kids 3 to 13. This down-to-earth guide offers advice for dealing with children’s difficult behavior and hot button issues including biting, tantrums, cheating, bad friends, inappropriate clothing, sex, drugs, peer pressure and much more. Each of the 101 challenging parenting issues includes specific step-by-step solutions and practical advice that is age appropriate based on the latest research. The Big Book of Parenting Solutions is available at

Daycare vs. Babysitter – Is There a Right Choice?

So I am about to do something I never ever thought that I would do…Hire a babysitter to watch # 3 in my house – Gasp! I am a big, big proponent of daycare and I am famous for standing on my soap box and telling anyone who will listen why to choose day care over a babysitter. And here I am seriously considering a sitter. So let me tell you why I’m torn. For my 1st child I absolutely was sending her to daycare. In a nutshell I prefer it. Let me say generally when I say day care I am referring to one that you have thoroughly researched and are sure it is licensed and has no violations against it and one that is NOT in someone’s house.

I can honestly go on and on about daycare but I don’t have the space here so I’ll put my top two reasons.

  1. Socializationthe socialization children receive in a daycare setting is priceless. Your child will learn how to share, play with other children and wait their turn and wash their hands and eat together at a table and …the learning is endless.
  2. Accountabilitychances are your child will never be alone with an adult in day care, it’s pretty difficulty, most daycares have open bathrooms for the little ones (no doors) so there’s no privacy. In all the years I have been a prosecutor in child abuse and sex crimes I have handled thousands of cases, I personally have never had a physical or sexual abuse case where the child was victimized at day care. My office has handled a handful of physical abuse case against a daycare worker but that is the exception not to rule. However, and this is huge, in most of my cases (when I say most I mean 100%)… where there is an allegation of sexual or physical abuse of a child the accused is a family member or a close friend. The accused is NOT a stranger. Unless you have a nanny cam there is no accountability for your sitter.

It is a huge step to trust someone with your child especially your first because chances are you have never seen the sitter take care of a child before. So you may ask why would I go against my own advice now and choose a sitter for #3? Convenience, that’s why. I am all ready to go back to work (not really but I must) and I have no child care lined up for #3. I was considering a few daycares and discussing this dilemma with my cleaning lady/ occasional babysitter/friend when she said “I’ll watch the baby!” WOO HOO really I thought? I love, love, LOVE this woman and so do my kids. I never even thought about having a babysitter until she suggested it. And you know what she said to me? “You can’t send #3 to daycare, you need someone here to clean up for you and to cook dinner for you!” REALLY? Yes I do actually. I really trust this woman and I have seen her with my kids. I have been to her house and know her family. Sometimes she even stops by unexpectedly on a Saturday and plays with my kids.

Returning to work with 3 kids will be a lot. And the less I have to do when I get home the easier my life is. My job is tremendously stressful and I don’t want to worry about all the extras when I get home from work. I want to come home and play with the kids and hear all that I missed while I was at work. All of my worries went out the window with a 3 minute conversation with a friend. I know my kids will be safe and happy with the sitter … still, that’s not to say there won’t be a camera in this house.

How to Stop Your Baby’s Wheezing — and Prevent Asthma

Are you concerned when you hear your baby wheezing? You’re not alone. “Wheezing is very common in infants,” says Dr. Stanley J. Szefler, a pediatrician and the head of pediatric clinical pharmacology at National Jewish Health in Denver. “Almost one in three children has a wheezing episode at some time in early childhood.”

The good news: A new study published in Pediatric Allergy and Immunology has identified consistent risk factors for wheezing in infants — which means there are steps you can take to help prevent it.

Wheezing 101

Remember when you were a kid and you’d blow up a balloon, then squeeze the opening shut and let air out little by little to make funny noises? Think of that balloon as your baby’s lungs. Your baby’s airway is smaller in diameter than an adult’s, and it becomes even narrower when he has a cold. “The airway wall thickens and increases the resistance of air being moved in and out of the lungs,” explains Szefler. “The wheezing is the sound that you hear when he’s having trouble pushing air in and out of that narrowed passageway.”

Is It Asthma?

It’s true that wheezing is a classic asthma symptom. But don’t assume your baby suffers from asthma, which affects nearly 10 percent of children, according to the U.S. Centers for Disease Control and Prevention. Even a run-of-the-mill cold can cause wheezing sounds, and let’s face it: Your kid is a walking sniffle machine. His immune system hasn’t yet built up the antibodies necessary to fight off common viruses. Many infants who wheeze grow out of it as their immune system grows stronger and the airways get larger, so doctors advise against diagnosing children under age 4 with asthma.

However, keep in mind that even though wheezing does not necessarily indicate asthma, a baby who wheezes frequently is at higher risk for developing the condition. “About 50 percent of children who wheeze in early childhood will go on to have asthma,” says Szefler.

