IT CAN HAPPEN TO ANYONE — Speaking about the Unspeakable
Hylton I Lightman, MD DCH (SA) FAAP
Last week’s tragedy in Lakewood was horrific.
A nearly 2-year old beautiful girl was unintentionally left in the car and died from vehicular heat stroke. In other words, she was left in a locked car which rapidly heated up – and the outside temperature was only 69 degrees.
Unfortunately, this is not an isolated incident. Since 1998, when the United States started keeping records on this, there have been 801 deaths, according to noheatstroke.org, an organization founded by Jan Null, a meteorologist whose passion is to prevent these types of death from happening. Mr. Null readily agreed to be interviewed for this article as did all people cited throughout.
Death by hyperthermia is a heat stroke. A heat stroke is a type of severe heat illness that results in a body temperature of greater than 104 degrees. When the core body temperature cannot cool down, everything breaks down and the gut leaks toxins. The combination of children’s bodies not cooling down as rapidly and as efficiently as adults and that cars, even in cool spring weather, can heat up swiftly in the sun, can be a lethal combination.
We are never to judge these parents or any parents who forget children in their cars. It can happen to any person. The highly educated, the lesser educated, the religious, the nonreligious, the wealthy, the middle class, the poor. Parents of all ages and ethnicities do it. 25% of all parents report that at some point, they have lost awareness of a child in the car. Clearly, each of us and all of us are vulnerable.
Parents who forget children in cars are not criminally negligent. And they are not “bad” parents. It happens because of the way our human brains work. Any parent, grandparent, caregiver or other person driving children is susceptible. Allow me to explain.
The competition between the brain’s memory systems
Neuropsychologist Dr. David M. Diamond of the University of South Florida is an expert on memory. Since 2004, he has studied the phenomenon of parents forgetting about children and leaving them in cars. e has also interviewed many parents of such children.
Dr. Diamond explains that our brains have several memory systems that compete with one another.
“Habit memory” involves tasks with repetitive actions that are performed automatically. or example, we wake up in the morning, say Modeh Ani, wash Negel Vasser and then begin the day. Another example of habitual memory is getting in the car and driving from home to office. Habit memory allows us to multi-task without being fully conscious so that while we are driving, we might have a conversation with another person or listen to a podcast. Think of this as being on auto-pilot mode.
“Prospective memory” allows is to hold information in our heads and plan to use it at some point in the future. e all try “to remember to remember.” It can either time-based or event-based and something that can be triggered by a cue. Example: I see the store’s advertisement (cue) which reminds me to purchase milk (action).
It is a daily occurrence that habit memory will prevail over the prospective memory. For example, I am driving home from work and know that the family needs milk for breakfast tomorrow morning, and despite knowing about this need, I somehow end up parked in front of my home and never stopped to get the milk. hy?
“The suppression of the prospective memory caused by the dominance of the brain’s habit memory is an almost daily occurrence,” Dr. Diamond says. “When we forget to stop for groceries on the way home from work, it’s because the habit memory system takes us directly home, suppressing our awareness (prospective memory) that we had planned to stop at the store.”
It would be wonderful if all prospective memory failures were as “pareve” as forgetting about a grocery item or two or even a more complete grocery shopping.
Go back for a moment to the recent Lakewood tragedy – The news reports cited that the parents, who will not be thankfully charged with her death, had a “misunderstanding” about the day’s plans.
Dr. Diamond underscores, “Our flawed prospective memory puts those we love at risk. This is especially true when we assume that precautions are not necessary because such tragedies happen only to negligent parents. The evidence is clear that the assumption is wrong.”
Change, stress, sleep deprivation and other factors we all know too well
Dr. Diamond is firm that although each case of a child being left unintentionally in a car is unique, they all share certain commonalities:
- A change in the parent’s routine that leads Mommy or Tatty to follow an alternate route or routine
- A change in how the parent interacted with the child during the drive, such as the child might have fallen asleep during the drive and is therefore silent
- A lack of a cue such as a sound or an object associated with the child, i.e., leaving the diaper bag on the front passenger seat
It seems that there is a “choice point” during the drive where the parent could go to the daycare or to another destination like work or home. At that choice, Dr. Diamond says, parents report having lost awareness that the child is in the car.
Parents who have forgotten children this way report stressful or distracting experiences before and/or during the drive. Sleep deprivation is also a major factor.
It is known that stress and lack of sleep can compromise the habit memory and impair the prospective memory. When stress and sleep deprivation are factored into the scenario, it is likely that the habit memory system will hijack the prospective memory system.
We frum Jews know only too well about stress and sleep deprivation. Our measures in these areas can be quite off the charts.
