DANGEROUS DAYS OF SUMMER OUTDOOR ACTIVITIES CAN MEAN MORE SERIOUS INJURIES.

Byline: Elena F. Epstein Correspondent

Andrew Box was preparing dinner downstairs when he heard the screams of his two daughters, Genavive, 6, and Nikita, 4. He ran to his second-story bedroom to find the window screen missing and his two daughters sprawled on the concrete walkway 15 feet below.

Jenifer Box was on the final stretch of her commute from her office in Los Angeles to her house in Castaic when she heard her husband's frantic voice on her cell phone. Within minutes she was boarding a Los Angeles County Fire Department helicopter with her daughters headed for Childrens Hospital Los Angeles. In a split second, the Boxes' life had turned upside down and Andrew and Jenifer were living every parent's nightmare.

``It was horrible, my children were in terrible pain, and there was nothing I could do,'' Jenifer Box says as she recalls that unforgettable day in 2002. ``I told myself to stay strong for them.''

Genavive and Nikita were just doing what all kids love to do - play. They were in their parents' bedroom when they stood on a 4-inch-wide windowsill to jump to the bed a few inches away. As they held hands, the screen of the open window behind them gave way and they plunged backward. Nikita's fall was broken by several rosebushes. Genavive landed on the concrete.

The Box sisters were fortunate. Nikita, who is now 6, had a mild concussion and required seven stitches over her right eye. She spent one week in the hospital and had no permanent injuries. Genavive, who is now 9, had a fractured skull and a broken collarbone. She spent one week in the Pediatric Intensive Care Unit and another three weeks going through physical and speech therapy to rewire the parts of her brain that were damaged. She is now completely recovered.

As the weather gets warmer and kids trade in their school supplies for boogie boards and skateboards, the number of injuries, similar to those suffered by the Box sisters, dramatically increases.

``In the winter we get two to four fractures a day, in the summer that number goes up to several dozen a day,'' says Dr. Alan Nager, head of the division of Emergency and Transport Medicine at Childrens Hospital Los Angeles. One of the busiest pediatric emergency departments in the country, Childrens Hospital treats close to 60,000 patients a year in its Emergency Department, which is designated as a Level I Pediatric Trauma Center by the Los Angeles County EMS Agency. As a Level I trauma center, it is equipped to treat seriously injured patients.

In addition to broken bones, the rate of traumatic brain injuries, lacerations and near drownings increases in the summer months. Most of these injuries, which could lead to permanent disabilities and deaths, are preventable with proper supervision, precautions and safety gear, according to Nager, who is also an assistant professor of pediatrics at USC's Keck School of Medicine.

``Trauma is the leading cause of death among children,'' explains Nager. ``It only takes one minute for a tragic accident to happen.''

Keeping kids safe

Dr. Alan Nager's top 10 steps to reduce summer injuries:

1. Pools and spas

-- Almost 1,000 children die each year from drowning, another 4,000 are hospitalized, and 16,000 are treated in emergency departments.

-- A child can become submerged in 10 seconds and die in the time it takes to answer a phone, find a towel or get a snack.

-- Always supervise children. Never leave unless another supervisor has taken your place.

-- Install pool fences with self-latching gates, and maintain all pool water, drains, surfaces and edges.

2. Wheels

-- Make sure kids riding bikes, skateboards, roller blades and scooters wear helmets and protective pads at all times.

-- Ensure that the proper type of helmets are used for the activity and sized correctly for the child's head.

3. Falls

-- Choose playgrounds with cushioned surfaces such as those covered with sand or shredded mulch.

-- Check the surfaces for hidden dangerous objects.

-- Avoid clothing with strings that can cause strangulation.

-- Do not allow children to play near open windows or on balconies.

-- Window screens do not always prevent falls.

-- Keep furniture away from windows and drapery and other cords above children's reach.

4. Dehydration

-- Ensure that children drink lots of water or sports drinks when they're out in the sun.

-- Avoid soda, which lacks important minerals.

-- Encourage adequate breaks in the shade.

-- Fatigue, dry lips and tongue, cramps, dizziness, headache and nausea are indications of too much heat.

5. Sunburns

-- Make sure that kids wear plenty of sunscreen with a minimum of SPF 30.

-- Reapply sunscreen every two to three hours, and always after swimming or sweating a lot.

6. Car safety

-- Before your start the car, ensure everyone is wearing a seat belt or is in an appropriate booster seat.

-- Do not allow children younger than 12 years to sit in the front passenger seat.

-- Do not leave children in cars alone, even for a quick errand. The temperature inside a parked can rise to dangerous levels in just a few minutes.

7. Street wise

-- Remember that children cannot adequately judge traffic speed and distances of oncoming traffic.

-- Teach children never to dash into the street to retrieve a ball or other play equipment.

-- Teach children how to cross the street (always at a crosswalk or corner) and never to dart between parked cars.

-- Children under 10 should not cross the street without an adult.

8. Beaches and lakes

-- Make sure kids are wearing appropriate footwear on the hot sand.

-- Stay clear of fire pits and barbecues.

-- When boating, require children to wear U.S. Coast Guard-approved personal flotation devices.

9. Strangers

-- Ensure proper adult supervision when children are playing in the street or at the park.

-- Teach children not to talk to strangers and to avoid contact with anyone offering toys or candy.

10. Traveling

-- If staying with relatives or friends, ensure that the house has proper safety devices, including a pool fence. Make sure potentially harmful items, such as medications, alcohol and firearms, are locked and out of the reach of children.

- E.E.

CAPTION(S):

2 photos, box

Photo:

(1 -- cover -- color) Safety first

Keeping your kids injury-free this summer

Michael Owen Baker/Staff Photographer

(2) Mom Jenifer Box, center, faced every parent's nightmare when daughters Genavive, left, and Nikita fell out of a second story window at their home.

Hans Gutknecht/Staff Photographer

Box:

Keeping kids safe (see text)