Prevent Wheezing

Researchers have identified three things you do take to keep your baby’s airways clear:

  1. Don’t smoke while you’re pregnant. In the Pediatric Allergy and Immunology study, smoking during pregnancy was linked to a 48 percent increased risk of recurrent wheezing in babies. “Some data suggests that maternal smoking may interfere with lung development. In fact, lung function is reduced in infants whose mother smoked in pregnancy,” says study author Dr. Luis Garcia-Marcos, professor of pediatrics and director of the Institute of Respiratory Health at the University of Murcia in Spain.
  2. Breast-feed. Other research has found that breast-feeding protects against various health conditions, including ear infections, sudden infant death syndrome (SIDS), asthma and diabetes. “Breast-feeding for three or more months was associated with a 20 percent decreased risk of recurrent wheezing compared to those who were breast-fed for a shorter period of time or not at all,” says Garcia-Marcos.
  3. Don’t send your child to day care too young. The study found that children who were in day care during the first year of life were 2.7 times more likely to experience recurrent wheezing. “Attending nursery school increases the chances of respiratory infections, which can trigger wheezing,” says Garcia-Marcos. The researchers also discovered that babies who suffered a cold in the first three months of life were about three times more likely than other babies to develop recurrent wheezing.

Treat Wheezing

Don’t panic if you notice your baby is wheezing. If he has a cold, it may be just a one-time episode. If the wheezing happens more than once and in the absence of a respiratory infection, then talk to your child’s pediatrician about an action plan. “The doctor may prescribe a medication … to prevent and/or relieve wheezing episodes,” says Szefler. Although the drugs prescribed are commonly used to treat asthma, doctors sometimes use them to help wheezing symptoms in young children, even before they’ve been diagnosed.

Checklist for Choosing a Safe Day Care

Finding the right day-care center requires a balance of many practical issues: location, cost, hours of operation. And you of course also want a nurturing staff. “But bottom line, your child’s health and safety is what matters the most,” says Patricia Skinner, executive director of the Capital District Child Care Council, a resource and referral agency serving six counties in the Albany, N.Y., region. “After all, it doesn’t matter how stellar the caregiver’s interactions are if there’s broken glass on the playground,” she says.

Narrow down your choices and find a safe day care for your child by considering these four questions:

  1. Is the center licensed (or registered)?choosing a daycare
    Most states require day-care centers to comply with minimum health and safety standards, so your first step is to find out if the facility you’re considering is state-approved. In New York State, for instance, freestanding child-care centers must be licensed, while those that operate out of a home must be registered. If you opt for an in-home caregiver who looks after one or two kids, many states exempt these individuals from registration or licensing. However, some states do require in-home caregivers to complete a criminal-history check or child abuse/neglect screening; others require basic health and safety training. For more information, visit
  2. Is the environment safe, both indoors and out?
    Always take a tour of the facility when children are there to look for potential hazards, like heavy objects that kids could pull down on top of themselves. “It’s great to get references, but there’s really no substitute for your own observations,” says Skinner. “You learn so much more when you spend time in a center and observe.” Pay particular attention to the playground and other outside areas, which is where most day-care injuries occur. Make sure that kids are never left unattended — even if they’re sleeping. Also ask about the staff-to-child ratio. The younger your child is, the lower the ratio should be. For instance, one family-home caregiver should take care of only two infants. But 4-year-olds do well with a ratio of 1-to-10 (one adult for 10 children).
  3. Does the staff follow proper infection-control procedures?
    Do staffers wash their hands after each diaper change? Is the food-preparation area clean and orderly? How often are the communal toys disinfected? (Toys should be disinfected on a daily basis or more often if they’re visibly soiled.) You should also ask if children wash their hands before eating and after using the bathroom, since kids are exposed to most germs by touching surfaces and then putting their fingers in their mouths. Ask caregivers all these questions, but also observe to see if the staff is really doing what they say they do.
  4. What are the policies regarding sick children?
    Child-care providers should have specific criteria outlining when to send a sick child home, and it’s good to know the particulars so you can decide what requirements are important to you. Many centers follow national health and safety guidelines developed by the American Academy of Pediatrics and the American Public Health Association (APHA), but some are more stringent.An example: AAP/APHA guidelines state that a child with a fever (defined as an oral temperature above 101 F, a rectal temperature above 102 F or an armpit temperature above 100 F) who is otherwise acting normally shouldn’t be excluded from child care. However, many centers use fever alone as a reason to send a child home. “The providers can set their own exclusion criteria, and some of them are more restrictive than the guidelines,” says Jean Wiseman, a registered nurse and child-care health consultant at the Capital District Child Care Council. “That’s partly because they’ve seen what can happen when an illness that’s not treated properly runs through every child in the program and all the staff too.” So if you worry that a day-care center’s stringent rules may one day exclude your child from care when you need it most, it’s likely in everyone’s best interest that sick kids don’t mix with healthy ones.

What to Do if Your Child Is Sick

It’s the scenario every working mother dreads: Your 3-year-old wakes up coughing, sneezing and clearly out of sorts; your husband is out of town on business; you’re due at the office in three hours for an important meeting. When your little one is too sick to go to his regular day care — but not sick enough to for you to justify rescheduling your meeting and using up yet another dwindling vacation day, you may have more options than you realize. Some hospital child-care facilities operate day-care programs for mildly ill children that are open to everyone in the community. In addition, some freestanding child-care centers offer separate infirmaries for sick kids. For more information about child-care options for sick children, visit the National Association for Sick Child Daycare