We are also multi-taskers par excellence. Our families are larger. It’s not uncommon for parents to be dealing with bottle and diapers, homework and high school and/or seminary and yeshiva applications AND shidduchim, many times all concurrently. The challenges of earning parnassah to support our families and lifestyles has been anecdotally documented. It’s not easy to juggle all these balls. Let’s not forget our action-packed days of getting up and out, keeping home and work going, preparing dinner, readying for Shabbos, etc. There is no lack of what to do when we are raising our families.
I would be remiss to leave out the perils of the cell phone. Let’s face it – many people, especially millennials, are always browsing and the cell phone has become a permanent appendage. It’s the way of life nowadays that can have negative repercussions, if not used properly. This piece of plastic and electronics can be distracting, as it disrupts our focus and attention.
A universal observation that Dr. Diamond has made is that each parent’s brain appears to have created the false memory that he or she brought the child to daycare. This incongruity explains why those parents believe their child is where he or she should be, even telling colleagues that they need to pick up their children.
Pediatric deaths by hyperthermia in cars is a recent phenomenon
Interestingly, pediatric deaths by hyperthermia resulting from children being left unintentionally in cars is a relatively recent phenomenon.
How do we explain this?
Mr. Null, Dr. Diamond and Amber Rollins, Director of kidsandcars.org, a public safety awareness organization that seeks to educate parents, caregivers and others about how to keep children safe from the perils that exist with cars, all point to the change of not allowing car seats to be in the front seat.
Some readers may remember when we put car seats on the passenger seat. It was not all that long ago. hen that happened, parents did not forget children because they were in plain sight; they were simply unforgettable. Yet technology progressed and airbags were introduced. Airbags would deploy and then BOOM — too many children in those car seats in the front were harmed.
Hence, legislation was promulgated so that we are now mandated to put children in the back, behind our heads. Unfortunately, there is truth to the adage, “Out of sight, out of mind.”
Young children and unattended cars should never happen, please
Parents leaving a child unintentionally in a car account for 54% of the 801 deaths of death by hyperthermia in cars since 1998. The other 46% have been caused by children gaining access to unattended cars and becoming trapped therein, as well as children being left intentionally in cars.
How do children gain access to unattended cars?
There are people who leave their cars unlocked, for whatever reasons. There are a number of scenarios that could happen. Here is a plausible one.
It’s a beautiful afternoon when children return home from day camp. Later in the afternoon, they are playing ‘Hide-and-Seek’ outside supervised by Ema, Daddy, Bubby, Saba or whomever. The adult-in-charge needs to step inside the house, perhaps to check on dinner or use the toilet. The adult might say to the 8 or 9 or 10-year old who is there, “Please hold down the fort and keep an eye on things while I run inside quickly.” The adult returns within 3-5 minutes and resumes supervising. It might be a short moment or two or several longer moments when the adult notices that 4-year old Shlomo is nowhere to be found. The adult calls out for Shlomo but there’s no answer. The adult scurries around, looking at the neighbor’s property, going back inside their own house and everywhere. Others engage in the search. Those moments when you cannot find a child when he is supposed to be somewhere are terrifying.
“Typically, cars are not the first ‘go-to’ place that people search for a missing-in-action child,” Mrs. Rollins says. “Yet a child perceives of a car as a ‘fun’ place to hide and hang out. If you have a pool, wouldn’t that be one of the first places you check? Make your car place #2.”
Once a child enters an unlocked car and locks the doors, he is trapped. The child safety locks kick into action and because they are child safety locks, the child cannot unlock them. As the car heats up and the child is inside, the unthinkable and unspeakable can happen.
Noheatstroke.org’s Jan Null is clear that children gaining access to cars accounts for 26.3% of deaths of kids, cars and hyperthermia. 18.9% of these deaths are caused by a caregiver knowingly leaving a child unattended in car. A survey of 1,000 parents in 2014 revealed that 14% of parents have done this. And fathers are more likely to behave this way that mothers.
Leaving a child unattended in a car – How can this happen?
“Impatience seems to be the order of the day,” Dr. Diamond explains. “People are in a hurry. People have so much to get done. An adult may think that an errand in a store will be ‘only’ 3 minutes – and before they know it, it’s more like 15 minutes.
Our packed lives are jammed-packed with everything we need and want to get done. As always, time is of the essence. Is this scenario all that unlikely?
G-d forbid, if you ever saw this, I urge you to break the window of the car and get out the child. A broken window is a nothing price to pay to have a healthy child.
The professionals interviewed for this article are emphatic that people who intentionally leave a child alone in a car are negligent.
“A child not in view puts the child in harm’s way,” Dr. Diamond emphasizes, “including at the risk of being kidnapped.”
This statistic of 46% of pediatric hyperthermia deaths are because children gain access to unattended cars or parents have left them intentionally in cars is the reason why many professionals in this field, including Dr. Diamond, Ms. Amber and Mr. Null, dislike the phrase coined by the media, “Forgotten Baby Syndrome (FBS).”
In our penchant to label and categorize things and events – part of how our brains work – people seek names for phenomena like this, the media included. Yet it does a disservice.
Neuroscientist Dr. Diamond explains that “FBS trivializes forgetting kids in car and makes it something akin to forgetting our phones or wallets in the car. But do we label everything so there is ‘Forgotten Keys Syndrome’ or ‘Forgotten Notebook Syndrome’?”
The solutions here are multifactorial and layered. They should all be used at different points in order to create a “win-win” for all so there are no more tragic deaths of children this way. As we know, the consequences of the death of a child reverberate for generations.
- Take this phenomenon seriously. Don’t think that you are the person to whom it will never happen. Give up thinking, “I love my child so much that I can’t imagine ever leaving him/her in the back of the car.”
- Be honest about the limitations of this fantastically fascinating marvel called the human brain especially when it functions during times of overload, stress and sleep deprivation. Embrace its limitations.
- You should physically open the car’s back door and check the back seat when leaving the vehicle. It is essential to implement this point 100%.
“It has been proven that it takes 21 days to make something into a habit,” says Mrs. Rollins.“Start this habit today.”
- Every day you are in the car, whether your baby is with you or not, take one item that you NEED to start your day and put it in the car in front of the car seat. It might be your laptop, employee ID badge, your lunch or briefcase. Make it something you NEED it as all items are important, with none nearing the importance of your precious child.
- “Look before you lock the car.” Another habit to start pronto!
- Communicate with your spouse and others in your home to maximize communication and minimize miscommunication.
Picture one parent pulling the car into the driveway while Rachell is sleeping soundly in the car seat. The back of the car is popped open which is followed by the frenetic rush to unload the groceries. Do not assume that Rachell has been moved from the car seat into the house. Verbally communicate to your spouse or an older child something like, “You get the bundles while I get Rachell.”
Remember: Any change in routine increases the risk factor of forgetting about a child.
- Ask your babysitter or daycare provider to call you by a certain time if your child has not been dropped off yet.
Let’s say Reuven is due at the babysitter no later than 7:50 am on weekday mornings. The babysitter should call you no later than 8 am if Reuven has not been dropped off yet. If the child has been left in the car, this layer can prevent a potential pediatric death by hyperthermia because of swift action.
“It should be part of your daily habit,”Dr. Diamond and Mrs. Rollins both stress. (Preventative ‘stress’ is good stress.)
- Lock all cars AFTER making sure there are no children inside.
- Keep cars and remote openers where kids cannot access them. Toddlers and children are sneaky, oops, I mean “creative.” Know they are and that they are much smarter than we realize. Plan accordingly.
- Put a chain lock high up on the front and back doors so children can only let themselves out with a parent present.
- Build a community of support for prevention. Speak to your neighbors, asking them to commit to locking their cars and making sure that keys and remotes are not easily accessible. Invite them to a block Kiddush once everyone has signed on.
- Technology, technology, technology –Thank G-d, we live in an era where technology abounds and people are thinking about this and taking action.
Lawrence resident, businessman, askan (and neighbor and friend) Menachem Jacobowitz has devoted nearly a decade to innovating and developing wellbeing products for the family through a company called Elepho. Together with his Elepho partner Michael Braunold, an engineer who is devoted to using technology for wellness and prevention, their eClip product is saving lives.
The eClip is attached to the baby, car seat or diaper bag and then is switched “on.” Using simple Bluetooth technology that works with smart phones, it sounds an alarm when the parent has stepped away from the car and several seconds have elapsed. In addition, it has a thermometer which tells the adult the temperature in the back of the car. The on/off switch is designed so a child cannot turn it off accidentally.
“The eClip is a great product and we have other plans in the works,” Mr. Braunold shares from his home in Raanana. “Because we’ve already developed the technology, we are speaking with car seat manufacturers. Perhaps there will be a time in the near future when car manufacturers will incorporate our technology.”
I urge my fellow pediatricians and medical colleagues to discuss this with all parents.
“Ray Ray’s Law,” named for a little girl whose life was tragically lost this way, was passed in Texas in 2015. Ray Ray’s mother lobbied for this law which mandates hospitals across the state to educate new parents on the dangers of hot-car related deaths. I sincerely hope that today, in 2019, every pediatric health care provider in Texas discusses prevention and technology at every point of face-to-face contact with parents and caregivers.
Spread the word. Educate yourselves. Avail yourselves of the technology. As the Talmud tells us in Sanhedrin, “To save one life is to save an entire world.”
As always, daven